High-Risk Pools, Pre-Existing Conditions and Other Lies: Why Tomorrow’s Health Care Vote Matters

dXvSVWord this evening is that the House Republican leadership has set a vote for tomorrow on the latest version of “Repeal and Replace.” Insiders and observers are saying that this is a sign Speaker Ryan and his whips have found the requisite number of “yeas” to get the bill out of the House and on to the Senate.

On the one hand, tomorrow’s vote doesn’t really matter. Whatever Frankenbill they cobbled together won’t last a day in the Senate before it gets shredded. And, whatever the Senate sends back to the House will be a non-starter for the lower house. So tomorrow is a little meaningless skirmish in a larger war. It will give the Umber Jackhole residing at 1600 Pennsylvania an empty victory he will claim in Tweet and incoherent interview alike but nothing much else.

On the other hand, the hand I care about this evening, tomorrow’s vote matters a lot. The Republican legislation – to the extent anyone knows what’s actually in it – substantially weakens the provisions of the Affordable Care Act. The authors of the bill know this. The administration knows this. Donald Trump doesn’t care what it does as long as it passes.

And yet all of these people are saying just the opposite and are thus perpetrating a fraud on the American people and on that basis, tomorrow’s vote matters very much. It is a test of whether our system still works, an opportunity to say, “Hell no” to this level of mendacity and grifter behavior.

If you’re already convinced on this point, you can skip the rest of this post and simply stop here with this call to action: Please call, email or visit your Congressperson tomorrow. Do it more than once. The main phone number is (202) 224-3121. You can find a list of Congressional offices (most with links to their direct phone numbers and emails) here. Don’t know how your Representative is? Look it up here.  Tweet at them, post on their Facebook pages. Share this with your friends and ask them to do the same. Ask your Representative to reject this legislation.

If, however, you’re unconvinced that tomorrow’s vote is worth your time or if some of your friends need more than just an ask from some random person on their Facebook feed, the rest of this post is for you and them.

At the core of the bill being voted on tomorrow is a set of changes that will allow insurers to return to many of their pre-ACA behaviors including greater price discrimination by age, the promotion of substandard plans, as well as cuts to Medicaid and – as has been much discussed – will create a pathway for the elimination of coverage for pre-existing conditions.

As I understand the proposed legislation, if a state asks the federal government for a waiver, insurers in that state can refuse to cover pre-existing conditions if 1) the insured person lets his or her coverage lapse and 2) the state sets up a “high-risk” pool or reinsurance program as a safety net. This is pretty much the way things worked in the pre-ACA days when – according to the New York Times – 35 states had such mechanisms.

So…let’s contemplate for a second how many Republican governors there are – 33. How many state legislatures are controlled by the GOP – 32. How many of those politicians have pledged their undying, unyielding hatred of Obamacare. Suddenly, that hurdle doesn’t seem so high.

The process for granting a waiver? Under the current Trump administration, I’m guessing that will be something that can be completed on a postcard and approved with a “looks good to me” review.

I’ll leave it to you to contemplate all the ways you can lose coverage in today’s world of economic dislocation. Suffice it to say shit happens.

“But wait! Wait,” the apologists will claim. Even if you’re right, those people will still have access to care. Through the high-risk pools.

Yeah, let’s talk about that idea.

Historically, as the Times article notes, those pools have been wildly underfunded, charged participants much, much higher premiums than the prevailing market, were capped in terms of how many people they would accept and how much they would pay out either in a year or a lifetime. As the Times noted, California had an annual cap of $75,000 per person and across all the plans – in all 35 states – a grand total of 230,000 people were able to get coverage.

230,000 people out of 321,000,000. Less than 1/10 of 1 percent of the population.

Needless to say the number of people with pre-existing conditions is substantially bigger than 1/10th of 1 percent. How much bigger? Try 270 times bigger. And, depending on where you live, a lot bigger.

That’s not hyperbole. That’s actual verified data, the stuff we used to call “facts” in the old days. Based on an analysis by the Kaiser Family Foundation, 27 percent of the people under 65 have a pre-existing condition. Add it all up, according to Kaiser, and you come up with more than 52,000,000 people who might find themselves with no coverage, unaffordable coverage or substandard coverage.

And, of course, as you get older, the prevalence of pre-existing conditions increases. The graphic from AARP below illustrates, the percentage of people in the 50-64 age bracket with a pre-existing condition ranges from 32 percent on the low end to 52 percent on the high end.

Map

You might not have a pre-existing condition, but if you live in a family of four chances are someone in your family does. If your block has 12 families on it, three of them might be uninsurable under a loosened standard of coverage and could be bankrupted by the cost of care. As Jimmy Kimmel tearfully noted, even newborns come with pre-existing conditions and a family without insurance – or an insurance plan with a lifetime or annual cap – can find itself have to choose between caring for their newborn or sending him to college, owning a home or a retirement.

In case you’re interested in exactly what constitutes a pre-existing condition, you might be surprised to learn that you could pretty easily fall in that category. Pre-ACA, the list of conditions considered pre-existing included:

 

  • AIDS/HIV
  • Alcohol and drug abuse
  • Alzheimer’s/dementia
  • Arthritis (rheumatoid), fibromyalgia, other inflammatory joint disease
  • Cancer
  • Cerebral palsy
  • Chronic obstructive pulmonary disease (COPD)/emphysema
  • Congestive heart failure
  • Coronary artery/heart disease, bypass surgery
  • Crohn’s disease/ ulcerative colitis
  • Diabetes mellitus
  • Epilepsy
  • Hemophilia
  • Hepatitis
  • Kidney disease, renal failure
  • Lupus
  • Mental disorders (severe, e.g. bipolar, eating disorder)
  • Multiple sclerosis
  • Muscular dystrophy
  • Obesity
  • Organ transplant
  • Paralysis
  • Paraplegia
  • Parkinson’s disease
  • Pending surgery or hospitalization
  • Pneumocystic pneumonia
  • Pregnancy or expectant parent
  • Sleep apnea
  • Stroke
  • Transsexualism

Pre-existing conditions could also injuries, previous surgical procedures and more.

I’m not alone in opposing this, of course, and neither is it a liberal thing. The famously conservative American Medical Association? Against it. Also the American Psychiatric Association, the American College of Physicians, the American Academy of Pediatrics, the American Academy of Family Physicians, the American Osteopathic Association and the American Congress of Obstetricians and Gynecologists. So too is the American Cancer Society, the American Diabetes Association, the American Heart Association, the American Lung Association, the Cystic Fibrosis Foundation, JDRF, March of Dimes, the National Organization for Rare Disorders, the National MS Society and others. The American Hospital Association? A no vote. Ditto for the Children’s Hospital Association and AARP. For too many reasons to enumerate, these organizations know the scam that’s being pulled and are screaming about it:

“None of the legislative tweaks under consideration changes the serious harm to patients and the health care delivery system if AHCA passes. Proposed changes to the bill tinker at the edges without remedying the fundamental failing of the bill – that millions of Americans will lose their health insurance as a direct result of this proposal.

“High-risk pools are not a new idea. Prior to the enactment of the Affordable Care Act, 35 states operated high-risk pools, and they were not a panacea for Americans with pre-existing medical conditions. The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage – if they are able to obtain coverage at all.

“Not only would the AHCA eliminate health insurance coverage for millions of Americans, the legislation would, in many cases, eliminate the ban against charging those with underlying medical conditions vastly more for their coverage.”

– American Medical Association President Andrew W. Gurman, M.D

Again, the authors of this bill also know all this. They know that they’re opening an easy pathway to exclusion of pre-existing conditions. They know the money they’ve set aside to support high-risk pools is inadequate for its intended purpose. They know the extra $8 billion they dramatically added to the bill today does nothing to change these calculations.

And yet they look us in the eye and tell us exactly the opposite. We cannot, should not, let this go unnoticed and unopposed. To the contrary, I hope that every Member of Congress goes to vote tomorrow with the credo of Anonymous echoing in his or her mind: We are legion. We do not forgive. We do not forget. Expect us.

That’s why tomorrow’s vote is important. Spread the word.

  • Austin

 

 

 

You don’t know nothing about Affordable Care — unless you watch the Daily Show

obamacare

Writing for MinnPost, my friend John Reinan declares the Affordable Care Act to have had “the worst new-product rollout in memory.” He writes:

[T]hree years after the passage of Obamacare — which itself took place after two years of heated, publicized debate — Americans understand very little about the program. In fact, a recent survey by the Kaiser Family Foundation found that nearly half of all Americans (44 percent) don’t realize that Obamacare is actually the law of the land. Fewer than one in four Americans has gotten any information recently about the health care law from a doctor, a health care organization, a federal agency or a state agency.

That’s just nuts. With three years to inform the public about the new law, the federal government has failed miserably. If this were a new car, a new soft drink or a new movie, people would be getting fired.

Emphasis mine. Perhaps this is a bit different in Minnesota, where our state’s new health insurance exchange, MNsure, has launched a full-on marketing assault in the lead-up to Obamacare open season in October. According to WallStCheatSheet.com:

Minnesota’s marketing scheme was also designed to address another problem; Kaiser’s August survey also showed that a large proportion of respondents, 19 percent, said they got most of their information about the Affordable Care Act from comedy programs like The Daily Show, while just 14 percent said they got most of their information from state agencies.

The god damned Daily Show. With an un-American (literally) as its pinch-hitting host for the summer. Ask not what your country can do for you; ask what your Daily Show can do for your country.

Pre-existing Language Condition

Pre-existing condition.

Lifetime cap.

Jargon. Jargon that gets in the way of understanding.

The President yesterday used these terms again when explaining the benefits of the Affordable Care Act that was upheld by the Supreme court.

Most Americans, barraged by conservative advertising, don’t like the law. But when asked about the law’s features, they like those. Democrats, particularly the president, have done a terrible job explaining in plain English what the law does.

How many Americans can explain “pre-existing condition” accurately?

“So you’re sick. You have diabetes,” the president should say. “You want health insurance to help pay for the huge costs of treatment and medicine. The insurance company says they won’t pay for any of the costs of treating your diabetes — can’t cover you for the very thing you need help with. So you can’t afford to get well. The Republicans think that’s okay. I don’t.

“So you have insurance, and then you get sick with diabetes. The insurance company says they won’t cover you anymore because you’re sick. The very thing you have insurance for causes the insurance company to dump you. And now you can’t afford to get well. The Republicans think that’s okay. I don’t.

“So you’ve been sick for awhile. Diabetes, skin cancer, now some broken bones. The insurance company says you’ve reached the lifetime limit of how much they’ll spend to help you, and now they won’t cover the cost of treatment. And now you can’t afford to get well. The Republicans think that’s okay. I don’t.

“Do you?”

The Institute of Medicine found almost 10 years ago that “nearly half of American adults face higher health risks because of trouble understanding medical terms and directions….Comprehending medicine’s arcane jargon is difficult for even the most educated person but is almost impossible for the millions who can’t read well, aren’t fluent in English or have vision or cognitive problems caused by aging.”

Speak more clearly, Mr. President. No jargon.

We have a friend here, my age, who pays huge monthly health insurance premiums. She doesn’t make very much money, she’s raising several young family members — grandkids, nieces — and can’t afford to pay her share of the drugs she needs. Hasn’t taken needed medication for over a year.

It’s not right. We need the reform Obama is leading. And we need him to help us understand that reform, and understand who’s standing in the way.

— Bruce Benidt

Top 5 Dying Facts That Endanger Obama’s Reelection

A brilliant and widely circulated Chicago Tribune obituary claims that Facts has died. If you haven’t read the whole thing, here is a flavor:

Through the 19th and 20th centuries, Facts reached adulthood as the world underwent a shift toward proving things true through the principles of physics and mathematical modeling. There was respect for scientists as arbiters of the truth, and Facts itself reached the peak of its power.

But those halcyon days would not last. People unable to understand how science works began to question Facts. And at the same time there was a rise in political partisanship and a growth in the number of media outlets that would disseminate information, rarely relying on feedback from Facts.

… Facts is survived by two brothers, Rumor and Innuendo, and a sister, Emphatic Assertion.

Services are alleged to be private. In lieu of flowers, the family requests that mourners make a donation to their favorite super PAC.

I’m a starry eyed optimist, so I choose to think Facts is still on life support hoping for a miracle recovery. But if the President and his team can’t successfully breathe life back into five key Facts that are currently on life support, it’s difficult to see how he can win in November.

Fact #1: Obama opted for a private health insurance reform model developed by Mitt Romney and other conservatives, rather than an insurance plan run by government.

Fact on life support.
• Fact on Life Support: Only 25% of people who took the Kaiser health reform quiz understood that Obama’s health reforms will not “create a new government run insurance plan to be offered along with private plans.”

• Implications of Death: GOP parrot trainer Frank Luntz has commanded his cockatiels to repeat the phrase “government takeover of health care” for a very sound political reason, because market research shows that is a compelling reason for moderate swing voters to oppose health care reform. The more swing voters believe that falsehood, the less they like Obamacare and Obama.

Fact on life support.
Fact #2: Bush policies and the economic downturn under Bush were the most powerful causes of the ballooning national debt, and Romney wants to extend those Bush policies.

• Fact on Life Support: Out of twelve issues, there is only one issue where voters say Romney would do a better job than Obama – handling the deficit. Voters currently believe Bush disciple Romney is the best person to tackle the debt that Bush policies largely created.

• Implications of Death: The size of the debt is especially concerning to moderate swing voters, so getting blamed for causing that problem badly hurts the President’s prospects of wooing that key constituency.

Fact #3: Obama’s stimulus package of tax cuts and investments helped ease the pain and damage done by the Great Recession.

Fact on life support.
• Fact on Life Support: Over half of independents (56%) believe the stimulus didn’t make any difference.

• Implications of Death: The central issue of the campaign is the economy, stupid. If swing voters don’t believe Obama was effective on the issue that concerns them the most, look out.

Fact #4: In terms of private sector job creation, things have gotten significantly better during Obama’s time in office than they were under Bush and the the Bush policies Romney proposes to resurrect.

Fact on life support.
• Fact on Life Support: Three-fourths (75%) of independents believe that the economy has gotten worse or stayed the same, and 77% of independents believe the economy is still in recession.

• Implications of Death: Even if most voters blame Bush for the economic meltdown, as most still do, according to polls, it’s difficult to see how swing voters who believe that things are still headed in the wrong direction will vote to rehire the incumbent President.

Fact #5: In the Obama years, taxes for the middle class were near historic lows.

Fact on life support.
• Fact on Life Support: Eighty-five percent of independent voters incorrectly believe taxes on the middle class either increased or have not changed.

• Implications of Death: Independent swing voters vote their pocketbooks, and oppose paying more in taxes. If they perceive that they were paying high taxes in the middle of a recession, the Democrat in charge will get the lion’s share of the blame, because Democrats are usually presumed to be advocating for higher taxes.

Of course, there are many other falsehoods hurting Obama. Little things like he is a foreigner, Muslim, socialist designing death panels to kill off your loved ones.

But in a year when the economy is the top issue, and with the health reform bill about to get hot again after the Supreme Court rules, these are the five dying Facts that are hurting Obama the most with swing voters. Team Obama needs to resuscitate good old Fact, or Obama’s political career will perish with him.

– Loveland

Republican Spin Doctors Misdiagnosing Obamacare

Republican spin doctors are emboldened by public opinion polls that consistently find that a majority of Americans disapprove of Obamacare. For instance, this morning’s Star Tribune carried a New York Times News Service story that was typical of the superficial poll coverage you usually see in the news. The headline read:

“47 percent disapprove of health care law, poll finds”

That headline is perfectly accurate, and Republicans think those findings are, as the Vice President would say, a “BFD.” They conclude that Americans oppose Obamacare because it is an overly radical “government takeover of health care.”

But it would behoove GOP spin doctors to probe more deeply into recent public opinion research. Because a more thorough reading of polls shows Republicans are on shaky ground with their promises to repeal Obamacare and replace it with some kind of a scaled back alternative.

For example, a March 2012 Pew Research poll found 45% disapprove of Obamacare. Romney wins, right?

Not so fast. The same Pew poll also probed why people disapprove, and it turns out that 53% of Americans either want to do as Democratic candidates suggest, “leave it as is” (20%) or “EXPAND IT” (33%), while only 38% want to do what the GOP field wants, to “repeal it.”

That doesn’t exactly look like Americans rising up against “government takeover of health care,” as GOP candidates continually portray it. According to that poll, most Americans want Obamacare as is, or supersized.

Likewise, a March 2012 Bloomberg poll finds that 57% either agree that the Affordable Care Act “may need small modifications, but we should see how it works” (46%) or “it should be left alone” (11%), while only 37% who think “it should be repealed.”

And then there is a March 2012 Kaiser poll. It finds that 41% of Americans support the Republican solutions of either “repeal and not replace” (23%) or “repeal and replace with a GOP alternative” (18%), while a larger group of 47% supports the Democratic solutions of either “keep law as is” (19%) or “expand the law” (28%).

Finally, Republicans who conclude that those top line Obamacare disapproval numbers indicate that Americans prefer to have Republicans fixing health care in the post-Supreme Court ruling world may want to read further into that Pew poll. Pew found a large plurality of Americans saying that Democrats would “do a better job dealing with health care,” with 49% preferring Democrats and just 35% preferring Republicans.

In other words, be careful what you wish for, Tea Partiers. If the Supreme Court blows up Obamacare, voters may very well prefer to elect Democrats to come up with Plan B.

Reading the top line Obamacare disapproval numbers without digging more deeply into voter research is spin doctor quackery. It’s like a physician concluding that a patient with a headache has a brain tumor, without first digging into detailed diagnostic scans and lab results.

– Loveland

Recall Wisconsin’s Recall

But what about the sequels?
Well, I see Wisconsin is starting to set dates for its recall elections. The news doesn’t thrill me. In fact, if I were a Wisconsin citizen, I would have to take a barf bag to the ballot box, and vote for Governor Scott Walker and his legislative supporters to keep their jobs.

I disagree with Governor Walker on just about every issue. I think he badly overstepped last year when he led his state like it was a flaming red Mississippi, instead of a moderate purple Wisconsin.

And I think he should keep his job, until his term is up.

Don’t get me wrong. It would feel very satisfying to watch Scott Walker wheeling file boxes full of Koch Brothers’ playbooks out of Wisconsin’s beautiful Capitol Building. But taking the long view, holding recalls over policy disagreements is a very bad idea.

Look, the guy didn’t commit a felony. He didn’t even commit a misdemeanor. He disagreed with me, and lots of his fellow Wisconites. And you know what? Disagreement is allowed in democracies.

As encouraging as it has been to see a million cheese heads rise up against naked corporate cronyism, I hate the precedent here. If we start recalling politicians every time the majority has a mid-term policy disagreement with a leader, two things are likely to happen. First, our democracy will get even more unstable and chaotic than it is today. Second, our leaders will get even more cautious and incremental than they already are, for fear that policy boldness will land them in an $80 million recall election.

To my friends on the left, how would you feel about President Obama being recalled for passing the Affordable Care Act, or Governor Dayton being recalled for pushing for higher taxes on the wealthiest Minnesotans? Those policies are as unpopular on the right as banning collective bargaining is on the left. But shouldn’t Obama and Dayton be able to move forward if they can assemble enough supportive votes in the duly elected legislative body? Well then, shouldn’t Governor Walker too?

Consider this: In the middle of the 2008-2009 economic meltdown, President Obama and his congressional supporters made an extremely unpopular decision to give financial assistance to automakers. At that time, 54% of Americans said this policy was “bad for the economy,” and many felt it was an alarming move toward socialism. But since Obama was allowed to serve a whole term, the policy was implemented. After seeing the policy play out, today 56% of Americans now believe it was “good for the economy.”

Fortunately, we Americans have a built-in means of expressing disapproval over policy disagreements. It’s called regular elections. It’s called making judgements based on an entire term’s body of work, rather than on snap judgements about single issues. I understand that means Badgers would have to suffer through an entire four-year term of Governor Walker and his legislative supporters. But that’s the way this representative democracy gig is supposed to work.

So enough with the constant calls for mid-term recalls, and resignations, as we have recently seen in Minnesota in the case of Representative Mary Franson. In a democracy, an honest policy disagreement in the middle of a term is cause for us to vigorously rebut, organize, and protest. But in a healthy representative democracy, an honest mid-term policy disagreement should not be a fireable offense.

– Loveland

Minnesotans Shouldering Hidden Anti-Obamacare Tax

This week the Minnesota Hospital Association (MHA) announced that its member hospitals paid $226 million in “charity care” last year. The MHA is referring to instances when uninsured and underinsured patients are unable to pay their hospital bills, and the hospitals get stuck with the expenses.

While the term “charity care” is used by hospitals, hospitals don’t end up bearing the whole burden. They make up for the bills substantially by charging more to their insured patients, and insurance companies subsequently shift these higher costs to insurance premium payers.

This post isn’t meant to be a criticism of either the hospitals or the insurers. They would go out of business if they couldn’t shift costs.

Supporters of preserving the Anti-Obamacare Tax.
But it is meant to be a criticism of Obamacare obstructionists. The MHA numbers are a reminder that those who have been aggressively blocking efforts to reduce the number of uninsured and underinsured through Obamacare are responsible for maintaining what is akin to an enormous annual tax on premium payers. An Anti-Obamacare Tax.

Given that a fully implemented Obamacare is predicted to reduce the uninsured rate from today’s 50.7 million people to about 18.7 million, and the number of underinsured people by about 70%, leaders opposing Obamacare in Congress, state legislatures and federal courts are effectively blocking the elimination of a huge annual burden on American households. If the anti-Obamacare obstructionists win, we all keep paying this Anti-Obamacare Tax.

And it’s not a small tax. In Ramsey County, taxpayers are up in arms over a proposed $10 million per year tax for the Vikings stadium. This hidden Anti-Obamacare Tax is much more painful. The Center for American Progress finds “on average, 8 percent of families’ 2009 health care premiums—approximately $1,100 a year—is due to our broken system that fails to cover the uninsured.”

– Loveland