Health care in Kentucky deserves protection

As it stands, the Republican plan will have catastrophic effects on families, children... (Senator Mitch McConnell alert...!!)

Letter to the editor published in the Commonwealth-Journal

Republican American Health Care Act and the negative impact it will have on (Kentucky) community- by Tim Bess

Our country’s healthcare system is in the midst of a massive upheaval. Never before have we witnessed such challenges that will impact both the type of care our community receives and the ability of our local hospital to continue providing the high-quality care that we know each of you have come to expect from physicians, nurses and staff.

Politicians in Washington, D.C., are considering a healthcare reform bill called the American Health Care Act (AHCA). 

This bill seeks to completely transform how we deliver care to you, but unfortunately, as it is currently being considered, not for the better. If passed in its current form, our local economy, as well as that of our state and country, will suffer. And our hospital, a bedrock of our community, will see severe negative effects.

Specifically, the House AHCA, as it stands, will have catastrophic effects on families, children, elderly and disabled individuals who depend on our hospital for care. It is projected to leave 23 million Americans without access to affordable healthcare coverage – many of whom live right here in our community.

Without coverage, many of these community members will be left without access to the healthcare services they need to live healthy and productive lives.

The bill could also mean significant job loss. Total jobs lost across the country could total nearly one million, including the loss of an estimated 16,500 jobs in our state alone by 2026 (commonwealthfund.org). And these effects will undoubtedly ripple into our community.

The overall impact of the Republican health care fiasco bills, ie, the AHCA and the BCRA (a regurgitated version of the AHCA) on our local economy would be devastating and felt for many years to come.

Our hope is that the U.S. Senate, will find a bipartisan solution that will have long-term durability so our patients have continued access to affordable care and our community can thrive.

We encourage every member of our community to contact our U.S. senators and let them know the importance healthcare access and coverage has for you, your family and our community. Tell them that you deserve access to quality and affordable healthcare and that this bill, including Medicaid cuts currently under consideration, could have a detrimental impact on you and your community for many years to come.

Healthcare should be protected, and it is up to us to make sure that it is.

Harmful American Health Care Act - Republicans undermine seniors

Published in the Bangor Daily News- published in  Bangor Maine Thursday, June 1, 2017

AHCA bad for seniors- Letter to the BDN editor

The American Health Care Act, deeply flawed legislation, will hurt millions of Americans and their families. 

According to the Congressional Budget Office report, an estimated 23 million people will lose their health coverage by 2026 if this bill passes.

When one considers what the American Health Care Act would mean for Maine, you can see why this bill should not be enacted.

First, the bill would allow insurance companies to charge higher premiums for people with pre-existing health conditions. According to AARP, there are 123,155 Mainers between ages 50 and 64 living with a pre-existing condition. For many, the new premiums would be unaffordable.

Second, the bill heavily penalizes older Americans in this same age group. Once again, it is the insurance companies who come out on top because they will be allowed to charge five times what others pay for the exact same coverage. According to the budget office, premiums for a 64-year-old earning $26,500 a year would increase from $1,700 to $13,700 in 2026. Let’s call this what it is: An age tax.

In addition, the bill reduces Medicare funding, which would put us on the road to turning Medicare into a voucher system. The bill would also slash Medicaid by over $800 billion, ultimately harming those who are most at-risk.

This bill is neither about health nor about care. Please call Sen. Susan Collins today and urge her to oppose the American Health Care Act.

Roberta Downey Bangor Maine

Cincinnati Inquirer letters to editor- Health Care

Two interesting "letters to the editor" responding to the House Republican health care plan, published in the Cincinnati Enquirer:

What is hard for me to understand is, Republicans are against abortion and yet they are overjoyed about not taking care of people with pre-existing medical conditions.

Also, what happens when the child that can't be aborted has a pre-existing condition?

Pre-conditions will cause people to die. Some of those have children. I have a friend that has cancer and has a 14-year-old. What happens to that child?

I had voted for Brad Wenstrup. But, as soon as I knew he had voted yes for this bill (AHCA), I immediately called his office and told whoever answered that he will never have my vote again.

From: Day Lemming, Hyde Park

And another letter:

It's time for US to get serious about health care

The folly surrounding the passage of the recent House bill (ACHA) on health care shows that maintaining the current partisanship only postpones a real solution to our health care needs in the United States. We can learn from many other countries how government at the national level supports and treats the health care of its citizens.

I would like to see the Cincinnati Enquirer highlight in a series the general outlines of health care in Canada, England, France, Germany, Russia, Japan, China and others.

We would like the Enquirer to compare the best of these systems with the House Bill 676 for a single-payer system in the United States. (!- Yes!)

Perhaps by some working knowledge of how other systems benefit their populations, we can begin to put our people first in providing the best care for our citizens. It's time health care gets the same attention as the defense of our country. Healthy citizens are the bedrock of our great nation.

From: Elaine Berninger, Cleves

Climb Every Mountain - rise up to Medicare for All

It's impossible to understand how Republicans continue to ignore the achievements of civilized nations that provide universal health care for all their citizens - including Russia!, while ignoring their responsibility to provide insurance coverage for our fellow Americans. (Canada provides universal care!)

Nevertheless, in the dismal failure the Republicans experienced in the humiliating defeat of their "replace" bill, called the American Health Care Act (AHCA), their stupidity may have finally driven home the concept of "universal health care". Indeed, even conservative pundit Charles Krauthammer "gets" this.

RealClear Politics by Tim Haines:
Krauthammer: Obamacare Succeeded In Creating Expectation Of Universal Health Care
On Friday's edition of  FoxNews 'Special Report', the syndicated columnist Charles Krauthammer made the case that President Obama's strategy for his signature "Obamacare" was not to create a perfect health care system, but to build the expectation that health care is "a human right", and something the government is responsible for supporting. 

Krauthammer said Obama was successful at "creating the expectation of universal health care". As a result "the zeitgeist (Oh, for heavens sake Krauthammer, use real English!- "dominant set of ideals and beliefs that motivate the actions of the members of a society") in the country has really changed." Put another way, the failed Republican's health care "repeal and replace" changed the dominant point of view about health care.  It's not a back door way to inject tax cuts for the rich, like the failed Republican plan tried and failed to do. Rather, it's a human right for all people.

Charles Krauthammer is a pundit

"The Democrats are going in one direction," Krauthammer explained. "When Obamacare explodes or collapses, or dies with a whimper and not a bang... the Democrats are going to head in one direction only: single payer. The British or Canadian system."

"That is the logic of Obamacare. It was a system which would temporarily create (an entitlement?) HELLO? It's not an entitlement when people pay premiums for the coverage!

Krauthammper is wrong to tell Fox News that Obamacare will not work because, in fact, it is financially possible. Beneficiaries who pay for the Affordable Care Act coverage expect to have essential benefits included in their insurance and, moreover, they're willing to pay for this benefit. Obamacare works because it is financially possible... But, said Krauthammer,  the Republcians have succeeded at creating the expectation of universal care, (yes!) and once you have that... What we're going to get is Democrats going to a single payer," he added.

Krauthammer, says we're experiencing "zeitgeist'? In other words, America has finally reached a "teachable moment" about how to conceptualize health care.  It's a human right.

"The zeitgeist in the country has really changed," he said.

Haha! Yup, I even looked up the word, for the benefit of readers (like me!) who might not entirely "get" what Krauthammer said to right wing FoxNews. In fact, the truth is, the debate over the failed Republican plan called the American Health Care Act has created a teachable moment in our daunting public policy debate about health care.

"Zeitgeist", to you  too, Krauthammer.  Let's expand Medicare to cover all people who qualify!

By the way, for a man who's board certified in psychiatry, you sure can confuse people with you weird words.  

Although Democrats, led by Rep. Nancy Pelosi, can justifiably rejoice in well organized opposition to the Republican's "repeal and replace" disaster, the fact is, we must climb even more political mountains to achieve the ultimate goal of passing universal coverage. Let's do it!

Republicans considered eliminating essential health benefits

"Instead of continuing to make a bad bill worse," Lawrence says Congress should start over again to come up with a bill that improves health and reduces cost. -(Maine Writer- well what about improving what's already in the law?)

Health insurance is really a misnomer. In fact, people buy "sickness insurance", because they only use it for sickness care. 

Health insurance is used when a beneficiary needs acute care like surgery, mental health, substance abuse, maternity, emergency or pediatric health services. Can this really be true? It makes no sense, in fact, it's positive lunacy! Nevertheless, Republicans considered a replacement for the popular Affodable Care Act or "Obamacare" by taking the essential benefits away from mandrory coverage. Removing the essential benefits as a requirement for insurance benefits will cereate a proverbial Niagra Falls of revenue for insurance comapnies. Beneficiaries would pay huge out of pocket expenses for benefits that wouldn't be covered in their plans. Whaaaaa? How can this be so?  

Indeed, it almost was so, because the Republicans became dangeorusly close to voting on the American Health Care Act (AHCA), their "replacement" for the ACA, whereby the essential health benefits most people use in their insurance plans would be cut. Make no mistake about it,, the Republicans really-really wanted to to pass the AHCA.  It was their time to repeal Obamacare after working for 7 years to dismantle the bill.  Republicans really-really wanted to pass the AHCA but they failed to even bring the bill to a vote today, March 24th, on the House floor.  It was the result of a complete failure of Republican leadership.  But, the final nail in the proverbial bill's heart was when a list of "essential benefits" was cut from the services required to be covered in a helath insurance plan.

USA Today Reports: Jayne O'Donnell , USA TODAY
Eliminating or reducing required health insurance benefits, now part of the Republican bill to repeal the Affordable Care Act, also threatens to kill the ACA's annual and lifetime limits on patients' costs, which was enacted to prevent bankruptcies due to medical costs. (This wrong minded provision would be a foot in the door to dismantling Medicare where there are no lifetime limits to coverage.)

Late Thursday night, House Speaker Paul Ryan released an amendment that would leave it up to states starting in 2018 which, if any, of these benefits have to be included in plans sold to people receiving tax credits to buy their insurance. About 85% of people who buy their insurance on the Affordable Care Act (ACA) exchanges get tax credits. This, the Speaker's office said, "will help lower costs and expand choices."

The limits on out of pocket costs only apply to the ACA-required 10 essential health benefits, which include prescription drugs and hospital care. So eliminating the benefit requirement makes the limits "essentially meaningless," says health care legal expert Tim Jost.

Currently, these benefits must be covered in employer-provided insurance and plans sold on the exchanges in states that use Healthcare.gov, while states that operate their own exchanges can have slightly different requirements. Plans for people who gained coverage under the ACA expansion of Medicaid also have to include these benefits.

In addition to prescriptions and hospital care, marketplace plan benefits also include:

• Pregnancy, maternity and newborn care

• Mental health and substance abuse disorder services

• Rehab services and devices for people with disabilities

• Preventive and lab services

• Dental care for kid
The latest amendment to the American Health Care Act (AHCA)would dedicate an additional $15 billion to the Patient and State Stability Fund (PSSF) for services covered in essential health benefits including maternity, mental health, and substance abuse care.

The money would help, says National Council for Behavioral Health CEO Linda Rosenberg, but it doesn't come close to offsetting the $880 billion cuts planned for the Medicaid program. (This provision was a shell game because there's no way the Stability Fund would be protected from being used for purposes it was not intended to pay for.)
"This is a grant and that’s an entitlement," says Rosenberg. "We don't do that with breast cancer - tell people you have to go to a place for treatment that got a grant for five years."

Hal Lawrence, a physician who is CEO of the American Congress of Obstetricians and Gynecologists, is also far from satisfied with the late night change.

“We support maternity coverage for all women in all insurance plans, regardless of who a woman works for or where she lives," says Lawrence. "This fund is not a solution and does not, in any way, mitigate the assault on women's health by returning maternity coverage to the vagaries of state politics."

"Instead of continuing to make a bad bill worse," Lawrence says Congress should start over again to come up with a bill that improves health and reduces cost.

The House's Freedom Caucus, a group of conservative Republicans, were pushing for language that would eliminate these required services, but House leaders originally said it couldn't be done under the special procedures through which the legislation is being moved through Congress. These require only 51 votes and don't allow for a Democratic filibuster. Wednesday night, Sen. Mike Lee, R-Utah, said the Senate parliamentarian had told him the insurance provisions would not necessarily violate those budget procedures.

Many consumers concerned about their high ACA premiums often complained that their plans included coverage they said they neither needed nor wanted. Women past childbearing years found their maternity and birth control coverage particularly galling or at least laughable, but some experts say such coverage costs need to be spread across all people to keep premiums reasonable.

"This notion that people can buy the plan they want" is flawed, says Linda Rosenberg, CEO of the National Council for Behavioral Health, which represents mental health and addiction treatment centers. Young people would only buy catastrophic coverage and the pool of people with regular insurance would be much sicker and costs would be prohibitively high, she says.

Health care economist John Goodman, however, says "it would be some help if insurers could have more flexibility in what they offer." Goodman, who helped draft one of the Republican ACA alternatives in Congress, says the required health benefits "force everyone to pay more money" for plans that cover services they may not need, such as for a very premature baby.
The opioid epidemic in congressmens' backyards

Along with keeping Medicaid intact, Rosenberg says the requirement that plans cover mental health and addiction treatment needs to stay in any bill that passes Congress. She says reducing the number of people covered by Medicaid and/or the coverage in Medicaid and ACA plans — as the Republicans' American Health Care Act would — threatens the ability of people suffering from mental health or addiction disorder to work and stay out of prison.

That describes the risk Samuel Hedgepeth says he would face if he lost his mental health and addiction coverage. He says he self-medicated for his bipolar disorder beginning at age 13 with alcohol and drugs including cocaine, heroin and other opioids. It wasn't until he got Medicaid in Maryland last year that he got treatment for his mental illness, despite 10 years in prison. He says he suffered from anger, paranoia and suicidal thoughts.

"My alcohol and my drug addiction — that was my way of coping" says Hedgepeth, who lives in Hyattsville, Md. "Your body starts craving it, and you're willing to do anything to satisfy that obsession."

Eliminating the required health benefits could also jeopardize more moderate Republicans' votes even if it attracts conservatives. Rep. Peter King, a moderate New York Republican, went from a "no" vote to undecided after talking to President Trump, but then said he was closer to "no" after the essential health benefit plan surfaced.

Many moderate members also "ran by saying their top priority was addressing the opioid epidemic, the worst drug crisis in U.S. history," says Meaghan Smith, a spokeswoman for a coalition of ACA supporters known as the Protect Our Care Campaign. Eliminating essential health benefits "will be devastating for people throughout the country trying to fight the opioid epidemic and it will be political disaster for these members of Congress."

As for screening tests, Goodman says "preventive medicine doesn’t pay for itself," adding that many tests are "very controversial."

If cancers aren't caught early because people are either uninsured or their plans don't have to cover preventive health screenings, doctors and other health experts say cancer rates and deaths will increase. The Kaiser Family Foundation has reported 36% fewer uninsured women had a mammogram in the last two years, and uninsured women were 30 to 50% more likely to die from the disease. Women who lacked insurance were also three times less likely to have had a Pap smear in the last three years and had a 60% great risk of late-stage cervical cancer.

Cervical cancer, says Lawrence, "is basically it’s a preventable cancer." The later cancer is diagnosed, however, the greater the risk of death.

"It’s a horrible idea that takes away women’s access to preventive and maternity care," Lawrence says of the AHCA. "What (members of Congress) will do is increase illness, pregnancy complications, cancer and death. Sadly, the AHCA takes us back to well before the ACA."

Speaker Ryan had 7 years to write a health care bill

House GOP Leaders Pull Trumpcare Vote- Speaker Ryan is proving he's certainly not a Tip O'Neil- who was a giant among political negotiators when he was the Speaker of the House.

Speaker Paul Ryan wants to blame Republicans for not supporting the American Health Care Act (AHCA) rather than admit the bill is flawed becaue it doesn't meet consumer (aka "voters") expectatons

Makes no sense for Speaker Ryan's to shift the blame about the lack of support for the Republicaan "American Health Care Act" (AHCA), and the ensuing public policy debacle, to blame those who,in the past, voted to repeal Obamacarre or The Affordable Care Act (ACA),. He believes the Republicans have an oblgation to pass any kind of health care coverage law, just because they happen to oppose Obamacare. But, what Speaker Ryan doesn't "get" is thaat quality health care is "compensated health care". To repeal Obamacare without a suitable replacement, inclusive of popular benefits like maternity care, coverage for pre-existing conditijons and keeping children up to ag3 28 on a parents plans, causes a lack of access to compensated care. In other words, in the Re[ublican plan, insurance companies will create healthcare plans whereby beneficiares will pay for no access at all. At the end of this story, the result is hospitals and health  facilities will be forecedto close for lack of patients who can pay for their care.

All of this drama is a back door way of giving those who earn over $250,000 a year a tax break. How stupid is that?

Paul Ryan Sells Health Care Bill As A 'Once-In-A-Lifetime Opportunity'- in other words, Speaker Ryan wants to say he has power enough to harm poor people. He is staking his entire political reputation on taking an insurance benefit from ACA beneficiaries who pay premiums for their coverage.

Well, at least on the first try, Speaker Ryan received a reality check. His obsession with passing this AHCA thru Congress without public hearings is causing more harm to the "repeal and replace". But, the real issue is, why bother to repeal Obamacare when it's working well? Rather than repeal, just work a bi-partisan deal to improve the current law.

But, instead, Ryan says, "This is the chance. This is a once-in-a-lifetime opportunity," he said, roving the stage with a wireless mic, gesturing at both the audience in front of him and the PowerPoint presentation behind him.

(TED Talk? Late-night infomercial? Nope — it was House Speaker Paul Ryan, making a hard pitch for his health care plan after a week of loud conservative criticism.)

After listening to conservative groups like the Club For Growth blast the bill as a "warmed-over substitute for government-run health care," Ryan went on offense, saying this is just the first step of an ongoing overhaul of the health system. (OMG- what's wrong with Republicans?  They should be taking pride in supporting and improving government's rose in health care rather than cutting the progress made over the past 100 years to improve quality and affordable access.)

But, regardless of the darma.....
Washington DC- The House Republican leadership’s effort this week to (needlessly! and... sloppily) drive home its Obamacare repeal legislation seemingly collapsed on Thursday afternoon, when President Donald Trump was ultimately unable to win the elusive support of the hard-right Freedom Caucus. 

According to GOP sources, the healthcare vote will be postponed. Meetings among Republican members are expected to continue through out the evening. On Wednesday night, the caucus directly circumvented House leadership and Speaker Paul Ryan’s office to negotiate directly with Trump and the White House.

In fact, the caucus has been the single biggest obstacle to passing the American Health Care Act (AHCA) in the House, and was reportedly nearing cutting a deal with the president. 

Members of the Freedom Caucus indicated that the president and House leadership were open to nixing the so-called "essential health benefits" from the House bill—a proposal that would prove anathema to more moderate Republicans in both the House and Senate.

Despite the frantic, high-level negotiations and courtship that lasted well into Wednesday evening, no new deal was struck, and the AHCA was left with an even more uncertain future than it had when the day started.Freedom Caucus aides who spoke to The Daily Beast on Thursday morning said that, despite the “cautious optimism” on bringing Trump more into their corner, nothing had changed. The caucus’s concerns with the bill—which members view as another big-government conservative sell-out—were still far too great to support it, and President Trump and Speaker Ryan still weren’t surrendering to all their demands.

A friendly meeting at the White House with the president and his key advisers on Thursday morning didn’t do much to appease members of the Freedom Caucus or its staunchly anti-AHCA chairman Rep. Mark Meadows. 

A friendly meeting at the White House that happened the day before didn’t make a dent, either. Even Trump’s high-profile visit to Capitol Hill to single out and warn conservative holdouts that “many of you will lose your seats in 2018 if you don’t get this done” didn’t move the needle in his direction.

For weeks, the House Freedom Caucus was publicly and loudly vowing to not blink in its game of chicken against the Trump White House and House GOP leadership. They made it a mission to kill the bill—and the caucus delivered. “We’re taking [Trumpcare] down,” a Freedom Caucus aide assured The Daily Beast on Tuesday morning. —Asawin Suebsaeng

Republicans in Congress have long vowed that they can make health care more affordable and accessible. Americans will now see if they can keep that promise. (But, the Republican Speaker had 7 years, since Obamacare was passed, to come up with a cogent plan.....)

Wall Street Journal Obamacare graph - worth 1000 words

http://www.wsj.com/graphics/compare-aca-vs-gop-healthcare/

House GOP Health Plan - AHCA- negatively compares to the Affordable Care Act - ACA

Estimating the cost and coverage of the proposed legislation

Secretary Tom Price is totally wrong to say these analyses are undependable. (Graph below)

In fact, Dr. Price knows TrumpCare reduces benefits while driving up the costs of benefits and co-pays. 

Congress led by Speaker Paul Ryan  is rushing to repeal the Affordable Care Act (ACA). Those at risk of losing coverage are the people who need it most – 82 percent come from working families, and 4 million additional children would be left uninsured.

Rather than admit the obvious, Secretary Price, instead, used classic "doublespeak". He told Savannah Guthrie of "NBCToday" that all Americans will have access to health insurance coverage.  HELLO? In fact, we all have access to coverage today; but many people can't afford to but the access they're entitled to receive.  What Guthrie said to Price in a Today interview was, although we might have access to the ability to purchase an expensive automobile like a BMW or a Lexis, it's not the same as being able to afford to buy a luxury car.  Secretary Price was caught off guard because he didn't memorize an answer to that comparisom so he called what Savannah said "a Bernie Sanders question". Soooo, hmmm? It worked for me.  

The Red Line explains the problem. Under the Obamacare coverage, the uninsured population was declining as more people were signing up for the Affordable Care Act. Under TrumpCare aka "AHCA" the uninsured numbers skyrocket.  Even if the uninsured rate went up only half what the projected numbers report, the overall impact would be devastating to the health care of millions who won't be able to afford the coverage because the premiums will be adjusted upward by advancing age. By the way, the cost of this terrible legislation will be paid for by cutting Medicaid, the largest payer for long term care in nursing homes. 

Moreover, the TrumpCare bill will cut health benefits to coal miners who suffer from "black lung disease".  

(Pneumoconiosis)

Americans must stand up against the unnecessary repeal of the working Affordable Care Act. Instead of repeal, Congress has the power to just improve it.

In the Wall Street Journal, the graph is a picture worth 1000's of patients words.