“If your baby is going to die, and it doesn’t have to, it shouldn’t matter how much money you make”

+1000 to Jimmy Kimmel.

Before 2014, if you were born with congenital heart disease, like my son was, there was a good chance you’d never be able to get health insurance because you had a preexisting condition…

If your parents didn’t have medical insurance, you might not live long enough to even get denied because of a preexisting condition. Babies shouldn’t die when surgery can save them.. It shouldn’t matter how much money you make.

His comments on health reform and preexisting conditions are here. His newborn son’s heartwarming story is below. My favorite line is simple: “We need to take care of each other.”

Two caveats to a touching photo-op

Speaker Ryan’s bill would allow states to waive ACA protections that now bar insurers from charging higher premiums to childhood cancer survivors. It would also allow states to weaken the Essential Health Benefit, which is so critical to ensure that insurance actually works for people who experience costly or life-altering conditions.

I haven’t even gotten to Medicaid and the impact of higher premiums for low-income people.

Is Obamacare in a death spiral? Probably not, but GOP market-based health policy might be

Me in Politico.

Since Republicans’ control pretty much everything in Washington and in most statehouses, they are accountable for the functioning of American government. Through “collapse and replace,” they are effectively holding themselves hostage. And whatever the partisan calculus, such rhetoric introduces political and policy uncertainty that dampens insurer and consumer commitment to the new marketplaces.

The long-run trajectory should really concern Republicans. The American Health Care Act, the putative replacement for the ACA, produced a surprisingly emphatic victory for Democrats. It bolstered the national consensus that every American is entitled to affordable and decent health coverage.

If the marketplaces can’t deliver on this promise, they won’t simply be scrapped. They will be supplanted by some form of expanded public coverage.

More here.

What does it mean to hold yourself hostage? Let me explain…
Continue reading “Is Obamacare in a death spiral? Probably not, but GOP market-based health policy might be”

“Paul Ryan Failed Because His Bill Was a Dumpster Fire….”

Me, at Politico, on the shambolic fate of the American Health Care Act.

There was a conspicuous smallness to this AHCA effort, a puzzling shoddiness given the human and political stakes. Many in the GOP, above all President Trump, seemed strangely uninterested in the policy details. To the extent Republicans did have an animating passion, it was to puncture President Obama’s legacy—and to avoid looking foolish by failing to honor their “repeal and replace” rhetoric.

Only they had no viable replacement. For all their endless warnings about how Obama’s signature health law was hurting American families, driving up costs and putting us on the path toward socialism, it turns out they didn’t care enough to put in the work.

More here. (Editor’s title).

“Hurt people hurt people.” That’s true of youth violence. It’s true in politics, too

Sunday’s Washington Post included a front-page story, “Fear, hope, and deportations,” which merits a careful and sympathetic read from liberals, conservatives, and journalists trying to understand what is happening in America  today.

Reporters Mary Jordan and Kevin Sullivan profile a 59-year-old Texas woman named Tamara Estes. She was born into some affluence, raised in “a grand home with a built-in pool.” But her mom died when she was four. Her dad died when she was nineteen. She married young, and by age 26 she was divorced with two kids. She has since traveled a sad path of downward economic mobility, never going to college, taking a succession of dead-end jobs. She now works as a school bus driver in Valley View, Texas, with an annual income of $24,000. “With four days left to payday, she has $118.72 in her checking account.”

She is a die-hard Trump supporter. She seethes at undocumented immigrants and their children in her own community. It’s pitiful to hear her. President Trump brings out the worst in his own neediest supporters before he betrays them.

Ms. Estes is also uninsured. Yet she supports a president and a party that specifically propose to put coverage out of reach for low-income near-retirees like herself. She so perfectly fits a certain political-demographic story that her biographic details might have been perfected at the MIT Media Lab or Huffington Post. As with most things, though, it’s a bit more complicated. I looked up what’s available to her under ACA, and it’s hardly surprising that she doesn’t feel particularly grateful for it.

I wrote about her story at healthinsurance.org. There’s a little snippet below.

Tamara Estes is not the world’s most appealing or most perfect person. She should take fewer puffs on bigoted and deceptive right-wing radio. She shouldn’t blame immigrants for her life’s disappointments and problems. Harming immigrants will do nothing to help her. As a friend noted on email, it wouldn’t hurt her to learn a little Spanish, too. If nothing else, she might learn a few kinds words for the kids she transports. She might be less lonely and isolated if she got to know her immigrant neighbors, who seem like lovely people.

But I can’t hate her. In violence prevention, we like to say: “Hurt people hurt people.” That’s true in politics, too. Tamara Estes is hurting, and she’s lashing out at her own neighbors. That’s ugly to see.

But she still needs help. She didn’t get enough from the ACA. She’ll get a lot less from President Trump, but we supporters of expanded coverage have given her too little reason to really know that. Whatever happens in the current knife-fight over health reform. We face a daunting moral and political challenge to fix that, to go in precisely the opposite direction Republicans are determined to go.

More here.

Today in shambolic health policy: CBO skewers the American Health Care Act

Even if the American Health Care Act never passes, today’s House Republicans will bear the stigma of having proposed it.

Especially in our polarized time, the Congressional Budget Office (CBO) is an essential nonpartisan authority, ready to advise Congress and the American public of the likely economic impact of major legislation. CBO’s current director was selected by Speaker Ryan, now-HHS Secretary Price, and other Republicans in consultation with Democrats. CBO isn’t perfect, of course. But it continues a proud nonpartisan tradition that couldn’t be more important.

Two days ago, CBO released its official score the American Health Care Act, House Republicans’ proposed bill to repeal and replace the Affordable Care Act. CBO’s assessment was….brutal. If AHCA is enacted, CBO estimates that fourteen million more Americans will be uninsured by the end of next year, twenty-four million more uninsured by 2026.

That’s not the worst of it. Table 4 below is drawn from the CBO report. Health insurance premiums for low-income older workers would skyrocket under AHCA. By how much?  The numbers are almost unbelievable.

On the nongroup market, annual net insurance premiums for a 64-year-old with an income of $26,500 would rise from $1,700 to $14,600. Yup, that an annual increase of $12,900, to buy a significantly less generous policy than is now available under ACA. For proponents of AHCA, that’s politically self-immolating.

AHCA also includes a huge tax cut for the wealthiest Americans. under which the top 400 wealthiest households alone receive tax cuts worth more than the premium tax credits provided in the twenty smallest states and the District of Columbia. Since this is the one thing Republicans agree on, I wish they would simply enact these on a party-line vote, add to the deficit, and call it a day.

In all my years of studying health policy, I have never seen a less professional, more shambolic performance than I have seen among Republicans seeking to pass AHCA. Even if this bill never passes, House Republicans will remain the people who proposed it. I just don’t understand their gameplan.

More here by me, at healthinsurance.org.

Still at it with the death panel thing

Death panel rhetoric is not quite working the way it did in 2010. I’m not sure what is more depressing: that a public official would make such a ridiculous statement, or that he might actually believe what he was saying.


PS: Now that President Obama has left office, I feel safe revealing that a vast conspiracy involving several teaching hospitals snuck my 87-year-old dad past the Medicare death panel for advanced cancer care in the era of Obamacare. Ironically, the conspiracy unfolded in the belly of the beast–liberal Massachusetts–where many people are saying that white heterosexual men older than 74 are no longer eligible for hospital care. Somehow, we pulled one over on the man. My dad is apparently cancer-free as of this week and doing well.

PPS: Bill Akins, the man in the video, is secretary of the Republican executive committee in Florida’s Pasco County. The Washington Post‘s David Weigel examined Akins’ Facebook page. It, um, wasn’t pretty. Just one example below. The GOP needs to do serious housecleaning. Its problems on matters of race didn’t start and won’t end with President Trump.
Continue reading “Still at it with the death panel thing”