Shifting Dollars From Poor To Give To the Rich Is a Key Part of the Senate Health Bill

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

Senate Majority Leader Mitch McConnell at his office on Thursday, when the Republican health plan was made public. CreditDoug Mills/The New York Times

The Affordable Care Act gave health insurance to millions of Americans by shifting resources from the wealthy to the poor and by moving oversight from states to the federal government. The Senate bill introduced Thursday pushes back forcefully on both dimensions.

The bill is aligned with long-held Republican values, advancing states’ rights and paring back growing entitlement programs, while freeing individuals from requirements that they have insurance and emphasizing personal responsibility. Obamacare raised taxes on high earners and the health care industry, and essentially redistributed that income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The draft Senate bill, called the Better Care Reconciliation Act, would jettison those taxes while reducing federal funding for the care of low-income Americans. The bill’s largest benefits go to the wealthiest Americans, who have the most comfortable health care arrangements, and its biggest losses fall to poorer Americans who rely on government support. The bill preserves many of the structures of Obamacare, but rejects several of its central goals.

Mitch McConnell, the Senate majority leader, in the Capitol on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

Like a House version of the legislation, the bill would fundamentally change the structure of Medicaid, which provides health insurance to 74 million disabled or poor Americans, including nearly 40 percent of all children. Instead of open-ended payments, the federal government would give states a maximum payment for nearly every individual enrolled in the program. The Senate version of the bill would increase that allotment every year by a formula that is expected to grow substantially more slowly than the average increase in medical costs.

Continue reading the main story

Avik Roy, the president of the Foundation for Research on Equal Opportunity, and a conservative health care analyst, cheered the bill on Twitter, saying, “If it passes, it’ll be the greatest policy achievement by a G.O.P. Congress in my lifetime.” The bill, he explained in an email, provides a mechanism for poor Americans to move from Medicaid coverage into the private market, a goal he has long championed as a way of equalizing insurance coverage across income groups.

High-income earners would get substantial tax cuts on payroll and investment income. Subsidies for those low-income Americans who buy their own insurance would decline compared with current law. Low-income Americans who currently buy their own insurance would also lose federal help in paying their deductibles and co-payments.

The bill does offer insurance subsidies to poor Americans who live in states that don’t offer them Medicaid coverage, a group without good insurance options under Obamacare. But the high-deductible plans that would become the norm might continue to leave care out of their financial reach even if they do buy insurance.

The battle over resources played into the public debate. Mitch McConnell, the Senate majority leader, said the bill was needed to “bring help to the families who have been struggling with Obamacare.” In a Facebook post, President Barack Obama, without mentioning the taxes that made his program possible, condemned the Senate bill as “a massive transfer of wealth from middle-class and poor families to the richest people in America.”

In another expression of Republican principles, the bill would make it much easier for states to set their own rules for insurance regulation, a return to the norm before Obamacare.

Under the bill, states would be able to apply for waivers that would let them eliminate consumer protection regulations, like rules that require all health plans to cover a basic package of benefits or that prevent insurance plans from limiting how much care they will cover in a given year.

Where Senators Stand on the Health Care Bill

Senate Republican leaders unveiled their health care bill on Thursday.

States could get rid of the online marketplaces that help consumers compare similar health plans, and make a variety of other changes to the health insurance system. The standards for approval are quite permissive. Not every state would choose to eliminate such rules, of course. But several might.

“You can eliminate all those financial protections,” said Nicholas Bagley, a law professor at the University of Michigan. “That would be huge.”

Americans with pre-existing conditions would continue to enjoy protection from discrimination: In contrast with the House health bill, insurers would not be allowed to charge higher prices to customers with a history of illness, even in states that wish to loosen insurance regulations.

But patients with serious illnesses may still face skimpier, less useful coverage. States may waive benefit requirements and allow insurers to charge customers more. Someone seriously ill who buys a plan that does not cover prescription drugs, for example, may not find it very valuable.

A protester being removed from outside the office of Mitch McConnell on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

There are features that would tend to drive down the sticker price of insurance, a crucial concern of many Republican lawmakers, who have criticized high prices under Obamacare. Plans that cover fewer benefits and come with higher deductibles would cost less than more comprehensive coverage.

But because federal subsidies would also decline, only a fraction of people buying their own insurance would enjoy the benefits of lower prices. Many middle-income Americans would be expected to pay a larger share of their income to purchase health insurance that covers a smaller share of their care.

The bill also includes substantial funds to help protect insurers from losses caused by unusually expensive patients, a measure designed to lure into the market those insurance carriers that have grown skittish by losses in the early years of Obamacare. But it removes a policy dear to the insurance industry — if no one else. Without an individual mandate with penalties for Americans who remain uninsured, healthier customers may choose to opt out of the market until they need medical care, increasing costs for those who stay in.

The reforms are unlikely to drive down out-of-pocket spending, another perennial complaint of the bill’s authors, and a central critique by President Trump of the current system. He often likes to say that Obamacare plans come with deductibles so high that they are unusable. Subsidies under the bill would help middle-income consumers buy insurance that pays 58 percent of the average patient’s medical costs, down from 70 percent under Obamacare; it would also remove a different type of subsidy designed to lower deductibles further for Americans earning less than around $30,000 a year.

Out-of-pocket spending is the top concern of most voters. The insurance they would buy under the bill might seem cheap at first, but it wouldn’t be if they ended up paying more in deductibles.

Mr. McConnell was constrained by political considerations and the peculiar rules of the legislative mechanism that he chose to avoid a Democratic filibuster. Despite those limits, he managed to produce a bill that reflects some bedrock conservative values. But the bill also shows some jagged seams. It may not fix many of Obamacare’s problems — high premiums, high deductibles, declining competition — that he has railed against in promoting the new bill’s passage.

Sen. Bernie Sanders: ‘Democratic brand is pretty bad’

(THIS ARTICLE IS COURTESY OF CNN)

Sen. Bernie Sanders: ‘Democratic brand is pretty bad’

(CNN)Sen. Bernie Sanders said Thursday he agreed with Democratic congressman Tim Ryan‘s claim that the Democratic brand is worse than President Donald Trump’s in some parts of the country.

“I speak as the longest serving independent in American congressional history, the Democratic brand is pretty bad,” Sanders told CNN’s Anderson Cooper on “AC360.”
“I think the Trump brand is also pretty bad as is the Republican brand. That’s why so many people are giving up on politics.”
Following the Democrat Jon Ossoff’s defeat in a Georgia special House election, some Democratic lawmakers have voiced their concerns about the party’s future.
The Vermont senator argued that the recent special elections need to be put in context.
“The context is all of them are Republican seats and Trump did, in most of those seats, did very, very well.” Sanders continued, “Democrats did much better than was the case in the last election.”

Sanders: GOP health care bill is barbaric

Sanders: GOP health care bill is barbaric
The former Democratic presidential candidate added that the Democrats have the momentum, but the party has to do some “internal soul searching.”
“Understand that for the last 10 years, the model that they have had really has not worked,” Sanders said. “It doesn’t work when you lose the US Senate, US House, the White House. When almost two-thirds of governors chairs are controlled by Republicans. When Democrats have lost a thousand seats and legislatures all over the country.”
Sanders told Cooper what he believes the Democrats have to do to win back voters.
Democrats need to “make it clear to working people of this country that the Democratic Party is on their side,” Sanders exclaimed. “The Democrats need a progressive agenda. They need to rebuild the party in states they have ignored for decades, where they have almost no presence right now and create a 50-state party.”

Shifting Dollars From Poor to Rich Is a Key Part of the Senate Health Bill

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

The Affordable Care Act gave health insurance to millions of Americans by shifting resources from the wealthy to the poor and by moving oversight from states to the federal government. The Senate bill introduced Thursday pushes back forcefully on both dimensions.

The bill is aligned with long-held Republican values, advancing states’ rights and paring back growing entitlement programs, while freeing individuals from requirements that they have insurance and emphasizing personal responsibility. Obamacare raised taxes on high earners and the health care industry, and essentially redistributed that income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The draft Senate bill, called the Better Care Reconciliation Act, would jettison those taxes while reducing federal funding for the care of low-income Americans. The bill’s largest benefits go to the wealthiest Americans, who have the most comfortable health care arrangements, and its biggest losses fall to poorer Americans who rely on government support. The bill preserves many of the structures of Obamacare, but rejects several of its central goals.

Like a House version of the legislation, the bill would fundamentally change the structure of Medicaid, which provides health insurance to 74 million disabled or poor Americans, including nearly 40 percent of all children. Instead of open-ended payments, the federal government would give states a maximum payment for nearly every individual enrolled in the program. The Senate version of the bill would increase that allotment every year by a formula that is expected to grow substantially more slowly than the average increase in medical costs.

Continue reading the main story

Avik Roy, the president of the Foundation for Research on Equal Opportunity, and a conservative health care analyst, cheered the bill on Twitter, saying, “If it passes, it’ll be the greatest policy achievement by a G.O.P. Congress in my lifetime.” The bill, he explained in an email, provides a mechanism for poor Americans to move from Medicaid coverage into the private market, a goal he has long championed as a way of equalizing insurance coverage across income groups.

States would continue to receive extra funding for Obamacare’s expansion of Medicaid to more poor adults, but only temporarily. After several years, states wishing to cover that population would be expected to pay a much greater share of the bill, even as they adjust to leaner federal funding for other Medicaid beneficiaries — disabled children, nursing home residents — who are more vulnerable.

Mitch McConnell, the Senate majority leader, in the Capitol on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

High-income earners would get substantial tax cuts on payroll and investment income. Subsidies for those low-income Americans who buy their own insurance would decline compared with current law. Low-income Americans who currently buy their own insurance would also lose federal help in paying their deductibles and co-payments.

The bill does offer insurance subsidies to poor Americans who live in states that don’t offer them Medicaid coverage, a group without good insurance options under Obamacare. But the high-deductible plans that would become the norm might continue to leave care out of their financial reach even if they do buy insurance.

The battle over resources played into the public debate. Mitch McConnell, the Senate majority leader, said the bill was needed to “bring help to the families who have been struggling with Obamacare.” In a Facebook post, President Barack Obama, without mentioning the taxes that made his program possible, condemned the Senate bill as “a massive transfer of wealth from middle-class and poor families to the richest people in America.”

In another expression of Republican principles, the bill would make it much easier for states to set their own rules for insurance regulation, a return to the norm before Obamacare.

Where Senators Stand on the Health Care Bill

Senate Republican leaders unveiled their health care bill on Thursday.

Under the bill, states would be able to apply for waivers that would let them eliminate consumer protection regulations, like rules that require all health plans to cover a basic package of benefits or that prevent insurance plans from limiting how much care they will cover in a given year.

States could get rid of the online marketplaces that help consumers compare similar health plans, and make a variety of other changes to the health insurance system. The standards for approval are quite permissive. Not every state would choose to eliminate such rules, of course. But several might.

“You can eliminate all those financial protections,” said Nicholas Bagley, a law professor at the University of Michigan. “That would be huge.”

Americans with pre-existing conditions would continue to enjoy protection from discrimination: In contrast with the House health bill, insurers would not be allowed to charge higher prices to customers with a history of illness, even in states that wish to loosen insurance regulations.

But patients with serious illnesses may still face skimpier, less useful coverage. States may waive benefit requirements and allow insurers to charge customers more. Someone seriously ill who buys a plan that does not cover prescription drugs, for example, may not find it very valuable.

Photo

A protester being removed from outside the office of Mitch McConnell on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

There are features that would tend to drive down the sticker price of insurance, a crucial concern of many Republican lawmakers, who have criticized high prices under Obamacare. Plans that cover fewer benefits and come with higher deductibles would cost less than more comprehensive coverage.

But because federal subsidies would also decline, only a fraction of people buying their own insurance would enjoy the benefits of lower prices. Many middle-income Americans would be expected to pay a larger share of their income to purchase health insurance that covers a smaller share of their care.

The bill also includes substantial funds to help protect insurers from losses caused by unusually expensive patients, a measure designed to lure into the market those insurance carriers that have grown skittish by losses in the early years of Obamacare. But it removes a policy dear to the insurance industry — if no one else. Without an individual mandate with penalties for Americans who remain uninsured, healthier customers may choose to opt out of the market until they need medical care, increasing costs for those who stay in.

The reforms are unlikely to drive down out-of-pocket spending, another perennial complaint of the bill’s authors, and a central critique by President Trump of the current system. He often likes to say that Obamacare plans come with deductibles so high that they are unusable. Subsidies under the bill would help middle-income consumers buy insurance that pays 58 percent of the average patient’s medical costs, down from 70 percent under Obamacare; it would also remove a different type of subsidy designed to lower deductibles further for Americans earning less than around $30,000 a year.

Out-of-pocket spending is the top concern of most voters. The insurance they would buy under the bill might seem cheap at first, but it wouldn’t be if they ended up paying more in deductibles.

Mr. McConnell was constrained by political considerations and the peculiar rules of the legislative mechanism that he chose to avoid a Democratic filibuster. Despite those limits, he managed to produce a bill that reflects some bedrock conservative values. But the bill also shows some jagged seams. It may not fix many of Obamacare’s problems — high premiums, high deductibles, declining competition — that he has railed against in promoting the new bill’s passage.

Inside the Health Care Bill: Trump Wanted ‘Heart.’ He Didn’t Get It

(THIS ARTICLE IS COURTESY OF NBC NEWS)

JUN 22 2017, 3:47 PM ET

Inside the Health Care Bill: Trump Wanted ‘Heart.’ He Didn’t Get It

WASHINGTON — The 142-page Senate health care bill released on Thursday is easy to summarize: It cuts health care spending for low-income and middle-income Americans and uses the savings to finance large tax cuts for the wealthy and the medical industry.

How it accomplishes this is simple as well: It makes large cuts to Medicaid and to subsidies for private insurance, meaning large chunks of money that the government would have spent on helping Americans afford coverage, pay for long-term care and reduce their out-of-pocket costs would instead be paid either by states or by the customers themselves.

Related: Senate Health Care Bill Includes Deep Medicaid Cuts

In this regard, the bill, which is called the Better Care Reconciliation Act, is broadly similar to the American Health Care Act that passed the House in May. There are some significant differences within that framework, however, especially when it comes to private insurance subsidies.

Let’s go through the main planks of the Senate plan:

Medicaid cuts

Medicaid covers about 70 million Americans, including low-income residents, seniors in nursing homes (over 60 percent of whom are on Medicaid) and people with disabilities.

The Senate bill would restructure the program, cap its spending and reduce its funding significantly over time.

Play

Protester Shares Her Reasons For Opposing Health Care Bill0:57

First, the Senate GOP bill would eliminate a major expansion of Medicaid under Obamacare.

The Affordable Care Act gave states federal funding to expand Medicaid coverage to people whose incomes were between 100 percent and 138 percent of the federal poverty line (the current cap is about $34,000 for a family of four). The Supreme Court later made the funding optional, but 30 states and the District of Columbia accepted it. The Senate bill would gradually end this expansion between 2020 and 2024.

But it would go a lot further than repealing Obamacare’s changes. It would also cap the amount of funding states can get on a per-recipient basis rather than continue the current system, in which states decide how much to spend and then have the federal government match their contribution.

Starting in 2025, the plan would then grow those per-recipient caps at a rate that’s unlikely to keep pace with increasing medical costs. A similar change in the House bill was projected to reduce Medicaid spending by $839 billion over a decade and cover 14 million fewer people. The Senate bill kicks in later, but its cuts would be even deeper than the House plan.

To make up the difference, states would either have to raise taxes, cut programs elsewhere or reduce benefits and coverage for recipients. That prospect has governors, including some Republicans like Ohio Gov. John Kasich, nervous that the reduced funding will hamper their ability to respond to health crises like the current opioid epidemic. The bill provides an extra $2 billion next year for substance-abuse treatment, a small number compared to its looming cuts.

But the Medicaid cuts also have small-government conservatives nervous. Congress has a history of passing cuts to services or tax increases and then delaying them down the line. The more time before they kick in, the greater the chance that government control might change hands or public opposition could prompt a reversal.

Private insurance subsidies

When it comes to Obamacare’s subsidies to buy private insurance, the Senate bill keeps the same basic structure, but provides less money for fewer people to purchase insurance that is less generous. These changes would also raise premiums for older people.

Under the current system, people who don’t get health insurance through work or a government program can qualify for help buying a private plan on Obamacare’s exchanges. The maximum amount you’re expected to contribute is capped based on your income.

There are limits, though. If your income is higher than 400 percent of the federal poverty line — about $98,000 for a family of four — you don’t get those subsidies. This is one of the biggest gripes about Obamacare: While most people qualify for aid, those who miss the cutoff have to pay full price, which can be difficult to afford.

The Senate bill would expand this complaint to a wider group. It would cut the subsidies off at 350 percent of the federal poverty line instead, about $86,000 for the same family. On the other hand, it would also cover some lower-income people who currently fall in the “Medicaid gap” in states that didn’t take the federal expansion.

Image: Healthcare.gov site
A screen view of the healtcare.gov site is shown on May 5, 2017. File Richard B. Levine / Zuma Press

Those who qualify for subsidies could also pay higher premiums. Under current law, no Obamacare recipients are expected to contribute more than 9.5 percent of their income in premiums. But the Senate bill changes this and make the caps more generous for younger customers and less generous for older customers. A 60-year-old making $42,000 would now have to contribute as much as 16 percent of their income to premiums.

In addition, the subsidies would be pegged to less comprehensive insurance. Under the current law, they’re calculated based on a “silver plan” that covers an average of around 70 percent of medical costs. The new bill would peg them to plans that cover only 58 percent of costs. That means higher deductibles, which have also been a major complaint among Obamacare users.

Out-of-pocket expenses would actually go up even higher for many Americans. Obamacare provided “cost-sharing reduction” payments to insurers, which they used to lower expenses for customers making up to 250 percent of the federal poverty line (about $61,500 for a family of four). For those at 150 percent of the line, these payments reduced the average deductible from $3,609 to just $255, according to the Kaiser Family Foundation. But the Senate bill ends those subsidies starting in 2019.

This is still a big difference from the House bill, which would have offered only fixed tax credits. Those credits would have likely fallen far short for many people, especially older, lower-income customers in places with high health care costs, which are often rural areas. Now the subsidies will scale up to meet the costs in their area, even if they fall short of current levels.

In addition to the subsidies, the bill provides significant funding to help stabilize insurance markets in the short-term (which have been jittery, partly due to the health care debate) and a $62 billion fund over eight years to help states potentially cover more expensive patients. But the funding is temporary, making the future uncertain.

Pre-existing conditions

The Senate bill does not let insurers deny people coverage based on a pre-existing condition or charge them more based on their health, which keeps two core pieces of Obamacare in place.

However, this doesn’t mean those with pre-existing conditions won’t potentially be affected. The bill does give states flexibility to waive Obamacare’s “essential health benefits,” a list of 10 broad categories of coverage every insurance plan needs.

Image: U.S. Capitol Police remove a woman from a protest in front of the office of Senate Majority Leader Mitch McConnell
U.S. Capitol Police remove a woman from a protest in front of the office of Senate Majority Leader Mitch McConnell. Mark Wilson / Getty Images

Republicans argue states should be able to eliminate those requirements in order to lower overall premiums and provide more flexibility to insurers and customers. In the pre-Obamacare era, insurance companies often didn’t cover items like maternity care or mental health treatment, two items that are included in “essential health benefits.”

Some health experts fear that insurers will try to shepherd healthier patients into cheaper plans that cover fewer items, leaving patients with pre-existing conditions struggling to find an affordable option that covers their treatment. So even though insurers will not be able to discriminate based on pre-existing conditions, the effect could be to make their care less affordable.

Importantly, items that aren’t considered essential health benefits could be subjected to lifetime or annual limits by insurers, a practice that Obamacare eliminated.

The individual mandate

There would be no individual mandate requiring that people buy insurance, which penalized people who went without coverage.

The goal was to encourage younger and healthier people to enter the market so insurers weren’t left on the hook for only more expensive patients who were more likely to seek coverage. It didn’t work as well as intended, however, and insurers complained that the penalties were too weak and left them with a sicker crop of patients who required them to raise premiums to cover.

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Schumer, Pelosi Denounce Senate GOP’s ‘Heartless’ Health Care Bill 1:19

This bill eliminates the penalties entirely, though, and instead counts on healthier people deciding coverage is affordable enough for them to get covered. That could be a problem if they conclude that the new insurance, which could have higher deductibles, is not worth the trouble.

“I just don’t see why people would sign up,” Joe Antos, a fellow at the American Enterprise Institute, told NBC News.

If they don’t come off the sidelines, or if they drop their existing coverage, premiums could rise for everyone as markets become dominated by sicker customers. The Society of Actuaries indicated in a statement on Thursday they would be watching this issue closely.

Taxes

Unless you were paying a penalty for not carrying insurance, it’s unlikely you’ll notice any change in your taxes as a result of the Senate bill.

For rich people, though, the Senate bill is a nice income boost. It eliminates a surtax on income and investment gains for individuals making over $200,000 a year and married couples making over $250,000 a year. The bill also cuts taxes on health companies like medical device manufacturers and prescription drug companies.

Does it have ‘heart?’

President Donald Trump said recently that the Senate bill should be “something with heart.”

“Heart” is a subjective idea, but Trump laid out very specific standards as a candidate and as president. By those standards, the bill falls short.

Trump explicitly pledged he would make no cuts to Medicaid. Instead, the bill will cut Medicaid by hundreds of billions of dollars. He promised “insurance for everybody” backed by federal spending: Instead the bill will likely cover millions fewer people than current law. He repeatedly promised lower deductibles: Instead a core feature of the bill pushes customers towards higher deductible plans. He argued his dedication to providing more generous health care distinguished him from conservative Republicans who sought smaller government.

“This bottom line is that this bill will result in a very significant reduction in insurance coverage, as well as large increases in premium and out-of-pocket costs for those who manage to retain coverage,” Matthew Fiedler, a fellow at the Brookings Institute, told NBC News.

Should the bill become law, these will be unambiguous broken promises.

The U.S. Constitution Says All Are Created Equal, GOP House And Senate Say Hell No

 

Once again the GOP federal Congress and Senate show their disdain (the feeling that someone or something is unworthy of one’s consideration or respect; contempt) for the poor and the working class American people. The GOP in their healthcare bill they are pushing down the throats of the American people show how much they despise at least the bottom 90% (incomes) of the people. I live in Kentucky so Senator Mitch McConnell is one of my two Senators so I am hoping that the next time he comes up for reelection that the people of this State vote this horses behind out of office. I am a registered voting Independent, I personally can’t stand either the Republican or the Democratic Party leaderships as in my opinion neither have any interest in being honest with the American people.

 

Even though this next ‘idea’ is not one I invented I have felt this way for many years concerning health care in America. There is only one health plan that should be allowed here in our Country and that is: every single person in America should have exactly the same insurance as the Congressmen, Congresswomen, the U.S. Senators and the President have, exactly the same as theirs. They are supposed to be the servants but they have illegally made themselves into our slave masters. I do not know anything about what their plans are, I do not know if they have to pay anything out of their own pockets for the monthly costs or if they have deductibles but shouldn’t ‘We The People’ be allowed to have at least as good of healthcare as ‘our servants’? For these people to be bringing ‘other’ healthcare bills to the ‘floor’ for a vote is pure and total hypocrisy! Okay, these are just my thoughts on this issue, what are your thoughts on this issue?

Senate Health Care Bill Includes Deep Cuts to Medicaid

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

The Senate majority leader, Mitch McConnell of Kentucky, is the chief author of the Senate’s health care bill.CreditDoug Mills/The New York Times

WASHINGTON — Senate Republicans, who have promised a repeal of the Affordable Care Act for seven years, took a major step on Thursday toward that goal, unveiling a bill to cut Medicaid deeply and end the health law’s mandate that most Americans have health insurance.

The 142-page bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.

The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.

But the Senate measure, like the House bill, would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid. And like the House measure, it would put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.

 

Video

How the G.O.P. Health Bill Would Change Medicaid

The reporter Margot Sanger-Katz examines how the Republican health plan aims to roll back a program that insures nearly one in five Americans.

By MARGOT SANGER-KATZ, ROBIN STEIN and SARAH STEIN KERR on Publish DateJune 22, 2017. Photo by Doug Mills/The New York Times. Watch in Times Video »

It would also repeal virtually all the tax increases imposed by the Affordable Care Act to pay for itself, in effect handing a broad tax cut to the affluent, paid for by billions of dollars sliced from Medicaid, a health care program that serves one in five Americans, not only the poor but almost two-thirds of those in nursing homes. The bill, drafted in secret, is likely to come to the Senate floor next week, and could come to a vote after 20 hours of debate.

If it passes, President Trump and the Republican Congress would be on the edge of a major overhaul of the American health care system — onesixth of the nation’s economy.

The premise of the bill, repeated almost daily in some form or other by its chief author, the Senate majority leader, Mitch McConnell of Kentucky, is that “Obamacare is collapsing around us, and the American people are desperately searching for relief.”

Mr. Trump shares that view, and the Senate bill, if adopted, would move the president a great distance closer to being able to boast about final passage of a marquee piece of legislation, a feat he has so far been unable to accomplish.

Where Senators Stand on the Health Care Bill

Senate Republican leaders unveiled their health care bill on Thursday.

Democrats and some insurers blame the Republicans and Mr. Trump for sabotaging the law, in part by threatening to withhold subsidies used to help pay for deductibles and co-payments for millions of poor people covered by the law.

In the Senate, Democrats are determined to defend a law that has provided coverage to 20 million people and is a pillar of former President Barack Obama’s legacy. The debate over the repeal bill is shaping up as a titanic political clash, which could have major implications for both parties, affecting their electoral prospects for years to come.

Mr. McConnell faces a great challenge in amassing the votes to win Senate approval of the bill, which Republicans are trying to pass using special budget rules that will allow them to avoid a Democratic filibuster. But with only 52 seats, Mr. McConnell can afford to lose only two Republicans, with Vice President Mike Pence breaking the tie. He may have already lost one — Senator Rand Paul, Republican of Kentucky, has indicated repeatedly that the bill is too liberal for him.

Democrats are unified in opposing the repeal efforts, and they have already assailed Republicans for the work they have done so far, criticizing them for putting the bill together without a single public hearing or bill-drafting session.

GRAPHIC

How Senate Republicans Plan to Dismantle Obamacare

A comparison of the Senate health care with the Affordable Care Act.

OPEN GRAPHIC

In the short term, the possible electoral consequences are more muted in the Senate than in the House, as only two of the Senate Republicans who face re-election next year, Dean Heller of Nevada and Jeff Flake of Arizona, are seen as vulnerable.

But Republican leaders still must contend with internal divisions that will be difficult to overcome. Numerous Republican senators from states that expanded Medicaid are concerned about how a rollback of the program could affect their constituents, and they face pressure from governors back home.

Some senators have concerns based on other issues specific to their states, including the opioid epidemic that has battered states like West Virginia and Ohio. And some of the Senate’s most conservative members could resist a bill that they view as not going far enough in dismantling the Affordable Care Act.

Senators will not have long to sort out their differences. Mr. McConnell wants to hold a vote before lawmakers return home for the Fourth of July recess. If the repeal bill is still looming over the Senate, Republicans are certain to face intense pressure from constituents who wish to see the Affordable Care Act remain in place.

The assessment being made by senators will be shaped in part by an analysis of the bill to be released by the Congressional Budget Office, the official scorekeeper on Capitol Hill.

The budget office found that the bill passed by the House last month would leave 23 million more people without insurance in a decade. Mr. Trump recently told senators that the House bill was “mean,” though weeks earlier he had celebrated its passage.

Abortion Adds Obstacle as Republicans Plan to Unveil Health Bill

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

Senator Mitch McConnell of Kentucky, the majority leader, hopes to unveil the contents of Republicans’ health bill on Thursday and pass it next week. CreditDoug Mills/The New York Times

WASHINGTON — Abortion flared up Wednesday as the latest hot-button issue to complicate passage of a bill to repeal and replace the Affordable Care Act, which Senate Republican leaders hope to unveil on Thursday and pass next week.

The repeal bill approved last month by the House would bar the use of federal tax credits to help purchase insurance plans that include coverage of abortion. But senators said that provision might have to be jettisoned from their version because of complicated Senate rules that Republicans are using to expedite passage of the bill and avoid a filibuster.

If that provision is dropped, a bill that has already elicited deep misgivings among moderate Republicans — and stiff resistance from Democrats, health care providers and patient advocacy groups — could also generate concern among abortion opponents, as well as conservative lawmakers.

Further complicating the measure’s prospects, insurance companies, which took a leading role in the health care fights of 1993-94 and 2009-10 but have been conspicuously quiet this year, released a blistering letter objecting to Republican plans to remake Medicaid and cut its funding.

Continue reading the main story

The changes being considered in Congress could “amount to a 25 percent shortfall in covering the actual cost of providing care to our nation’s neediest citizens,” the top executives of 10 insurance companies wrote this week. “These amounts spell deep cuts, not state flexibility, in Medicaid.”

As senators struggle to develop a health care bill, their handiwork appears to be too moderate for some Senate conservatives and too conservative for some Senate moderates. The latest version, without the abortion-coverage prohibition and with steep Medicaid cuts, may prove unacceptable to some in both camps. To pass it, Senate leaders can afford to lose only two Republican votes of the 52 in the chamber.

Republican senators got a glimpse Wednesday of the highlights of the bill, which was drafted in secret by the majority leader, Senator Mitch McConnell of Kentucky, and top aides. White House officials were granted a formal briefing, which risked irking many senators who had yet to see the actual bill.

The House abortion provision has sweeping implications because many health plans subsidized under the Affordable Care Act include coverage for abortion services. The provision has encountered outspoken opposition from officials in states like Oregon, where most health plans on the public insurance exchange cover abortion.

But senators said the provision might have to be dropped for a more prosaic reason: It may not comply with the Senate rules that Republicans are using to speed the health care bill through the Senate.

The bill is scheduled to go to the Senate floor next week under these procedures, which limit debate and preclude a Democratic filibuster.

“It’s one of the problems we have to work with,” Senator Orrin G. Hatch, Republican of Utah and the chairman of the Finance Committee, said of the abortion issue. “We’re not quite sure how that’s going to be resolved.”

Mr. McConnell is determined to get a vote on the bill by the end of next week, before a break for the Fourth of July holiday, but he still does not have enough committed votes to ensure passage.

Senator Rand Paul, Republican of Kentucky, made clear on Wednesday that he was not on board with the Republican bill.

“I’m still hoping we reach impasse, and we actually go back to the idea we originally started with, which is repealing Obamacare,” Mr. Paul said, adding, “I’m not for replacing Obamacare with Obamacare lite.”

Document: Health Insurers Speak Out

The House bill and the Senate version, like the Affordable Care Act, would provide tens of billions of dollars in tax credits to help people pay insurance premiums.

The federal government is expected to spend more than $30 billion this year on tax credits to help lower- and middle-income people pay premiums. The Senate bill would provide more assistance to lower-income people than the House bill, which bases tax credits on a person’s age.

The Senate bill would also repeal most of the taxes imposed by the Affordable Care Act. It would delay the effective date of a tax on high-cost employer-sponsored health coverage, but Republicans plan to offer an amendment next week to eliminate this “Cadillac tax,” which is opposed by labor unions and employers.

Senators Thom Tillis of North Carolina and Susan Collins of Maine, both Republicans, said they understood that the House restrictions on the use of tax credits for insurance covering abortion had encountered parliamentary problems.

“What I heard earlier from the parliamentarian is they didn’t think it would pass” muster under Senate rules, Mr. Tillis said.

Mr. Tillis and Ms. Collins said they understood that Senate Republican leaders were hoping to devise some kind of workaround to address concerns of anti-abortion lawmakers. But it was not clear whether those anti-abortion lawmakers would be satisfied with such a plan, which could involve separate legislation.

Republicans have been promising to repeal the health law ever since it was signed by President Barack Obama in 2010. On Wednesday, in the final hours before the Senate repeal bill was to be unveiled, members of Congress, consumer groups and health care executives engaged in frenetic advocacy in hopes of shaping the bill.

Women’s groups and at least two moderate Republicans, Ms. Collins and Senator Lisa Murkowski of Alaska, continued to object to a provision of Mr. McConnell’s bill that would cut off funds for Planned Parenthood.

In a letter to Mr. McConnell on Wednesday, more than two dozen House members in the conservative Republican Study Committee listed several parts of the House bill they view as crucial, including cutting funds to Planned Parenthood and restricting the use of the tax credits. The bill, they wrote, fulfills “an important conservative commitment to promote life and protect the unborn.”

Leaders of the 10 insurance companies told Mr. McConnell that proposed caps on federal Medicaid spending would cause “an enormous cost shift to the states,” which could force them to raise taxes, reduce benefits, cut payments to health care providers or eliminate coverage for some beneficiaries. Among those signing the letter were top executives of AmeriHealth Caritas, Molina Healthcare, Blue Shield of California and Healthfirst, in New York.

But Senator John Kennedy, Republican of Louisiana, said the Medicaid provisions were one of the bill’s chief attractions for him.

“In my state,” Mr. Kennedy said, “we are now spending 47 percent of our budget on Medicaid. That’s up from 23 percent in 2008. It’s crowding out money for universities and roads and public safety and coastal restoration, and it just keeps climbing.”

Even senators who might support the legislation said they did not want to be rushed.

Asked how he felt about the prospect of voting for a bill a week after its release, Senator John McCain, Republican of Arizona, said, “I feel terrible about it.”

12COMMENTS

Senator Ron Johnson, Republican of Wisconsin, said, “I need the information, I need to hear from constituents, and that’s going to take some time.”

Debate on the Senate bill will be shaped by an analysis from the Congressional Budget Office, which will estimate the impact on federal spending and the number of people without health insurance. Under the House bill, the office said, the number of uninsured would be 23 million higher than under the Affordable Care Act in 2026. And for some older Americans and sick people, it said, premiums and out-of-pocket costs could be significantly higher.

White House to Republicans: Trump reserves the right to throw all of you under the bus

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

The Fix

White House to Republicans: Trump reserves the right to throw all of you under the bus

June 20 at 3:29 PM
Spicer: Trump ‘wants a bill that has heart in it’
White House press secretary Sean Spicer said President Trump wants Congress to pass a health-care bill that “has heart in it,” on June 20 at the White House. (Reuters)

Senate Republicans are confronting a potentially career-altering decision: whether to vote for a health-care bill that polls show is vastly unpopular and could backfire stupendously. And on Tuesday, White House press secretary Sean Spicer had a chance to provide them some reassurance that President Trump wasn’t going to throw them under the bus if things go sideways.

Instead, he basically shrugged his shoulders.

Reports in recent days have quoted Trump, in private settings, as both calling the House GOP’s health-care bill “mean” and saying the Senate bill needed “more heart.” Asked about that second report, from CNBC on Tuesday, Spicer practically confirmed the quote — or at least he didn’t dispute it, as the White House often does.

“The president clearly wants a bill that has heart in it,” Spicer said. “He believes health care is something that is near and dear to so many families and individuals. He made it clear from the beginning that it was one of his priorities.”

If you are a Republican who is thinking about sticking your neck out for this bill, that has to make you think twice.

Last month Trump held a Rose Garden celebration with House Republicans after they passed their version of a health-care bill. Some even thought that festivities were a little over-the-top. But the president clearly wanted to celebrate a first legislative win.

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His actions since then, however, suggest he doesn’t necessarily want his brand attached to this bill and all the sausage-making that goes with it. Recent polls have shown Americans oppose the legislation by a 2-to-1 margin or even a 3-to-1 margin, and the nonpartisan Congressional Budget Office estimates indicate it could reduce the number of insured Americans by 23 million over a decade and raise premiums for older, poorer people. And whatever the perceptions and projections are today, the law of unintended consequences certainly applies when it comes to large-scale legislation. It’s a massively difficult vote to take for any member.

The White House will almost surely come around and say all the right things when the Senate ultimately reveals its bill. And for Trump and Spicer, it’s probably smart to withhold your full endorsement to make sure that bill will reflect the things the White House feels are important. But the fact that Trump is saying these things behind closed doors about a bill he once celebrated has to make Republican senators think twice.

What if the bill they are working on does wind up causing major problems? What if it doesn’t even pass, and most all of them put themselves on the record voting for something that can still be used in a pretty brutal attack ad using those CBO numbers? There is basically nothing to suggest that Trump is going to allow himself to go down with this ship. And unlike your normal politician, he’s not going to feel bound by loyalty, his past statements or that Rose Garden celebration. When Trump feels like disowning something politically, Trump will disown it.

Perhaps the White House could be forgiven for not fighting back strongly enough against reports of Trump’s initial “mean” comment last week. But now it’s happened again; Trump and his White House have basically put the House’s bill at arms-length twice in the span of a week. And on Tuesday it suggested that it reserves the right to bash the bill at a later date if Trump feels like it.

Given the bill will need 50 of 52 Republican senators to vote for it, that’s a pretty terrible message to send right now.

Senate Leader Mitch McConnell Proving He Cares Nothing About The Voters, Only Doners

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

Politics

Senate leaders plan to rush a health-care bill to a vote, and there’s nothing Democrats can do about it

June 19 at 1:11 PM

When the Republican-led Senate Rules Committee briefly flirted with the idea of restricting television interviews in the hallways of the Capitol last week, it became only the most obvious manifestation of how the party’s leaders were handling the development of a bill to overhaul Obamacare: out of the public eye.

While that effort was quickly sidelined after some outcry, the Republican leadership in the Senate was otherwise unfazed in its push to craft a bill that would expose its members to as little negative public attention as possible. No repeat of the town hall meetings that drew angry constituents who yelled at House Republicans and, they clearly hope, no weeks and weeks of swamped office phone lines.

In an article for the Monkey Cage, George Washington University’s Sarah Binder explained the four ways in which the Senate effort was unusually secretive. Sure, members of Congress would always rather pass legislation without dealing with negative criticism, but rarely have they gone so dark on such a big effort.

Here’s what’s in the new CBO report on the Republican health-care bill
The Congressional Budget Office has released its score on the revised American Health Care Act. Here’s what’s in the report. (Daron Taylor/The Washington Post)

The question that arises, though, is what Democrats could actually do about it. Binder told me that the answer was probably a simple one.

Nothing.

“I have a hard time seeing a real avenue for successful obstruction by the Democrats,” Binder said. The situation is unusual enough that making hard and fast predictions is tricky, she said, but “Republicans have been so aggressive on procedure here that I’d expect them to … get this through without any heed of what the Democrats were raising.”

In particular, Binder addressed a proposal outlined in a series of tweets last week by Ezra Levin, a former deputy policy director for House Democrats. Levin suggested that the Democrats could introduce an almost infinite number of amendments that would choke the Senate calendar indefinitely until they got what they wanted.

The plan hinges on the way in which the bill is being moved through the Senate. To avoid the need for Democratic votes — which the Republican majority wouldn’t get — the Obamacare replacement is being advanced using what’s known as the reconciliation process. That process involves a special set of rules that are meant to fast-track debate over the budget, but, given that it also means legislation can avoid a filibuster in the Senate, it has also been used to pass controversial bills. (Several fixes essential to the passage of Obamacare were moved using the reconciliation process, for example.)

Those rules, defined by law, include allowing only 20 hours for debate but it also includes a process called “vote-a-rama,” in which amendments may be proposed and must be voted on before the final passage of the bill. That’s where Levin’s idea comes in: He proposed introducing tens of thousands of amendments that would need to be voted on before the Senate’s bill could be passed. In theory, Levin figured, Democrats could introduce enough amendments to shut down the Senate for a year.

Binder disagrees.

“In reality, that’s not going to happen,” she said. What was more likely, she said, is that someone would make a point of order that the Democrats were being “dilatory” — that is, slowing down the process unnecessarily. The presiding officer — the Republican senator on duty to manage floor debate — would be asked to rule on whether that was the case and would likely agree. Democrats could appeal the decision, but a majority vote would end the process.

The Senate’s Health Care Secrecy Is a Breathtaking Contempt for Democracy

(THIS ARTICLE IS COURTESY OF SLATE POLITICS)

The Senate’s Health Care Secrecy Is a Breathtaking Contempt for Democracy

Millions will suffer, for a tax cut.

170613_POL_AHCA-RadicalProcedures
Senate Majority Leader Mitch McConnell speaks to members of the media after the weekly Senate Republican Policy Luncheon at the Capitol May 9.

Alex Wong/Getty Images

While much of Washington fixates on Donald Trump and his scandals, a small band of Senate Republicans is working—in secret—on a bill that would slash health insurance for tens of millions of Americans and jeopardize access for millions more. And they’re doing this on a so-called fast track meant to preclude debate. The reason for this rushed process? To obscure the obvious: that at heart, the American Health Care Act is little more than a massive tax cut for the wealthiest Americans.

Jamelle BouieJAMELLE BOUIE

Jamelle Bouie is Slates chief political correspondent.

Once the working group emerges from its cloister, the bill will be scored by the Congressional Budget Office, and then—in a sharp break with procedure—bypass the committee process and go straight to the floor without a public hearing. There are even suggestions that Senate Majority Leader Mitch McConnell will use legislative gamesmanship to avoid debate entirely, so Republicans can pass the bill without any discussion of its contents and provisions. As Paul Ryan did in the House of Representatives, McConnell intends to restructure one-sixth of the American economy with as little input as possible, freezing out experts, industry representatives, and Democratic lawmakers. This, despite overwhelming opposition from the public; in one recent poll, just 23 percent of respondents said they approved of the Republican health care bill.

And what will the public get if and when the final version of the bill is passed into law? Millions of Americans will either lose their health insurance, see massive new costs, or face added obstacles, from “lifetime” caps on care to limits based on pre-existing conditions.

There’s no indication Republicans are thinking deeply about free market reforms to the American health care system. But let’s just say they are. Perhaps a drastically less-regulated insurance market is worth the cost to ordinary individuals and families. If that’s the case, then Republicans owe the country both honesty and transparency. It will get neither. Instead, every indication is that the GOP will push through with a process that holds deliberation in contempt. That’s not to say Republicans aren’t responding to someone—there are groups, like the Republican base, that want this bill—but the broad public opposes the effort.

As it stands, there’s a chance the Senate health care bill could pass before the July 4 holiday. Compare this to the process behind the Affordable Care Act. It took most of 2009 for Democrats to produce a bill: months of negotiation—including a summer of talks between Democratic and Republican senators—that involved debate and input, as lawmakers produced drafts, defended proposals, and sold their plan to the public. Congress saw testimony from patients and other ordinary people, and citizens were able to lobby lawmakers with their input.

It was as open a process as possible, and while Democrats weren’t immune to misleading rhetoric (“if you like your plan, you can keep it”), the final law wasn’t a surprise. It did what Democrats and the president said it would. And the party was proud of their work. “This is a big fucking deal,” Vice President Joe Biden famously whispered.

None of this is true of Republicans and the AHCA. Theirs is a closed, secretive process. There are no drafts, no inkling of the plan. No speeches defending its major planks or hearings where lawmakers and experts hash out concerns. When pressed with questions, Republicans from the Senate working group refuse to answer. Indeed, asked if it was important to bring a bill to the public, Republicans say, in effect, no. “Well, I think we’re not worried so much about that as we are getting it together so we can get a majority to vote for it,” said Sen. Orrin Hatch.

This might be tolerable if Republicans were open about the effects of their plan. But they aren’t. They’re lying. Tom Price, secretary of health and human services, insists that the bill preserves Medicaid, telling CNN, “We believe the Medicaid population will be cared for in a better way under our program because it will be more responsive to them.” In reality, the bill phases out the Medicaid expansion and makes additional cuts, slashing 14 million people from the program. President Trump has made assurances that the bill “guarantees” coverage for people with pre-existing conditions, which just isn’t true. Vice President Mike Pence promises “a dynamic national health insurance marketplace that lowers costs, increases quality and gives more choices to working families.” Given the massive coverage losses projected under the GOP’s health care plan, there’s no evidence that anything approaching that promise is on the horizon.

Republicans are pushing forward on an unpopular bill that, by every independent account, will harm millions of Americans. To justify this sprint, the White House is actively sabotaging insurance markets while telling the public that the Affordable Care Act is failing. And in taking this course, they’ve shown a breathtaking contempt for democracy, insulating themselves from any political pressure, lying about the policies in question, and hiding this bankrupt process from the country.

This cowardly and factional governing—meant to satisfy a small minority of Republican Party backers, not the public at large—will likely backfire. Given Democratic anger, the president’s unpopularity, and broad discontent with the bill in question, there are decent odds this story ends with a Democratic victory in the 2018 elections and a chance to repair the damage. But between now and then, real people will suffer. Real people will have to decide if they can afford continued treatment. Real people will die. And as far as anyone can tell, the point of all of this—the secrecy and dishonesty and likely pain—is tax cuts. That’s it.

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truthtroubles.wordpress.com/ Just an average man who tries to do his best at being the kind of person the Bible tells us we are all suppose to be. Not perfect, never have been, don't expect anyone else to be perfect either. Always try to be very easy going type of a person if allowed to be.

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