Trump suggests Republicans will let ACA market collapse, then rewrite health law

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

Power Post

Trump suggests Republicans will let ACA market collapse, then rewrite health law

 July 18 at 10:52 AM
President Trump predicted Tuesday morning that Republicans may wait for the federal insurance market to collapse and then work to broker a deal to rewrite the nation’s landmark health-care law.In a series of tweets, Trump blamed the demise of a months-long effort to rewrite the Affordable Care Act on Democrats “and a few Republicans,” but he suggested that the drive to overhaul the law was not completely over.

“We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!” he tweeted. He added in a separate tweet: “As I have always said, let ObamaCare fail and then come together and do a great healthcare plan. Stay tuned!”

Trump’s latest comments appeared likely to intensify the current political uncertainty on Capitol Hill, where GOP leaders were debating what to do next, as well as raise anxiety among insurers that must commit to staying on the federal health exchange within a matter of weeks.

Republicans are reeling after two more GOP senators declared their opposition Monday to the party’s plan to overhaul the nation’s health-care system, likely ending their quest to make good on a GOP promise that has defined the party for nearly a decade and has been one of Trump’s top priorities.

Two Senate Republicans oppose health-care bill, jeopardizing vote
The U.S. Senate’s healthcare overhaul appears to be in trouble after two more Republicans say they oppose a revised version of the bill. (Reuters)

Senate Majority Leader Mitch McConnell (R-Ky.) opened the Senate on Tuesday morning touting his latest plan — to vote on a pure repeal, with a two-year delay, by taking up the House’s health-care bill. But while conservatives and Trump have been pushing for such a repeal as a last resort, it appeared unlikely that the vote would succeed.

Two Republican senators, Susan Collins (Maine) and Shelley Moore Capito (W.Va.), expressed opposition Tuesday to the repeal-only option, apparently burying it.

“I did not come to Washington to hurt people,” Capito said on Twitter. “I cannot vote to repeal Obamacare without a replacement plan that addresses my concerns and the needs of West Virginians.”

“This doesn’t have to be the end of the story,” McConnell said. “Passing the repeal legislation will allow us to accomplish what we need to do on behalf our people.”

McConnell said the Senate would next take up “a repeal of Obamacare combined with a stable two-year transition period.” He said that President Barack Obama had vetoed such legislation before but that “President Trump will sign it now.”

While he noted that the measure had overwhelming support among Republican senators in 2015, the Senate leader also acknowledged that his party has suffered a political setback.

“I regret that the effort to repeal and immediately replace the failures of Obamacare will not be successful,” he said. “We will now try a different way to bring the American people relief from Obamacare.”

Republican Sens. Mike Lee (Utah) and Jerry Moran (Kan.) issued statements Monday declaring that they would not vote for the revamped measure. The sudden breaks by Lee, a staunch conservative, and Moran, a McConnell ally, rocked the GOP leadership and effectively closed what already had been an increasingly narrow path to passage for the bill.

They joined Sens. Rand Paul (Ky.) and Collins, who also oppose the latest health-care bill. With just 52 seats, Republicans can afford to lose only two votes to pass their proposed rewrite of the ACA. All 46 Democrats and two independents are expected to vote against it.

Lee supports the idea of moving ahead with a straight repeal of the existing law, and his spokesman, Conn Carroll, said Tuesday he would back a motion to proceed on a bill that would achieve that aim. But many centrist Republican senators have said they oppose dismantling key aspects of the ACA without an immediate replacement, given that roughly 20 million Americans have gained coverage under the law.

The confusion over next steps highlights the predicament now faced by Republicans, who have made rallying cries against Obama’s 2010 health-care law a pillar of the party’s identity. They may be forced to grapple with the law’s shift from a perennial GOP target to an accepted, even popular, provider of services and funding in many states, which could make further repeal revivals difficult.

Meanwhile, Trump and other Republicans will confront a Republican base that, despite fervent support for the president, still seeks a smaller federal government and fewer regulations.

All of these forces remained vexing factors Monday as senators bailed on the bill. And no evident solution was offered by the White House — which has been limited in its sale of the GOP plan — or from McConnell, for how to bring together a party in which moderates and conservatives are still deeply divided over the scope of federal health-care funding and regulations.

In many ways, the leadership plan did not go far enough for those on the right, but was too radical for GOP centrists. It scaled back some key ACA requirements and made deep cuts over time in Medicaid, but preserved popular provisions of the law such as a ban on denying coverage to consumers with costly medical conditions.

But the fact that it would reduce federal Medicaid funding and phase out the program’s expansion in 31 states and the District of Columbia rankled several key GOP governors and senators, who feared that their states would be saddled with the unpalatable choice of either cutting off constituents’ health coverage or facing a massive new financial burden.

The opposing pressures have left McConnell in a tough position as he has struggled to find a solution, which is why he has now thrown out the idea of moving to an immediate repeal.

Abolishing several of Obamacare’s central pillars — including the mandate that taxpayers buy coverage, federal subsidies for many consumers’ premiums and Medicaid coverage for roughly 11 million Americans — could wreak havoc in the insurance market. A Congressional Budget Office analysis in January estimated that premiums in the individual insurance market would rise between 20 and 25 percent next year and would roughly double by 2026.

At the same time, according to the CBO, the number of uninsured would spike by 18 million next year and rise to 32 million by 2026.

“For insurers, the worst possible outcome in this debate has always been a partial repeal with no replacement, which is exactly what Congress is about to take up,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, in an email. “Insurance companies would be on the hook for covering people with preexisting conditions, but with no individual mandate or premium subsidies to get healthy people to sign up as well.”

But GOP leaders had no choice but to shift gears after Lee and Moran declared they could not support the party’s current health plan.

“In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle class families; nor does it create enough free space from the most costly Obamacare regulations,” Lee said in a statement.

Moran said the bill “fails to repeal the Affordable Care Act or address healthcare’s rising costs.”

The two senators timed the release of their statements and made clear that modest tinkering around the edges of the legislation drafted by McConnell would not be enough to meet their demands. They joined a pair of GOP colleagues in calling for a complete redrawing of the legislation that would take many months, short-circuiting McConnell’s wish to end the debate this month.

The news threw the effort to pass the legislation into turmoil, with additional Republicans weighing in on Twitter about a flawed process that must take a new direction. Trump tweeted late Monday that “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan.”

Sen. Lindsey O. Graham (S.C.) called for a “new approach” while Rep. Mark Meadows (N.C.) tweeted, “Time for full repeal.” White House aides, meanwhile, said they still plan to press ahead.

The setbacks appear to have left McConnell and House Speaker Paul D. Ryan (R-Wis.) with few good options. Conservatives have suggested moving a bill that would simply repeal the Affordable Care Act and set up a timeline of several years to figure out how to replace it, a politically risky move that also might lack support to pass.

Another move, which McConnell threatened recently, would be to work with Democrats to prop up the insurance exchange markets that have been imploding in some states — which probably would win passage but would infuriate the conservative base that has been calling for the end of the Affordable Care Act.

“Regretfully, it is now apparent that the effort to repeal and immediately replace the failure of Obamacare will not be successful,” McConnell said in a statement released late Monday. He revealed plans to move forward with a vote in the coming days anyway, in some ways daring his Republican opponents to begin debate and open the legislation up to amendments.

Democrats quickly jumped at the opportunity to declare the effort dead.

“This second failure of Trumpcare is proof positive that the core of this bill is unworkable,” said Minority Leader Charles E. Schumer (N.Y.). “Rather than repeating the same failed, partisan process yet again, Republicans should start from scratch and work with Democrats on a bill that lowers premiums, provides long-term stability to the markets and improves our health-care system.”

But Ryan showed little interest Tuesday in making common cause with Democrats, telling reporters that House leaders “would like to see the Senate move on something” to keep the repeal-and-replace process alive.

In a closed-door conference meeting, according to several members present, Ryan told colleagues that the ball remains in the Senate’s court and announced no plans for further action on health care in the House. He also urged House members to be patient and not to openly vent frustration with the Senate, the members said.

Publicly, he emphasized that the Senate had “a razor-thin majority” and that passing legislation is “a hard process.”

Republican leaders had returned to the Capitol on Monday still pledging to press ahead with plans to pass a far-reaching overhaul, but the day had begun with uncertainty as the health of Sen. John McCain (R-Ariz.) put the future of the flagging effort deeper in doubt.

In a speech on the Senate floor, McConnell said that he had spoken with McCain on Monday morning and that “he’ll be back with us soon.” The Arizonan is recovering from surgery to remove a blood clot above his left eye that involved opening his skull.

McConnell had delayed action on the health-care bill until ­McCain’s return in hopes that he could be persuaded to vote yes. That hope faded after Lee’s and Moran’s announcements, however, with McCain issuing a statement from Arizona calling for a fresh, bipartisan start.

Senate Republicans have been under self-imposed pressure to complete their work on health care. As they have struggled to show progress, McConnell has said he would keep the chamber in session through the first two weeks of August, postponing the start of the summer recess period to leave time to work on other matters.

Kelsey Snell, Mike DeBonis and Ed O’Keefe contributed to this report.

GOP Healthcare Bill Written For Everyone Except Themselves: They Keep Golden Plan We Have To Pay For

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

New GOP health care bill will determine winners, losers

 July 15 at 2:36 AM
WASHINGTON — Republicans’ latest health care plan would create winners and losers among Americans up and down the income ladder, and across age groups.It would give consumers more responsibility for their insurance choices, a goal long held by conservatives who argue that’s key to a true health care market. Younger adults and healthy people in the solid middle class may find more agreeable options. But low-income people may not be able to afford coverage, along with older and sicker adults.

And there are potential unintended consequences for people with employer-provided insurance, currently about 170 million Americans. Allowing individuals to pay premiums from tax-sheltered accounts may create incentives for employers to stop offering coverage, say some independent analysts.

The legislation would put limits on federal spending for Medicaid, a partnership program with states to cover low-income people, the disabled and nursing home residents. The drawback is that state officials could eventually face no-win choices, such as having to pick between paying for coverage for low-wage working mothers and support services for elderly people trying to stay out of nursing homes.

As Senate Majority Leader Mitch McConnell, R-Ky., steers toward debate and votes next week, here is a look at some of the latest changes and major issues:

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CRUZ’S PLAN

The new Senate bill incorporates the core of a proposal from Sen. Ted Cruz, R-Texas, that would reorganize the market for policies purchased by individuals. As many as 20 million Americans get coverage this way, about half through subsidized markets like HealthCare.gov, created under former President Barack Obama.

Cruz would change basic requirements that Obama’s law imposed on individual plans, including standard benefits such as pregnancy, maternity and newborn care; wellness visits and mental health treatment. The law also requires the same premium rates for sick and healthy people.

Under the Cruz approach, an insurer can offer plans that don’t comply with such requirements, provided they also offer coverage that does. The problem, say critics, is that the healthy would flock to low-premium, skimpy plans, leaving the sick to face escalating prices for comprehensive coverage.

“Healthy people would have opportunities to buy lower-premium, skinnier plans, while people with pre-existing conditions not eligible for premium subsidies could find themselves priced out of insurance,” said Larry Levitt of the nonpartisan Kaiser Family Foundation.

The latest bill includes another $70 billion to help states keep health insurance affordable for older, sicker customers. But it’s not clear how those backstops would work, and the federal funding eventually would end.

Some insurers are worried because of a technical change with huge practical implications: Health plans that enroll healthier customers would no longer have to cross-subsidize those with sicker patients, as is currently required.

“We think it is unworkable,” said Justine Handelman, top Washington lobbyist for the BlueCross BlueShield Association. She predicted skyrocketing costs for taxpayers also, stuck with the bill for sicker patients.

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EMPLOYER ESCAPE HATCH?

McConnell’s new bill made a major change to tax-sheltered health savings accounts, which was also advocated by Cruz.

Under the bill, health savings accounts could be used to pay premiums with pre-tax money. Under current law, they can only be used to cover out-of-pocket costs, such as deductibles and copayments.

The change is meant to level the playing field for people buying individual plans, as compared to people getting employer coverage. The value of workplace insurance is tax-free for employees and tax-deductible for employers.

But some analysts say McConnell risks undermining workplace coverage.

The upside is that the change might encourage more self-employed people to buy individual health insurance policies. The downside is that some employers may see it as an invitation to drop health benefits, particularly since the GOP also would repeal Obama’s requirement that larger companies provide health care or face fines.

“Allowing individuals to purchase insurance with pre-tax dollars eliminates one of the advantages to employer-provided insurance,” said Elizabeth Carpenter of the Avalere Health consulting firm. “That may lead some employers to consider whether or not they want to continue to offer health insurance.”

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THE POOR AND THE SICK

McConnell kept some of the Obama-era tax increases used by Democrats to finance expanded coverage. But the money will be going to shore up private insurance, not the Medicaid program. Medicaid accounts for half or more of the 20 million Americans gaining coverage as a result of the Affordable Care Act.

Medicaid covers low-income people, from many pregnant women and newborns, to disabled people and many elderly nursing home residents. The GOP bill would start by phasing out enhanced federal financing for Obama’s Medicaid expansion, adopted by 31 states. Perhaps more significantly, it would limit future federal funding for the overall program. As a result, it’s estimated Medicaid would cover 15 million fewer people by 2026.

The bill would add $45 billion to help states confronting the opioid epidemic pay for treatment and recovery. But that hasn’t swayed the American Medical Association, which points out that people in recovery also need comprehensive health insurance.

Republican governors don’t like the Medicaid cuts, and some have been vocal. About half the states that expanded Medicaid now have GOP chief executives.

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Nevada Gov. Brian Sandoval, a Republican who oversaw a Medicaid expansion, said more than 200,000 people gained coverage in his state.

“You think about 210,000 men, women and children, senior citizens, the drug addicted, the chronically ill,” Sandoval said. “These are people that used to get their treatment in emergency rooms, if they got any treatment at all. I keep going back to the fact that they are living a better quality of life.”

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Associated Press writer Jennifer McDermott in Providence, Rhode Island, contributed to this report.

Copyright 2017 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

There Must Be Only One Health Insurance Program Allowed In America!

 

Americans are you sick and tired of the D.C. politicians playing with your healthcare and with your ability to pay for it? Obamacare, Trump-care, repeal and replace, repeal and don’t replace, this amendment and that amendment, are you sick of the political noise and of the politicians not giving a damn about you or your family? Personally I am sick of both political parties who only cater to the Lobbyist and not the voters. This latest GOP Healthcare plan showed once again that the Republican so-called Leadership only cares about the Lobbyist as they released copies of the Bill to Lobbyist before even releasing it to other ‘rank and file’ Republican Senators. For 7 years Republican Lawmakers whined, complained, threatened and promised to repeal and replace ‘Obamacare’ right away as soon as they were in a position to do so. Yet after all of that time they didn’t even have the beginning of any plan.

 

Here is my plan, yet not just my plan as I have seen a few other people voice this same opinion in writing and verbally. It is a simple plan and it is the most ‘Constitutional’ plan that I believe exist. If indeed if these bought and paid for politicians believe in the Constitution and the Scriptures about all people being created equal and that all people should be treated as equals then there is only one Healthcare program that should be for all people. The concept is simple and it should be legal as it is and has been in place for some folks for decades now. I will quit talking and just spit it out now.—I do not know anything about the plan that covers all of the Senators and Congress men and women and the President but what ever that plan is—that should be the plan that all of the American people have with no exceptions. After all, if it is good enough for ‘our public servants’ then it is good enough for their supposed bosses, ‘We The People’ then it is good enough for the American people also, isn’t it?

Republican Heath Care Bill: Senator Mitch McConnell No Longer Strutting Like A Bird Fed Cat

(THIS ARTICLE IS COURTESY OF CNN)

Just because it was the weekend leading into the Independence Day holiday doesn’t mean there weren’t developments for Republicans’ plans to repeal and replace the Affordable Care Act. Here’s what you might have missed:

Despite tweets on Friday from President Donald Trump and several high-profile Republican senators, the “repeal, then replace later” option is not really on the table and isn’t something that will be pursued by GOP leadership as they try to pull together the 50 votes they need to pass their health care plan. Negotiations are continuing as planned for a proposal that repeals and replaces Obamacare simultaneously.
As CNN reported Friday, there is almost no chance senators will vote on a health care bill the week senators return from recess. Expect the health care negotiations to be a multi-week process.
Senate Majority Leader Mitch McConnell is sending several different proposals and basic outlines to the Congressional Budget Office to help speed up the final scoring process, as CNN reported several times last week. Although the top White House legislative official, Marc Short, said Sunday on Fox News that McConnell sent two bills to CBO for scoring; that’s not exactly the case. McConnell actually sent two outlines, plus several other proposals that may make it into a final bill.
The future of the proposal continues to depend on whether there is some compromise resolution on the same issues, including a softer landing for the eventual Medicaid reforms and how to craft some acceptable version of Texas Sen. Ted Cruz’s regulations amendment into the final proposal. In his comments Sunday, Short appeared to give the White House endorsement to Cruz’s regulations proposal, which if so would be no small thing.
Opioid funding and changes to regulations related to the use of health savings accounts appear to be settled and locked in.
A still looming, very real fight that will be coming when they return: whether to repeal the 3.8% investment tax in Obamacare or not. This is not at all settled, but sources tell CNN this is something that won’t be dealt with until Congress returns to Washington.

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.

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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.

Play

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 returns more pessimistic than ever on healthcare

(THIS ARTICLE IS COURTESY OF THE HILL NEWSPAPER)

Senate returns more pessimistic than ever on healthcare

Senators went into a recess skeptical over whether they could agree to legislation repealing and replacing ObamaCare.

They will return on Monday more doubtful than ever.

Sen. Richard Burr (R-N.C.), one of Senate Majority Leader Mitch McConnell’s (R-Ky.) most loyal allies, said Thursday that it’s “unlikely” the GOP will get a healthcare deal.

“I don’t see a comprehensive healthcare plan this year,” he told a local news station.

Senate Republicans hoped to have a draft bill this week, but it now looks like there will at best be an outline.

A Senate Republican aide said it’s too early to begin drafting legislation that can come to the floor in the next few weeks.“Parameters are more likely,” said the aide, who explained that McConnell wants to keep the details held closely so the legislation doesn’t get picked apart before lawmakers have a chance to consider it carefully.

“The last thing we want to do is litigate this in the press,” the aide said. “We want to discuss parameters and concepts without releasing a draft.”

“Maybe they can start talking to members about a specific product next week, but I would not be surprised if we don’t,” said another Senate GOP aide.

More unhelpful news came in the form of a Kaiser Family Foundation poll underscoring how unpopular the bill approved by the House is.

It found that three-quarters of Americans surveyed think the House bill does not fulfill President Trump’s promises on healthcare.

A full 82 percent said federal funding for ObamaCare’s expansion of Medicaid should be continued, an issue that deeply divides the Senate GOP. The House bill ends the ObamaCare funds in 2020.

Yet another factor for Republicans is Trump’s approval rating, which has fallen to its lowest point with Republicans since he took office in the latest Reuters/Ipsos tracking poll.

Republicans already had sought to lower expectations.

McConnell conceded last week that, “I don’t know how we get to 50 [votes] at the moment.”

He sounded more optimistic about passing major tax reform legislation, rating its chances as “pretty good.”

Republicans control 52 seats and can afford only two defections from their ranks. Vice President Pence could cast the deciding vote in case of a 50-50 tie.

The Senate GOP hasn’t given up hope on healthcare and faces tremendous pressure from the White House and House Republicans to hold a vote.

Republicans for years have promised to repeal ObamaCare, so failure would be a major blow. They also face pressure to finish their work on healthcare because of the tax reform push.

The GOP is using special budgetary rules to prevent Democrats from filibustering legislation on tax reform and healthcare.

Republicans can’t move to tax reform until the healthcare debate is finished because once they pass a new budget resolution that would allow them to move tax legislation with 51 votes, they will lose the vehicle set up to enable a healthcare bill that would circumvent a Democratic filibuster.

Those on a special 13-member working group have heard very little about the drafting efforts that were supposed to take place over the recess.

Senate Budget Committee Chairman Mike Enzi (R-Wyo.) was to provide the framework in consultation with GOP leaders and Senate Finance Committee Chairman Orrin Hatch (R-Utah).

A major sticking point in the Senate is Medicaid. The House bill would cut nearly $900 billion from the program and cap the federal contribution for expanded enrollment in that program by 2020.

Several Republican governors from Medicaid expansion states, led by Govs. John Kasich (Ohio) and Rick Snyder (Mich.), earlier this year came out against the House bill, warning that it failed to provide adequate resources.

Sen. Rob Portman (R-Ohio) said he wants a more gradual “glide path” for capping the expansion, an idea not popular with conservatives.

Twenty Republican senators, including Portman, represent states that opted to expand Medicaid, and many of them worry that cutting federal funding will cause significant budget problems at home.

But another group of GOP governors, primarily from states that opted out of the Medicaid expansion, want to end federal support for the expansion.

Senators are divided as well over proposals to limit federal assistance for health insurance subsidies, which would hit older, low-income Americans disproportionately.

McConnell hasn’t set a deadline for passing the ObamaCare repeal-and-replace bill, but he has indicated concern about the debate dragging on for months, which could imperil tax reform.

“We can’t take forever,” he told Bloomberg TV last month.

By raising doubts about the possibility of getting a deal that musters 51 votes, the GOP leader is putting pressure on his colleagues to either come together or move on before the August recess.

McConnell has told colleagues that the 13-member working group will put together a bill and that he will bring it to the floor for a vote, but he has stopped short of promising that it will pass — in contrast to Speaker Paul Ryan (R-Wis.), who earlier this year guaranteed that the House bill would pass.

If the Senate bill fails on the floor, McConnell is likely to declare the GOP conference has worked its will and move on.

Even as the House voted to narrowly pass the House’s American Health Care Act last month, there was already strong pessimism among Senate Republicans about the chances of putting together a comprehensive package in the upper chamber.

A senior GOP senator at the time said the chances of getting 51 votes for legislation based on the House healthcare bill were less than 1 in 5.

When House Republicans debated healthcare reform earlier this year, some of their Senate colleagues said privately that they thought it might be better if the legislation died in the lower chamber.

G.O.P. Health Bill Would Leave 23 Million More Uninsured in a Decade, C.B.O. Says

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

Protesters demonstrated outside the Capitol as Republican members of the House narrowly passed the health care bill this month. CreditGabriella Demczuk for The New York Times

WASHINGTON — A bill to dismantle the Affordable Care Act that narrowly passed the House this month would increase the projected number of people without health insurance by 14 million next year and by 23 million in 2026, the Congressional Budget Office said Wednesday. That 10-year figure is slightly less than originally estimated.

It would reduce the federal deficit by $119 billion over a decade, less than the $150 billion in savings projected in late March for an earlier version of the bill. And in states that seek waivers from rules mandating essential health coverage, the new law could make insurance economically out of reach for some sick consumers.

“Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums,” the budget office concluded.

GRAPHIC

New C.B.O. Score: G.O.P. Health Bill Would Save Government Billions but Leave Millions Uninsured

A look at crucial numbers in the Congressional Budget Office report.

OPEN GRAPHIC

The new forecast of the nonpartisan Congressional Budget Office, Capitol Hill’s official scorekeeper, is another blow to Republican efforts to undo President Barack Obama’s signature domestic achievement. The Senate has already said it will make substantial changes to the measure passed by the House, but even Senator Mitch McConnell of Kentucky, the majority leader, is sounding uncertain about his chances of finding a majority to repeal and replace the health law.

Continue reading the main story

“I don’t know how we get to 50 at the moment,” Mr. McConnell told Reuters on Wednesday. “But that’s the goal.”

The new report from the budget office is sure to influence Republican senators, who are writing their own version of the legislation behind closed doors. The report provided fresh ammunition for Democrats trying to kill the repeal bill, which they have derided as “Trumpcare.”

 

Video

How the GOP Health Plan Would Treat the Sick

Reporter Margot Sanger-Katz examines high-risk pools, the controversy at the heart of the health care debate.

By ROBIN STEIN, MARGOT SANGER-KATZ and SUSAN JOAN ARCHER on Publish DateMay 24, 2017. Photo by Brendan Smialowski/Agence France-Presse — Getty Images. Watch in Times Video »

Republicans in Congress generally focus more on reducing health costs than on expanding coverage. Their proposals will inevitably cover fewer people than the Affordable Care Act, they say, because they will not compel people to buy insurance.

Republicans have been trying to repeal Mr. Obama’s health law since the day he signed it in March 2010. But the task is proving more difficult than they expected. Many parts of the law have become embedded in the nation’s health care system, and consumers have risen up to defend it, now that they fear losing its protection. At the same time, other consumers, upset about the mandate to buy insurance they can barely afford, are demanding changes in the law.

The budget office issued two reports on earlier versions of the House bill in March. Both said that the legislation would increase the number of uninsured by 14 million next year and by 24 million within a decade, compared with the current law.

GRAPHIC

The Parts of the Affordable Care Act That the Republican Bill Will Keep or Discard

A comparison of the amended bill with key components of the Affordable Care Act.

OPEN GRAPHIC

Republican senators appear as determined as ever to replace the health law.

“The status quo under Obamacare is completely unacceptable and totally unsustainable,” Mr. McConnell said Wednesday, a few hours before the budget office issued its report. “Prices are skyrocketing, choice is plummeting, the marketplace is collapsing and countless more Americans will get hurt if we don’t act.”

“Beyond likely reiterating things we already know — like that fewer people will buy a product they don’t want when the government stops forcing them to — the updated report will allow the Senate procedurally to move forward in working to draft its own health care legislation,” he added.

The instability of the health law’s insurance marketplaces was underscored again on Wednesday when Blue Cross and Blue Shield of Kansas City, a nonprofit insurer, announced that it would not offer coverage under the law for 2018. The insurer lost more than $100 million in 2016 selling individual policies under the law, said Danette Wilson, the company’s chief executive.

Senator Chuck Schumer of New York, the minority leader, speaking to reporters in Washington on Tuesday.CreditAl Drago/The New York Times

“This is unsustainable,” she said in a statement. “We have a responsibility to our members and the greater community to remain stable and secure, and the uncertain direction of the market is a barrier to our continued participation.”

While the vast majority of people the company covers get insurance through an employer or a private Medicare plan, Blue Cross of Kansas City covers about 67,000 people in Kansas City and western Missouri under the federal health care law. The company’s departure could leave 25 counties in western Missouri without an insurer, said Cynthia Cox, a researcher at the Kaiser Family Foundation.

Democrats say much of that instability stems from Republican efforts to repeal and undermine the Affordable Care Act. The Senate minority leader, Chuck Schumer of New York, harshly criticized House Republicans for voting on their revised repeal measure without an updated analysis from the budget office.

“Republicans were haunted by the ghost of C.B.O. scores past, so they went ahead without one,” Mr. Schumer said. That action, he said, was reckless — “like test-driving a brand-new car three weeks after you’ve already signed on the dotted line and paid the dealer in full.”

The House repeal bill was approved on May 4 by a vote of 217 to 213, without support from any Democrats. It would eliminate tax penalties for people who go without health insurance and would roll back state-by-state expansions of Medicaid, which have provided coverage to millions of low-income people. And in place of government-subsidized insurance policies offered exclusively on the Affordable Care Act’s marketplaces, the bill would offer tax credits of $2,000 to $4,000 a year, depending on age.

A family could receive up to $14,000 a year in credits. The credits would be reduced for individuals making more than $75,000 a year and families making more than $150,000.

Senior Republican senators say they want to reconfigure the tax credits to provide more financial assistance to lower-income people and to older Americans, who could face much higher premiums under the House bill.

The House bill would roll back a number of insurance requirements in the Affordable Care Act, which Republicans say have driven up the cost of coverage.

In the weeks leading up to passage of the House bill, Republican leaders revised it to win support from some of the most conservative members of their party.

Under the House bill, states could opt out of certain provisions of the health care law, including one that requires insurers to provide a minimum set of health benefits and another that prohibits them from charging higher premiums based on a person’s health status.

Insurers would not be allowed to charge higher premiums to sick people unless a state had an alternative mechanism, like a high-risk pool or a reinsurance program, to help provide coverage for people with serious illnesses.

Senate Republican have been meeting several days a week, trying to thrash out their differences on complex questions of health policy and politics, like the future of Medicaid.

Asked why Democrats had been excluded, Mr. McConnell said, “We’re not going to waste our time talking to people that have no interest in fixing the problem.”

Democrats have said they would gladly work with Republicans if the Republicans would renounce their goal of repealing Mr. Obama’s health care law.

GOP Rep Tells Mom Her Son On Medicaid Should Just Get A Better Job If He Wants Health Care

(THIS ARTICLE IS COURTESY OF THE HUFFINGTON POST)

POLITICS

04/22/2017 07:56 pm ET | Updated 10 hours ago

GOP Rep Tells Mom Her Son On Medicaid Should Just Get A Better Job If He Wants Health Care

Rep. Warren Davidson also compared health insurance to a cell phone.

YOUTUBE
Rep. Warren Davidson (R-Ohio), seated in the white shirt, tells a woman her son should get a job that provides health insurance if he wants decent coverage.

Rep. Warren Davidson (R-Ohio) told the mother of a service industry worker who has benefited from the Affordable Care Act’s Medicaid expansion that her son should get a better job if he wants decent insurance when Obamacare is repealed.

The woman, a constituent of Davidson’s in former House Speaker John Boehner’s old district, explained to Davidson at a town hall in Enon, Ohio on Tuesday night first covered by ShareBlue that her grown son lacked health insurance for four years, because his job in the service industry did not provide it. He received coverage through Medicaid when Obamacare expanded the program by offering to pick up almost all of the costs for states that lowered their eligibility thresholds.

She is now worried about President Donald Trump’s plan to rollback the landmark law’s Medicaid expansion, fearing it will leave her son with the bare-bones catastrophic health insurance, which, she said, is “basically no insurance at all.”

“Can you explain why my son and millions of others in his situation are not deserving of affordable, decent health care that has essential benefits so that he can stay healthy and continue working?” she asked.

Her son’s best route to getting decent insurance without Medicaid is to find work in an industry where employers provide it, according to Davidson.

“OK, I don’t know anything about your son, but as you described him, his skills are focused in an industry that doesn’t have the kind of options that you want him to have for health care. So, I don’t believe that these taxpayers here are entitled to give that to him. I believe he’s got the opportunity to go earn those health benefits,” he responded, eliciting boos from the crowd.

You can watch their full exchange at the 37-minute mark in the video above.

The woman’s reference to “essential benefits” alludes to the fact that House Republican leaders at one point tried to win over hardline conservatives by removing federal regulations requiring insurance plans to cover 10 basic benefits, including trips to the emergency room, as well as maternity and newborn care. In lieu of these benefits, low-premium, high-deductible catastrophic plans could cover even fewer procedures than they do now.

But Davidson implied that finding a better plan was as simple as shopping for a higher-quality consumer product like a cellphone.

“If he doesn’t want a catastrophic care plan, don’t buy a catastrophic care plan. If you don’t want a flip-phone, don’t buy a flip-phone,” Davidson said, eliciting loud groans from the audience.

“I’m sorry, health care is much different than a cell phone and I’m tired of people using cell phone analogies with health care,” the woman responded, before walking away from the microphone.

BILL CLARK/GETTY IMAGES
Rep. Warren Davidson represents former House Speaker John Boehner’s old district. He had a gruff response to a constituent’s question about Obamacare repeal.

Davidson’s metaphor resembled remarks by Rep. Jason Chaffetz (R-Utah), who suggested in March that people should not buy iPhones if they wanted the money to pay for health insurance.

But as Davidson’s constituent noted at the town hall ― and many observers pointed out when Chaffetz said it ― buying health insurance is completely different than shopping for everyday consumer products.

Consumers do not have the same power to command lower prices for health care, since it is not a product they can choose to not have. People also often lack the information and resources to choose a health care provider based on its cost value.

Those are just a couple reasons why health insurance is wildly more expensive than paying for a phone bill ― and obtaining coverage would remain perilously out of reach for millions of Americans without help from the government.

That’s a big deal, because unlike phones, Americans’ lives would be at risk if they did not have health care.

Although President Trump and House Republicans have already failed to negotiate an Obamacare replacement bill at least twice, the White House is dead-set on trying again as part of negotiations to continue funding the government. The latest idea floated by budget director Mick Mulvaney would involve trading Democrats a dollar in Obamacare funding for every dollar they approve for construction of the wall.

[H/T ShareBlue]

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