(THIS ARTICLE IS COURTESY OF THE HUFFINGTON POST)
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Care Act’s Medicaid expansion that her son should get a better job if he wants decent insurance when Obamacare is repealed.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.
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.
(THIS ARTICLE IS COURTESY OF THE NEWS SITE POLITICO)
When former Indiana Gov. Mike Pence embraced Obamacare’s Medicaid expansion with conservative twists — such as requiring enrollees to contribute to their care — critics lamented poor people would be locked out while backers cheered the program’s focus on personal responsibility.
Neither side’s expectations were quite borne out. Two years later, as the program emerges as a national model thanks to Pence’s role in the Trump administration, the reality on the ground shows what happens when political philosophy collides with the practical challenges of providing health care to tens of thousands of people, many of them in crisis.
Advocates for the poor in Indiana argue that liberal fears of depressed enrollment were overblown. More than 400,000 Hoosiers are enrolled, despite state requirements that low-income residents make nominal monthly contributions to their care or face stiff penalties.
Likewise, Republicans’ contention that the system would promote personal responsibility and prod beneficiaries to ration their care and make better decisions about what treatments to seek also turned out to be overly optimistic.
By all accounts, the expansion — known as the Healthy Indiana Plan 2.0 — has made a difference. Health officials in Scott County, Ind., a poverty-stricken community about 30 miles from Louisville, Ky., paint a picture of a program that’s bolstered a patchy social safety net — especially during a major HIV outbreak triggered by the opioid epidemic — without bankrupting the Hoosier State or punishing enrollees.
To be sure, the program isn’t perfect, they say. But they overwhelmingly give more positive reviews than not.
“I feel that it has been a good success,” said Dawn Sanders, an outreach worker for Covering Kids & Families of Indiana, a statewide consumer group working in Scott County. “It’s working.”
Healthy Indiana’s influence is expected to increase in the months ahead whether or not Obamacare survives, as state officials and the Trump administration look to replicate some of its conservative features, potentially unleashing a wave of new state restrictions on how non-disabled adults get coverage without any action from Congress.
“The Healthy Indiana Plan has long been, and continues to be, a national model for state-led Medicaid reforms,” HHS Secretary Tom Price wrote in response to senators after his confirmation hearing.
“It is important that Medicaid’s design helps its members to transition successfully from the program into commercial health insurance plans, as [Healthy Indiana’s] consumer-driven approach and underlying incentive structures encourage,” he told lawmakers.
Seema Verma, meanwhile, a Pence ally who helped design the program before she was tapped to run CMS, now has the power to give states greater flexibility to reshape their own programs according to conservative principles.
Kentucky and Arizona have already borrowed aspects of Indiana’s plan while others, including Wisconsin, could move to enact new limits that resemble the approach.
Indiana’s plan also provides a measure of political cover to lawmakers in red states where supporting Obamacare’s coverage expansion is still deeply controversial. Republicans across the country have found it easier to back an expansion of government-funded health care for the poor if it more closely resembles a private insurance market. Yet liberals remain deeply skeptical because of the way the system is designed to cut people off who don’t make monthly payments, at least temporarily.
Both sides could find their assumptions challenged based on the experience in places like Scott County.
The Indiana plan does punish people above the poverty line who stop making monthly contributions by locking them out of coverage for six months. But because most enrollees have incomes below the poverty line, lockouts have been rare, according to state evaluations of the first year of the program. Instead, those below the poverty line who don’t pay are bumped from plans with more generous benefits — including coverage of vision and dental care and better prescription drug benefits — into skimpier plans with higher out-of-pocket costs.
“It sounds like, ‘Oh my gosh, people are going to have to pay.’ But people that were uninsured were paying for it already,” if they go to the doctor, said Beth Wrobel, who runs a federally qualified health center in Valparaiso, in the northern part of the state.
Diabetic patients who visited Wrobel’s clinic before the start of Healthy Indiana incurred significantly higher costs paying for their regular medical supplies and routine testing, she said. Now, under the more generous benefit package, “the most you have to pay is $26 a month, and that’s at the high end. Most of our patients pay between $1 and $10 a month,” Wrobel said.
“For the same amount that you were paying at that moment for your diabetic care, you could get medical, dental, behavioral health, optometry and pharmacy. [Healthy Indiana] treated the whole body,” she said.
Randy White, CEO of Fayette Regional Health System in Connersville, in the east-central part of the state, agreed that Healthy Indiana “is not harsh.”
If the liberal specter of a punitive system pushing out enrollees hasn’t quite materialized, neither has conservatives’ vision of a market-like system where patients with “skin in the game” make hard choices about their own health spending. That’s because family members, health workers and nonprofits are helping cover their out-of-pocket costs.
“With some people, I think [personal responsibility] might be a little bit lost,” Sanders said in her office at the Scott County Partnership, a nonprofit. “We try and do what we can in the little bit of time we have with them. But you can only give them so many pamphlets.”
About 2,100 of the enrollees who gained coverage through Indiana’s expansion live in Scott County, a poor, sparsely populated area that gained notoriety where an HIV outbreak took off two years ago, fueled by needle sharing and opioid abuse.
Sanders recalled how a man with substance abuse problems signed up for health coverage in the small town of Austin, Ind., which had set up a “one-stop shop” to get people enrolled and provide medical services like HIV screenings and vaccinations.
“He knew he had hit rock bottom. And he knew he needed help,” Sanders said. “He no longer lives in the area, but he had to be able to get away from this. He has stayed clean this whole time. He now has his children back. We have quite a few success stories, as far as that’s concerned.”
As of early April, there were 216 county residents with HIV, according to Scott County Health Department Administrator Michelle Goodin, but roughly three-quarters of the patients don’t have enough of the virus in their blood to spread it to others. New cases are still being diagnosed.
“We’ve got about 30 to 40 people usually that are HIV-positive in our facility,” said Sheriff Dan McClain, whose staff helps prisoners apply for Medicaid so that they can receive benefits, including mental health and substance abuse treatment, as soon as they are released. “We offer them a test for HIV and … we offer to sign them up for HIP 2.0,” he said.
With an ad-hoc support network fortifying the safety net, some liberal groups and Democratic lawmakers question whether the conservative tweaks are really adding value or simply burdening enrollees with unnecessary complications. Without those hurdles, they say enrollment would be even higher.
Progressives also fear that if the Indiana model is embraced in states that initially did traditional expansions of Medicaid, it would erode enrollment gains.
“Work requirements, lock-out periods, time limits and imposition of onerous premiums and cost-sharing on Medicaid families, who are generally living on a budget of roughly less than $15,000 per year, are not only punitive but also counterproductive in the long-term,” Sen. Ron Wyden (D-Ore.) and Rep. Frank Pallone (D-N.J.) wrote in a letter to HHS last month to discourage it from approving additional restrictions, many of which would be program firsts. “Requiring poor families to pay more than they can afford for care makes them less likely to access the care they need and less likely to maintain their coverage.”
State surveys of how Healthy Indiana is working present a fragmentary picture, and despite the program’s popularity in Indiana, there are some signs of hampered enrollment because of its complex structure and broader concerns about affordability. For example, roughly half of the enrollees in the more comprehensive benefit package worried about being able to afford their monthly payments. Left-leaning groups have used the data to raise flags about harmful implications for other states.
The first-year report also estimated that roughly 1,240 enrollees received financial help from nonprofits to pay their premiums, a paltry slice of overall enrollment. But residents here believe many more enrollees likely rely on family members, friends and others sources undetected by official surveys. Sanders and others pointed out that the premium cost of keeping someone covered in the program’s more generous benefit package — which includes vision and dental benefits as well as more robust coverage of prescriptions — is as little as $12 for an entire year.
“We’ve paid it out of our pocket many times at the office just to get them hooked up,” said Jeanni McCarty, a nurse at Foundations Family Medicine in Austin. McCarty said she has four family members affected by HIV and five relatives who have passed away from drug abuse-related problems.
Indiana officials by the end of the month will send CMS two more reports, including one that specifically examines the use of health savings-like accounts to help beneficiaries cover their costs. Pence’s successor, Republican Gov. Eric Holcomb, has already asked the Trump administration to extend the program through January 2021 with a handful of tweaks — though notably absent is a request to institute a work requirement as a condition of receiving benefits.
“We don’t want to put policies and programs in place that are not member-centric,” said Jennifer Walthall, secretary of Indiana’s Family and Social Services Administration. “Increasing barriers is not the name of the game.”
(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)
At least President Obama is honest. Or so goes the common perception. He tried, maybe he made mistakes, the other side was mean to him, but through it all, he didn’t lie.
That view got smithereened this week. It was always hard to believe the president’s repeated claim that he didn’t know his own secretary of state was using an off-the-books e-mail server to avoid public scrutiny, in the process virtually guaranteeing that she would commit multiple felonies by taking classified information into the open.
Now we know Obama was lying. His own aides said so, in e-mails uncovered by WikiLeaks and made public this week.
In March 2015, Obama made the ridiculous claim that he had learned about Clinton’s e-mail server “the same time everybody else learned it, through news reports.” In fact, not only did he know she was using a private e-mail address for state business, but he had corresponded with her via that address.
“We need to clean this up — he has e-mails from her — they do not say state.gov,” Cheryl Mills, a top aide, wrote to John Podesta, another senior adviser, on March 7, 2015.
Obama spokesman Josh Earnest did indeed try to “clean this up,” two days later, by changing the subject.
“The point that the president was making is not that he didn’t know Secretary Clinton’s e-mail address — he did — but he was not aware of the details of how that e-mail address and server had been set up, or how Secretary Clinton and her team were planning to comply with the Federal Records Act,” Earnest said.
[Obama is] just another lying politician.
Try that technique on your wife sometime when she finds out you were at a blonde’s house when you said you were going to church. “I didn’t mean to say I was at Holy Name — I wasn’t — but I just want to clarify that I was not aware of what year the church was built.”
Despite the sacred sheen of Obama idealism that the media have been struggling to keep polished all these years, our president is an ordinary politician who lies for the same reason other pols do. He thinks whatever means he uses are justified by the ends — his awesome mission to make America a better place.
In promoting ObamaCare, Obama repeatedly and shamelessly lied to the American people: “If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too,” he said on June 6, 2009, in one of dozens of similar remarks. Obama knew this was untrue at the time; it was built into the plan that millions would lose the health plans they had.
There is a distinction between lies and political BS.
BS can involve starry-eyed thinking that won’t survive acquaintance with reality. Obama might have actually believed himself when he promised “the most transparent administration in history.” Today it’s obvious that instead, Obama’s White House has been “one of the most secretive,” as Washington Post media columnist Margaret Sullivan put it.
It wasn’t mere B.S. when Obama lied about Benghazi: “We revealed to the American people exactly what we understood at the time,” he said on Feb. 2, 2014, though his administration knew the night of the Sept. 11, 2012 attacks that they were planned, terrorist acts. On Sept. 16, 2012, UN Ambassador Susan Rice, working from White House-approved talking points, repeatedly blamed the Benghazi attacks on a nonexistent protest over an inflammatory video.
Our president is an ordinary politician who lies for the same reason other pols do
Obama lied about the Fast and Furious operation that allowed some 2,500 firearms to be bought by Mexican drug cartels. One such gun was used to murder US Border Patrol agent Brian Terry: “The Fast and Furious program was a field-initiated program begun under the previous administration,” Obama said on Sept. 20, 2012. In fact, the program was launched by Obama’s Bureau of Alcohol, Tobacco and Firearms in October 2009.
Obama lied about immigration: “My position hasn’t changed,” he said on Nov. 20, 2014, as he announced unilateral executive action to normalize the status of illegal immigrants, a move he had repeatedly and correctly said he lacked the authority to make.
Obama lied about the IRS’s targeting of conservatives, even contradicting his own statements that the harassment was “inexcusable” and made him “angry” on May 15, 2013. Less than a year later, when the heat was off, he said there was “not even a smidgen of corruption” and the IRS’s vendetta against right-leaning groups was totally excusable as a bureaucratic snafu.
You get the idea; Google “Politifact Obama false” for lots more along the same lines.
Once upon a time, when we were all bedazzled by his freshness, Obama set about saying whatever it took to get elected. Remember when he promised health-care negotiations would be broadcast on C-SPAN, when he said his deeply held religious beliefs meant he couldn’t support gay marriage, when he said he would not raise any kind of taxes on families earning less than $250,000?
Faith in him proved enduring. Some of his fanboys insist to this day that Obama is a transcendent figure, a “lightworker.”
Nonsense. He’s just another lying politician.