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.

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.

Here Are All the Ways President Trump Praised the GOP Health Care Bill He Just Called ‘Mean’

(THIS ARTICLE IS COURTESY OF TIME.COM)

Here Are All the Ways President Trump Praised the GOP Health Care Bill He Just Called ‘Mean’

6-13-2017
President Donald Trump on Tuesday criticized the House-passed health care bill, calling it “mean” in a meeting with Republican senators and urging them to develop a “more generous” version. But just over a month ago, the president repeatedly praised the GOP-sponsored legislation, describing it as a “great plan” after a vote confirmed the bill’s approval in the House.

Here are all the ways Trump lauded the American Health Care Act in his speech from the White House Rose Garden on May 4th:

Trump said the bill would make insurance prices go down

“And I will say this, that as far as I’m concerned, your premiums, they’re going to start to come down,” Trump said during the beginning of his remarks, before later adding: “And I think, most importantly, yes, premiums will be coming down. Yes, deductibles will be coming down. But very importantly, it’s a great plan. And ultimately, that’s what it’s all about.”

A forecast from the Congressional Budget Office, an independent, nonpartisan agency, said that premiums will actually increase over the next few years should the bill pass in its current form, and long-term effects will ultimately fall to individual states.

He said it was good because it would repeal and replace Obamacare

“Right now, the insurance companies are fleeing. It’s been a catastrophe. And this is a great plan,” Trump said. “I actually think it will get even better. And this is, make no mistake, this is a repeal and replace of Obamacare. Make no mistake about it. Make no mistake.”

He said it was great because it was done quickly

“And this really helps it. A lot of people said, how come you kept pushing healthcare, knowing how tough it is? Don’t forget, Obamacare took 17 months. Hillary Clinton tried so hard — really valiantly, in all fairness, to get healthcare through. Didn’t happen,” Trump remarked. “We’ve really been doing this for eight weeks, if you think about it. And this is a real plan. This is a great plan. And we had no support from the other party.”

He said it had “great features”

“But we want to brag about the plan, because this plan really — uh oh,” Trump began before he was cut off by a laughing audience. “Well, we may. But we’re just going to talk a little bit about the plan, how good it is, some of the great features.”

The CBO in the same aforementioned report said that if the bill goes through in its current condition, 23 million Americans will lose insurance over the next 10 years.

And overall, he said it was good because of the “talent” that helped develop it

“So what we have is something very, very incredibly well-crafted. Tell you what, there is a lot of talent standing behind me. An unbelievable amount of talent, that I can tell you. I mean it,” Trump gushed.

“But we have an amazing group of people standing behind me,” the president added. “They worked so hard and they worked so long. And when I said, let’s do this, let’s go out, just short little shots for each one of us and let’s say how good this plan is — we don’t have to talk about this unbelievable — wasn’t it unbelievable? So we don’t have to say it again. But it’s going to be an unbelievable victory, actually, when we get it through the Senate.”

Why Should The Employee (Congress/Senate/President) Get Better Insurance Policies Than Their Bosses, The People?

shared Teanderthal Party‘s photo.

16 hrs ·

 (I copy pasted this from a forward a friend posted on FB, I agree
 with this statement, do you?)

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]

V.P. Pence Is Floating His ‘Healthy Indiana 2.0’ Program To Replace Obamacare

(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.”

President Obama: Just Like Hillary: Just Another Lying Politician!!!

(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.

Modal Trigger

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.

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oldpoet56

oldpoet56

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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