Don't Fall for GOP Claims on Protections for Preexisting Conditions

At times I am amazed at how stupid Republicans think the public is when it comes to believing their lies.  True. with Trump supporters, especially evangelical Christians who tend to be the least educated segment of society, there is a high level of stupidity, some fueled by intellectual laziness and some spurred by racism to which the GOP has played ever since the rise of Richard Nixon's "southern strategy."  But when it comes to health care - especially maintaining protections for preexisting conditions - anyone paying any attention can see that the rhetoric that one is hearing from Republican congressional candidates is 180 degrees the opposite of the votes and actions over the last two years.  For example, how can one be a champion of protecting preexisting conditions (as claimed by Republican Senate candidate Josh Hawley who hopes to unseat Democrat Claire McCaskill) while in charge of a state filed lawsuit seeking to end those very protections.  Locally, the same holds true for Rep. Scott Taylor who is singing one line now, but voted very differently.  A piece in the Washington Post looks at GOP lies which are in high gear as election day approaches.  Here are excerpts:

What began over the summer as a halfhearted attempt by Republicans to push back against Democratic attacks on the issue of health care has exploded into a full-throated reversal of their positions, particularly on protections for sick Americans.

In Missouri, Republican Senate candidate Josh Hawley has been hammered by the woman he hopes to unseat, Democrat Claire McCaskill, for being among the attorneys general who have asked a federal court to render unconstitutional the Affordable Care Act, or Obamacare, which compelled insurance companies to cover those with preexisting conditions.

“You don’t go to court and get rid of important protections when there is no backup, when people will be in a free fall,” McCaskill said in a debate Thursday night.

In Texas, where he is trying to beat back a well-financed challenge by Democratic Rep. Beto O’Rourke, Sen. Ted Cruz said in a debate Tuesday that he would “protect preexisting conditions.” Cruz forced a government shutdown in 2013 over his effort to repeal Obamacare. In a House race in California, Republican Rep. Dana Rohrabacher is, like Hawley, using his child’s illness to attest to his embrace of protections for preexisting conditions, even though he repeatedly voted to quash the Obamacare bill that first secured them.

Democrats and health-care specialists say that the proposals being put forward by Republicans contain exemptions that mean the sick would not be fully protected or would be charged exorbitant rates for coverage, as they were before the ACA became law.

Still, the sudden scramble by Republicans underscores the speed with which voters have also reversed themselves on the most popular provisions of the act, even as Republicans worked relentlessly to repeal them. It also raises a political irony: The same issue that gave birth to the tea party and propelled Republicans to power in the 2010 midterm elections could cost them dearly eight years later.

Republicans appeared to have been caught flat-footed about the change in voter opinion about insurance coverage, which has been cited by voters in multiple polls this year as the issue they care most about.

[A]s the GOP shifted its focus to tax cuts — which have not gained traction among voters — Democrats built an entire midterm campaign strategy around preserving the law’s most popular provision.

The actions of Republicans, including the president, before this election year have not matched their rhetoric over the past few weeks.  For more than eight years, their greatest and most unifying party rallying cry has been repealing Obamacare.

Trump also has bragged repeatedly about his administration’s many steps to undermine the law and water down protections, even as his administration has refused to defend any part of the law against the lawsuit filed by Republican attorneys general. “I think the big issue is the brazenness [with] which this mantle is being put on to say this is something they’ve always supported,” said Sabrina Corlette, professor of health policy at Georgetown University.  Most health-policy experts say the Republican position is contradictory because without a replacement plan in place, people with past or existing illnesses would lose the protections they have now.

“The irony is that what allowed the House to pass [the repeal bill] was a proposal to weaken protections for preexisting conditions. This was not an obscure part of the debate,” said Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation.

If you care about health care coverage - and Social Security and Medicare - the only option is to vote Democrat on November 6, 2018.  Do not fall for the GOP lies.  

Today's GOP: Cruelty, Incompetence and Lies

As I note frequently, I am a former Republican.  Once upon a time I held a city committee seat for the Republican Party of Virginia Beach.  I even was the original incorporator of that entity as filings at the Virginia State Corporation Commission confirm.  Yet now I find myself embarrassed to ever have been a Republican give the hideousness of today's Republican Party.  A hideousness starkly revealed by the Graham-Cassidy healthcare bill currently in the U.S. Senate which would have millions of Americans and leave those with pre-existing conditions without coverage.  Virtually every part of the healthcare industry opposes the bill as does AARP which will hopefully go on a rampage against Republicans in the 2018 election cycle if this travesty passes (if it does, it will be based solely on Republican votes).  So why is the GOP leadership pushing so hard for this bill?  Two main factors, in my view: thanks to Citizens United, the big money players in the GOP donor class want its passage and will punish the GOP if this massive tax cut for the wealthy disguised as "reform" is not passed.  The other factor is the make up the GOP base which is controlled by Christofascists and racists, groups best defined by their hatred of others and their hatred of Barack Obama.  In their warped and hate-filled minds, this bill will punish minorities and others they despise.  The irony will be, of course, that they themselves will end up suffering greatly when many find themselves without health care at some point down the road.  A column in the New York Times looks at the cruelty, incompetence and lies behind this foul bill.  Here are excerpts:

Graham-Cassidy, the health bill the Senate may vote on next week, is stunningly cruel. It’s also incompetently drafted: The bill’s sponsors clearly had no idea what they were doing when they put it together. Furthermore, their efforts to sell the bill involve obvious, blatant lies.

Nonetheless, the bill could pass. And that says a lot about today’s Republican Party, none of it good.

The Affordable Care Act, which has reduced the percentage of Americans without health insurance to a record low, created a three-legged stool: regulations that prevent insurers from discriminating against people with pre-existing conditions, a requirement that individuals have adequate insurance (and thus pay into the system while healthy) and subsidies to make that insurance affordable. For the lowest-income families, insurance is provided directly by Medicaid.

Graham-Cassidy saws off all three legs of that stool. Like other Republican plans, it eliminates the individual mandate. It replaces direct aid to individuals with block grants to states, under a formula that sharply reduces funding relative to current law, and especially penalizes states that have done a good job of reducing the number of uninsured. And it effectively eliminates protection for Americans with pre-existing conditions.

[E]veryone, who knows anything about health care warns [the bill] would cause chaos.  It’s not just progressives: The American Medical Association, the insurance industry and Blue Cross/Blue Shield have all warned that markets would be destabilized and millions would lose coverage.

How many people would lose insurance? Republicans are trying to ram the bill through before the Congressional Budget Office has time to analyze it — an attempt that is in itself a violation of all previous norms, and amounts to an admission that the bill can’t bear scrutiny. But C.B.O. has analyzed other bills containing some of Graham-Cassidy’s provisions, and these previous analyses suggest that it would add more than 30 million people to the ranks of the uninsured.

Both Cassidy and Graham insist that their bill would continue to protect Americans with pre-existing conditions — a claim that will come as news to the A.M.A., Blue Cross and everyone else who has read the bill’s text.

Independent analyses find that most states would, in fact, experience serious cuts in federal aid — and everyone would face huge cuts after 2027.

So we’re looking at an incompetently drafted bill that would hurt millions of people, whose sponsors are trying to sell it with transparently false claims. How is it that this bill might nonetheless pass the Senate?

One answer is that Republicans are desperate to destroy President Barack Obama’s legacy in any way possible, no matter how many American lives they ruin in the process.

Another answer is that most Republican legislators neither know nor care about policy substance. This is especially true on health care, where they never tried to understand why Obamacare looks the way it does, or how to devise a nonvicious alternative.

I’d add that the evasions and lies we’re seeing on this bill have been standard G.O.P. operating procedure for years. The trick of converting federal programs into block grants, then pretending that this wouldn’t mean savage cuts, was central to every one of Paul Ryan’s much-hyped budgets. The trick of comparing dollar numbers over time to conceal huge benefit cuts has, as I already noted, been around since the 1990s.

In other words, Graham-Cassidy isn’t an aberration; it’s more like the distilled essence of everything wrong with modern Republicans. . . . even if the handful of Republican senators who retain some conscience block it — we’re looking at you, John McCain — the underlying sickness of the G.O.P. 

I again find myself how any one morally decent vote Republican given what the GOP has become both at the state and at the federal level.  It epitomizes moral bankruptcy and cruelty towards others. 

Will Revived GOP Health Care Effort Bring Back Preexisting Condition Bars?

Those who have felt safer in the wake of the Republican Party's failure to pass legislation to repeal and "replace" Obamacare need to still be afraid.  Efforts are stirring among House Republicans to have another go at "reform" and the consequences could be that the health insurance market would return to much of its pre-Obamacare nature: those with preexisting conditions could be excluded from policy coverage and those with health problems could see premium costs soar to a point where any tax credits awarded under the GOP plan would barely scratch the costs of coverage.  To use a term the GOP coined, insurance companies would become death panels largely determining who gets treatment and who dies.  The main force behind the effort id the "conservative" House Freedom Caucus, a group that espouses respect for Christian values but which obviously has cast aside the Gospel message of caring for the sick.  A piece in the New York Times looks at the foul proposals brewing in the House of Representatives.  Here are excerpts: 

Monday night, word emerged that the White House and the group of conservative lawmakers known as the Freedom Caucus had discussed a proposal to revive the bill. But the proposed changes would effectively cast the Affordable Care Act’s pre-existing conditions provision aside.

The terms, described by Representative Mark Meadows, Republican of North Carolina and the head of the Freedom Caucus, are something like this: States would have the option to jettison two major parts of the Affordable Care Act’s insurance regulations. They could decide to opt out of provisions that require insurers to cover a standard, minimum package of benefits, known as the essential health benefits. And they could decide to do away with a rule that requires insurance companies to charge the same price to everyone who is the same age, a provision called community rating.

The proposal is not final, but Mr. Meadows told reporters after the meeting that his members would be interested in such a bill. To pass the House, any bill would need to find favor not just with the Freedom Caucus, but also with more moderate Republicans. It would also need to attract the support of nearly every Republican in the Senate to become law.

The ability to opt out of the benefit requirements could substantially reduce the value of insurance on the market. A patient with cancer might, for example, still be allowed to buy a plan, but it wouldn’t do her much good if that plan was not required to cover chemotherapy drugs.

The second opt-out would make the insurance options for those with pre-existing conditions even more meaningless.

Technically, the deal would still prevent insurers from denying coverage to people with a history of illness. But without community rating, health plans would be free to charge those patients as much as they wanted. If both of the Obamacare provisions went away, the hypothetical cancer patient might be able to buy only a plan, without chemotherapy coverage, that costs many times more than a similar plan costs a healthy customer. Only cancer patients with extraordinary financial resources and little interest in the fine print would sign up.

There is a reason that many conservatives want to do away with these provisions. Because they help people with substantial health care needs buy relatively affordable coverage, they drive up the price of insurance for people who are healthy. An insurance market that did not include cancer care — or even any cancer patients — would be one where premiums for the remaining customers were much lower. The result might be a market that is much more affordable for people with a clean bill of health. But it would become largely inaccessible to anyone who really needs help paying for medical care.

We do not have to speculate to know what the world looks like without essential health benefits and community rating. It was how most state insurance markets worked before Obamacare. Back in 2009, most sick people who did not get insurance through work or a government program were excluded from coverage if they had a history of health problems like allergies or arthritis. Plans that did not cover pregnancy care or drug addiction treatment were widespread.

[I]nsurance in the old high-risk pools tended to be expensive, and often came with long waiting periods or benefit limitations, even for the very sick.

What states would choose to do with this set of options is hard to predict. Before Obamacare, few states required community rating of health plans. And few states required insurers to cover all of the benefits deemed essential under Obamacare, though most did require a few types of treatments to be covered. State governments would face a difficult choice: either take away the requirements, and leave sick patients without insurance options, or keep them and see people unable to afford coverage under the new subsidy system.

Mr. Meadows said that the proposal presented to the Freedom Caucus would retain the pre-existing conditions policy. But that would be true in only the most literal sense. The mix of policies could allow insurance companies to charge sick people prices that few of them could pay. And it could allow them to exclude benefits that many healthy people need when they get sick. The result could be a world where people with pre-existing conditions would struggle to buy comprehensive health insurance — just like before Obamacare.

As I have argued for some time, the only real solution is a single payer system like the rest of the advanced world utilizes that would take the power of life and death away from insurance companies.  It is really that simple. 

Report Undermines Claims That Millions Will Lose Coverage Due To Obamacare

The Congressional Republicans and various talking heads of the far right continue to run around predicting that the sky is falling because of the Affordable Health Care Act, a/k/a Obamacare.  In addition, they claim that millions of Americans will lose coverage under Obamacare and, of course, little or nothing is said about the benefits that are being brought to millions of Americans.  A new report looks at the GOP claims and disproves the claim that millions will lose coverage.  Here are excerpts from a piece in Think Progress that reviews the report's findings:

Obamacare’s detractors have argued that millions of Americans will lose their health coverage due to the changes introduced by Obamacare. But according to a new analysis, this ignores counterbalancing policies in the law. The report finds that less than 10,000 people will lose coverage coverage without an immediate and affordable replacement.

[F]or the vast major that 4.7 million, the cancellation of a plan simply means a shift into a new and often better form of coverage. The report lays out three ways this happens.

First, there’s the extended grandfather period. Even before Obamacare was enacted, health plans on the individual market — which usually operate on year-long contracts — changed on consumers all the time. Benefits could be altered or premiums jacked up. In order to give consumers more reliability, Obamacare placed much tighter controls on how and why insurers may charge different customers different premiums, and mandated a core package of benefits all plans must provide. Unfortunately, this also meant many pre-Obamacare plans that didn't meet those new qualifications would have to be cancelled. In order to smooth that transition, the law allowed insurers to “grandfather” in certain pre-Obamacare plans by allowing them to be renewed for one more year at any point in 2013.

Second, there’s Obamacare’s subsidies and Medicaid. In order to help Americans better afford coverage on the individual, Obamacare provides tax credits to anyone on the exchanges making between 100 and 400 percent of the federal poverty level (FPL). That’s between $23,000 and $94,000 for a family of four. Over half of all married couples made $75,678 or less in 2012. Obamacare also provided the states the resources to expand Medicaid to anyone making up to 138 percent of the FPL.

Citing analysis by the Kaiser Family Foundation, the Democrats’ report estimates that 60 percent of the 2.35 million who can’t take advantage of the extension will either qualify for subsidies or for the Medicaid expansion. That’s another 1.4 million out of the original 4.7 million cited by the AP. That number would be even larger if it weren’t for the states that refused the Medicaid expansion.

Third, there’s access to catastrophic coverage. Another failsafe built into Obamacare was the possibility of a “hardship exemption” for any American who faced serious hurdles in complying the law’s mandate that everyone purchase health coverage. In December, the administration decided that exemption applied to anyone who’d seen their previous coverage cancelled due to Obamacare’s policy changes. That means they won’t be subject to the mandate’s penalty, and that they’ll be allowed to purchase cheaper “catastrophic coverage” along with the Obamacare-compliant plans on the exchanges.

The new report found that of the 2.35 million who can’t renew their pre-Obamacare plans through 2014, 99 percent will have the option to buy low-cost catastrophic coverage.

The fact is the plan “cancellations” were a regular occurrence on the individual market even before Obamacare, as customers saw plans changed or terminated and had to enroll in new ones. Studies have found that one third in the individual market left their coverage after only one year, and over 80 percent did not stay in their coverage longer than two years. The initial shift into coverage that complies with Obamacare can look like an acceleration of all that, but the law also introduced a host of new policies to make coverage more accessible, affordable and stable going forward.

As I have noted before, the real solution is a universal single payer  system.  As written, Obamacare continues to leave individuals and families at the mercy of the insurance industry.  It simple made the system less brutal and limited the arbitrary and capricious behavior of insurers somewhat.

The Healthcare Industry's Vested Interest in Obamacare Succeeding

The Republican Party is so busy prostituting itself to the Christofascist/Tea Party elements of the party base that oppose the Affordable Health Care Act, a/k/a Obamacare - many of whom are frankly motivated primarily by a racist base hatred of Barack Obama - that they seem to be ignoring another powerful interest group that has significant reasons: the healthcare industry.  Many powerful players in the healthcare industry realize that repealing Obamacare and going back to the increasingly broken system that was previously in place is simply not acceptable.  With the ranks of the uninsured soaring but for Obamacare and healthcare costs out of control, at some point the entire structure will collapse without change.  The Los Angeles Times looks at why the healthcare industry will ultimately strive to make Obamacare work.  Here are excerpts:

WASHINGTON — President Obama's healthcare law, struggling to survive its botched rollout, now depends more than ever on insurance companies, doctor groups and hospitals — major forces in the industry that are committed to the law's success despite persistent tensions with the White House.

Many healthcare industry leaders are increasingly frustrated with the Obama administration's clumsy implementation of the Affordable Care Act. Nearly all harbor reservations about parts of the sweeping law.

But since 2010, they have invested billions of dollars to overhaul their businesses, design new insurance plans and physician practices and develop better ways to monitor quality and control costs.

Few industry leaders want to go back to a system that most had concluded was failing, as costs skyrocketed and the ranks of the uninsured swelled.

Nor do they see much that is promising from the law's Republican critics. The GOP has focused on repealing Obamacare, but has devoted less energy to developing a replacement.  Healthcare industry officials generally view several GOP proposals, such as limiting coverage for the poor and scuttling new insurance marketplaces created by the law, as more damaging than helpful to the nation's healthcare system.

"The principle of providing the opportunity for everyone to get health coverage and of joining everybody together in shared responsibility is the right one," said James Roosevelt Jr., president of Tufts Health Plan, one of Massachusetts' largest insurers. "No one has presented a credible alternative."

The value of the alliance between the administration and major insurers, hospitals, clinics and others in the healthcare industry can readily be seen in steps they have taken to help the White House overcome the rocky start of the law's new insurance marketplaces.

Major retail pharmacies, such as CVS Caremark, have agreed to market the law's benefits in their stores. And hospitals and health clinics in many states are helping patients sign up for coverage.

For many of these organizations, the prospect of new customers and a more rational system outweighs their sometimes intense irritation with the Obama administration.

Despite the frustrations, most insurers remain committed to moving to a new market that would achieve the central promise of the Affordable Care Act: that all consumers can buy health plans even if they have preexisting medical conditions.

Even the chief executive of WellPoint, the nation's second-largest health insurer, which spent heavily in 2010 to help defeat Democrats in Congress who had voted for Obamacare, signaled optimism this week about the prospects for people signing up for coverage under the law in coming months.

"The potential is there for a significant uptake," Joseph Swedish said in an interview this week at a conference for corporate executives sponsored by the Wall Street Journal.

Hospitals, which provided crucial backing for the law in hopes it would reduce the number of uninsured patients, have been redesigning the way they deliver care to keep patients out of the hospital, another goal of the law.

We are still not entirely sure where we are going," said Judy Rich, chief executive of Tucson Medical Center in Arizona, which has been partnering with local doctors to help patients stay healthy so they don't need to be hospitalized.  "But every time we reevaluate the options, we come back to one conclusion: This is fundamentally the right thing to do."

"The fact is that doctors and hospitals around the country are committed to achieving the goals of the health law: expanding coverage and, more importantly, raising quality … and making healthcare more cost-effective," he said.  "There is no going back."

Government Shut Down - The GOP Obsession with Obamacare

So far many of the dire warnings of the GOP demagogues about Obamacare have failed to come to fruition and in a number of states it appears that premiums will be less expensive that the doomsday Cassandras predicted.  It seems that other than the Tea Party/Christofascist crowd, the only folks screaming are greedy business owners who view employees as modern day serfs and similarly greedy doctors who claim poverty while living far better than most of the populace (I have yet to meet a poor doctor in my legal practice - I tend to avoid them as clients because most are obnoxious and don't want to pay for services rendered).  So why is the GOP willing to shut down the federal government that will harm vast numbers of individuals and businesses?  A column in the Washington Post looks at the GOP obsession with destroying Obamacare and throwing millions of Americans back into an uninsured status. Here are highlights:

With the right wing in full-throttle defund-Obamacare mode, everyone seems to be wondering whether the August recess will bring a rerun of the now-mythical Summer of ’09, when the Tea Party came into its own and changed the national conversation on health care. One question seems to be whether the continuing Obamacare obsession will eclipse immigration reform.

But the Asheville Citizen Times of North Carolina offers an account of something else entirely: A GOP Congressman, Patrick McHenry, getting confronted by a constituent — one Skip Edwards — who is upset with his votes to repeal Obamacare, because of his own medical and financial situation. What’s particularly interesting is Rep. McHenry’s claim that he supports parts of the Affordable Care Act, chiefly the bit prohibiting discrimination against people with preexisting conditions:

Edwards and his wife, both 63, had health insurance until he lost his job during the recessio

n and the East Asheville couple found themselves in financial trouble despite staying relatively healthy.

Edwards and others wondered why McHenry would vote against a plan they feel is better than nothing at all. He said he would not vote for something he feels is bad policy.

McHenry floated a few familiar GOP solutions — allowing the buying of insurance across state lines and increasing competition — but Edwards said he wasn’t satisfied.

It’s easy to rail about Obamacare’s evils inside the safe confines of the conservative media echo chamber. But it may not be so easly for GOP lawmakers to explain to their constituents that they support repealing specific provisions in Obamacare, i.e., the ban on discrimination against preexisting conditions. 

[A]s unpopular as Obamacare admittedly remains, the battle over health care in 2014 may also be partly decided by the prosaic question of which side is perceived as genuinely wanting to fix our health care system. It remains to be seen whether suggestions such as those McHenry offered will be enough.

On top of this, conservative are putting heavy pressure on GOP lawmakers not just to keep trying to repeal Obamacare, but to shut down the government to force an Apocalyptic stand against the law. If it’s hard to explain repealing certain parts of the law, how will GOP lawmakers explain shutting down the government to defund it?

It also remains to be seen whether such episodes will get anywhere near the play that will likely be lavished on tales of Obamacare implementation going awry. Sure, constituents who don’t want the law’s provisions taken away may not be wearing funny three cornered hats or holding up signs proclaiming that tyranny has arrived on American shores, so they may not get much media attention. But surely they are an important part of the story, too.

Truth be told, the GOP simply doesn't care about a vast portion of the American population.  We're disposable garbage,  especially if we are black, Hispanic, or gay.