Pre-existing Conditions – R&R – Reachout and Rebuild

What are Trump’s chances?

David Posnett — Sat, 03 Oct 2020 13:48:27 +0000

What are the chances of hospitalization, ICU admission, and death in a COVID-19 patient like Donald Trump?

There is a ton of data relating to age of the patient, sex of the patient, obesity, pre-existing conditions, etc. There are important caveats, however: there may be different outcomes depending on the quality of the medical care, availability of new treatments, but also different outcomes depending on the timing of the infection within the course of the pandemic. Much of the data available on the web are analyses from Feb. through April 2020, early in the course of the pandemic. Current observations suggest that the case fatality rate (deaths per total diagnosed cases) is changing for the better. Much of the data is also different depending on the country or region selected for analysis. F. ex. in Southern and Western states of the US patients are younger than in the North Eastern states, according to recent trends!

For patients like D. Trump (74 yo; obese; male) the chances are:

hospitalization	about 30%
ICU admission	about 10-15%
death	about 5-10%

NB: obesity, with a BMI (Body Mass Index) of just over 30 in Pres. Trump’s case, increases the death rate by perhaps about 2-fold.

In one study from Georgia of 305 Covid-19 patients that were hospitalized, 39% were admitted to the ICU, but among those older than 65, 54% were admitted to the ICU. Of those in the ICU 37-48% died.

DT is already hospitalized. He now has perhaps a 1:2 chance of being admitted to the ICU and if he is admitted to the ICU, maybe a 1:3 or greater chance of death.

Here are some graphs to illustrate:

Death rates in the Spring of 2020 in various countries

Overall Case Fatality Rate (death rate) in the US over time

And here is a related article on the likely reasons for hospitalizing DT.

We Got to Work Together

David Posnett — Tue, 05 May 2020 14:49:41 +0000

“Being different is cool” – a lesson from kids in Germantown, PA.

A truly powerful video relevant to our current times (click on the image to see the musical video):

Recognized by the United Nations for Extraordinary Public Service

“On the Other Side of the Fence” is a touching documentary about a musical (by the same name) that was created to foster empathy and partnership between children from two Philadelphia schools for over 30 years.

Drug Prices: How Pharma Games the System

David Posnett — Sun, 28 Oct 2018 15:55:50 +0000

We have all seen the TV ads for Humira…

What they don’t show is the cost. For instance there are a number of different TNFalpha blockers, including Humira (adalimumab) and Embrel (etanercept). The following site lists their comparable pricing: https://www.goodrx.com/tnf-blockers

These drugs are used for autoimmune disorders like Rheumatoid Arthritis (32%), Psoriasis (30%), Ulcerative Colitis (19%), Crohn’s Disease (19%). These are chronic diseases that can not be “cured”. In stead they are rendered manageable by medication that may have to be taken life long.

Why are these drugs so expensive? Priti Krishtel explains:

A Humira Prescription Costs $38,000 A Year Because Our Patent System Is Being Abused

Priti Krishtel

Guest Writer

ASSOCIATED PRESS

Sue Lee, 76, has plaque psoriasis, an incurable, chronic skin condition that causes itchy, painful sores. To give her some relief, Lee’s doctor prescribed Humira, a patent-protected drug with no generic option. In 2012, the drug cost about $19,000 a year. Today, it costs more than $38,000 a year. Even with Medicare, Lee, who retired last year and lives in Kentucky, would have to drain the little savings she has in order to afford the drug.

Retirement should be the peaceful denouement of a lifetime of work. Instead, millions of seniors are being forced to draw down on their retirement savings or forgo necessities like food and rent to pay for arbitrarily and mercilessly high-priced prescription drugs. Some skip doses to make ends meet or, like Lee, simply suffer in silence. As the proportion of seniors to the total population grows, the problem is only going to get worse.

Not surprisingly, older Americans are hit especially hard by high drug prices. People ages 65 and older use far more prescription drugs than younger Americans; at any given time, older Americans are taking an average of 4.5 different prescriptions. Seniors are also three times more likely than those in their 20s to need costly specialty drugs, like Humira, that treat relatively uncommon conditions and have few, if any, generic alternatives. Making matters worse, over the last decade drugs widely used by older Americans have tripled in price on average, far exceeding the rate of inflation.

With 1 in 5 Americans expected to be 65 or older by 2030, the country is staring down the barrel of a massive health care and fiscal crisis.

There are a lot of reasons why drug prices in the U.S. are so high. They aren’t regulated, so pharma companies can and do set prices as high as they want. And Medicare, the largest purchaser of drugs, is forbidden from negotiating those prices down. But another important and often overlooked factor is the ongoing manipulation of our patent system.

An analysis released last month by my organization, the Initiative for Medicines, Access & Knowledge, shows that there have been an astonishing 247 patents filed on Humira, nearly half of them in just the last four years. Richard Gonzalez, CEO of the drug’s maker, AbbVie, has said that “any company seeking to market a biosimilar version of Humira will have to contend with this extensive patent estate, which AbbVie intends to enforce vigorously.” In other words, the company has created such a morass of patents around Humira as to deter generic competition in the U.S. for years to come.

It’s a deliberate strategy designed to prolong the company’s monopoly, and AbbVie isn’t alone in using it. In a separate report released by I-MAK in August, we found there are an average of 125 patent applications filed and 71 patents granted for each of the 12 highest-grossing drugs in America. In many cases, these “add-on” patents were for minor or obvious modifications — a different dosage form, for example — that don’t meet the standard for breakthrough invention that the patent system was designed to reward. Still, they have often succeeded in prolonging exclusivity well beyond the 20 years of protection intended under U.S. law. For example, the U.S. patent on Humira expired in 2016, but add-on patents and reported settlements made with generic suppliers will keep generic alternatives out of reach of patients until at least 2023.

For Lee in Kentucky, the high cost of Humira in the U.S. means her psoriasis hasn’t been treated in nearly a year. When the sores get really bad, she puts ice packs on her body, sits at her desk and fights back tears.

With 1 in 5 Americans expected to be 65 or older by 2030, the country is staring down the barrel of a massive health care and fiscal crisis. Unless something is done to stop frivolous patents from delaying generic entry, Medicare and the millions of seniors who rely on it will experience unprecedented strain.

Overpatenting is a problem that needs to be brought into full public view, starting with our representatives in Congress holding hearings so that patent abuse can be exposed. Right now, America’s patent system is far more sympathetic to claims of “originality” than those of other countries, and less likely to consider public health impact. It will ultimately take a motivated and mobilized citizenry to enact the necessary reforms to stop this root cause of high drug prices.

If we don’t act now, every one of us will one day face the nightmare of not being able to afford and access the medicines we need. For the millions of Americans like Lee who are in desperate need of relief, that nightmare is right now.

Priti Krishtel is the co-founder and co-executive director of I-MAK.org, a global nonprofit organization of attorneys, scientists and health experts who have worked to lower drug prices for 15 years.

10 REASONS WOMEN MUST #FlipThe1st!

David Posnett — Fri, 26 Oct 2018 14:25:08 +0000

Issue #2: August, 2018 by Jacquelyn Gavron and Amy Turner

Lee Zeldin repeatedly votes for laws that jeopardize the health and financial wellbeing of 55% of his constituents: the 310,000 females in New York’s 1st Congressional District. Women in NY01 deserve a representative who understands that when women succeed, families and communities do too. Here’s Zeldin’s voting record, which speaks for itself.

#1 “FEMALE” IS NOT A PRE-EXISTING CONDITION

Zeldin and the GOP-controlled house voted to repeal the Affordable Care Act (ACA) and replace it with the American Health Care Act (AHCA). Had it passed, 61,951 people in NY01 would have lost their health care (ACASignups.net). And insurance companies would be allowed to charge women more than men and refuse to cover:

Essential services—pregnancy, maternity and newborn care
Pre-existing conditions —pregnancy, C-sections, celiac disease, hysterectomies, eating disorders, and treatment for domestic violence and sexual assault
Preventive services—mammograms, screenings for cervical cancer, osteoporosis, anemia, gestational diabetes and preeclampsia; and breastfeeding support and supplies.

Did you know. . . Zeldin has received a whopping $267,975 in contributions from insurance companies since 2014. (OpenSecrets.org).

#2 WOMEN DESERVE EQUAL PAY

In Suffolk County, women earn $51,014 for a job that pays men $65,326—$14,312 less. (labor.ny.gov). Don’t expect Zeldin to help. He’s repeatedly undermined equal pay protection by:

Voting to block Congress from considering the Paycheck Fairness Act, a bill to end the pay gap and protect workers from retaliation for sharing info on their wages. (H.R. 1619, 2015)
Voting to make it extremely difficult for women seeking equal pay to bring a class action lawsuit against their employers. (HR 1927, 2016).

#3 LET WOMEN CONTROL THEIR OWN BODIES

Zeldin voted for a bill to ban abortion at 20 weeks (directly challenging Roe v. Wade), which was opposed by the American Congress of Obstetricians and Gynecologists as a serious threat to women’s health and not based on sound science. Zeldin has supported:

Amending the constitution to ban abortion except to save life of mother
A nationwide ban on private insurance coverage of abortion
Federal legislation allowing parents to prevent their daughters from receiving abortions
Requiring rape victims to wait 48 hours before obtaining an abortion
Barring the government from distributing emergency contraceptives

#4 GUN VIOLENCE IS A WOMAN’S ISSUE

Zeldin co-sponsored the federally mandated concealed carry bill, which would override New York’s strict gun laws and let gun owners with a history of violence against women roam our neighborhoods with a hidden, loaded gun. Most people don’t know the hidden toll guns take on women:

50 women a month are shot to death by a current or former partner
4.5 million American women have been threatened with guns, often by intimate partners, so they live in fear for themselves and their children for days, months and even years.
U.S. women are 16x more likely to be killed with a gun than in other high-income countries.

#5 WE NEED PAID FAMILY LEAVE

Most workers are covered by the Family Medical Leave Act, which lets you take up to 12 weeks of leave a year to care for family members. But for most people, that leave is unpaid. The GOP solution? Take a “loan” from Social Security and delay receipt of your retirement income.

#6 SOCIAL SECURITY: ON THE CUTTING BLOCK

The GOP tax scam gives huge tax cuts to the wealthy and large corporations that add $2 trillion to the national debt. They’re using this as an excuse to slash Social Security—it’s especially important to women as they earn less, take more time out of the workforce, live longer, save less and get smaller pensions.

In NY01, 150,262 people receive Social Security. Zeldin said he’d “continue to support legislation that protects and supports Social Security and Medicare” (letter, 6/2017) but he:

Voted YES to a constitutional amendment that would allow Social Security to pay beneficiaries only if a federal budget surplus could offset them. (HJ Res.2, 4/12/18)
Voted to block the transfer of tax revenue to keep the Disability Insurance afloat—unless it was part of a larger plan to cut benefits or tax increases. (HRes 5, 1/6/15; Politico).

#7 GOP GUNNING FOR MEDICARE & MEDICAID

In New York, nearly 2 million women rely on Medicare for their health insurance. Zeldin voted for a budget resolution (H.Con.Res 71, 10-15-17) that would pay for Trump’s huge tax cuts by:

Slashing Medicare by $487 billion
Increasing the age at which you can apply for Medicare from 65 to 67 nscpssm.org

More women than men are covered by Medicaid as they often work in lower paying jobs, and many work for small businesses that don’t offer health insurance. But Zeldin voted to take way the Medicaid option. And Trump recently gave the go-ahead for states to take away Medicaid from people who aren’t working a minimum number of hours a month. This disproportionally hurts women because they:

Often work in low-wage jobs with inconsistent hours that may not meet the requirements.
Typically care for children or other family members and aren’t in the paid workforce

#8 UN-AFFORDABLE CHILD CARE

Trump’s tax scam doubled the maximum child tax credit from $1,000 to $2,000—“but the parents of about 29 million kids won’t get the credit because their families earn too little.” (TPC.org).

#9 PLANNED PARENTHOOD

Zeldin has repeatedly voted to defund Planned Parenthood. Perhaps he doesn’t understand that Planned Parenthood provides a wide range of health care services to 2.4 million clients, including, prenatal care, breast exams, PAP smears, vasectomies, HIV and STD testing and treatment, and sex education.

#10 WOMEN DESERVE A REP WHO VALUES WOMEN

In January 2017, thousands of Zeldin’s constituents showed up at women’s marches in D.C., NYC, Port Jeff, Sag Harbor and other places to advocate for women’s rights. But rather than acknowledge their concerns, Zeldin questioned their sanity, suggesting that some of his constituents might hold views that are “off the reservation” and using his 37th birthday two weeks later as an occasion to express his “love” for “even those Hillary supporters who have lost [their] beautiful minds since the election.”

GOP Health Bill’s Changes Go Far Beyond Preexisting Conditions

David Posnett — Mon, 25 Sep 2017 20:48:06 +0000

KAISER HEALTH NEWS — REPEAL & REPLACE WATCH

By Julie Rovner September 22, 2017

Sen. Bill Cassidy (R-La.) speaks as Sen. Dean Heller (R-N.V.) and Sen. Lindsey Graham (R-S.C.) listen during a news conference on health care September 13, 2017. Senators Graham, Cassidy, Heller and Johnson unveiled a proposed legislation to repeal and replace the Obamacare. (Alex Wong/Getty Images)

The latest GOP effort to “repeal and replace” the Affordable Care Act is getting a lot of attention, even if its passage seems unlikely. But there is far more to the measure than its changes to rules regarding preexisting health conditions.

In fact, the bill proposed by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) would disrupt the existing health system more than any of the measures considered so far this year, according to supporters and critics.

For backers of the bill, that disruption is a good thing. But others are appalled. As insurance industry analyst Robert Laszewski put it in a note to clients this week, “Would you rather lose your Republican Senate seat because you couldn’t pass an Obamacare repeal-and-replace plan or because you blew up the health insurance system?”

Some of those alterations have generated little discussion but would have major impacts. Here are four unheralded changes:

— The Bill Caps Federal Funding To Medicaid

Much focus has been placed on the bill’s funding formula, which would take money from states that expanded the Medicaid program for the poor. Less notice has been paid to the fact that this bill, like some other GOP options over the summer, would, for the first time, cap overall federal Medicaid funding. The federal government has provided an open-ended funding match since the program’s creation in 1965 — meaning the federal government has provided its share of whatever states spend to care for low-income children, pregnant women, seniors and people with disabilities. More than 70 million people are covered by Medicaid, including those added as a result of the ACA.

Republicans have been pushing unsuccessfully to limit the federal government’s funding of Medicaid to states since the 1980s.

State Medicaid directors — including both Republicans and Democrats — are alarmed at the idea that something of such magnitude could be done with so little debate or consideration. “Graham-Cassidy would completely restructure the Medicaid program’s financing, which by itself is three percent of the nation’s Gross Domestic Product and 25 percent of the average state budget,” said a statement from the group.

The Congressional Budget Office estimated in June that an earlier version of the cap would reduce federal Medicaid spending 35 percent by 2036. As a result, said CBO, states would “need to … decide whether to commit more of their own resources, cut payments to health care providers and health plans, eliminate optional services, restrict eligibility for enrollment, or adopt some combination of those approaches.”

“There won’t be enough money to do what’s authorized under current law,” said Jessica Schubel of the left-leaning think tank the Center on Budget and Policy Priorities.

— The Bill Gives Unprecedented Power To The Secretary Of Health And Human Services

Republicans complained bitterly about the power delegated by Congress to the secretary of Health and Human Services in the ACA. But conservative analyst Chris Jacobs pointed out that the Graham-Cassidy bill gives the HHS secretary more power still.

The bill creates a dizzyingly complex formula for the funds now being spent on the ACA, which is intended to draw money away from wealthier states (that mostly expanded Medicaid under the health law) toward poorer ones (that mostly did not). But there is a huge loophole, noted Jacobs. The bill gives the HHS secretary authority to change the formula on his or her own.

“That’s a trillion-dollar loophole that leaves HHS bureaucrats with the ultimate say over how much money states will receive,” Jacobs wrote.

And, he said, it’s the opposite of “federalism,” or giving states more authority, which the bill’s sponsors claim to be advancing.

“Draining the swamp shouldn’t involve distributing money from Washington out to states, whether under a simple formula or executive discretion,” he wrote. “It should involve eliminating Washington’s role in doling out money entirely.”

— The Bill Cuts Off All ACA Funding After 2026

The bill would lump together all funds being spent under the health law to help people pay premiums, out-of-pocket health costs and expand Medicaid to non-disabled adults and redistribute those funds to the states in the form of block grants. States could then use that money for almost anything health-related.

What few people have noticed, however, is that those block grants end abruptly after 2026. Originally, many thought this was because of congressional budget rules that limit new programs to no more than 10 years.

In fact, those rules only say that a program cannot add to the deficit after 10 years. The block grant is paid for by ongoing taxes generated from the ACA, so there is no budget requirement to end the block grant.

The reason seems to be a desire to require Congress to come back and revisit the program. A spokesman for Cassidy said the program “just has to be reauthorized in 2026 just like the CHIP program.” CHIP is the Children’s Health Insurance Program, also created in a budget bill in 1997. Congress was supposed to reauthorize that program by the end of September, although it looks as if lawmakers will miss that deadline, despite bipartisan support.

Others, however, worry that cutting the money off after 2026 means Congress could no longer use the current funding mechanism. Instead, lawmakers would have to come up with massive cuts to other programs or new tax increases if they wanted to continue providing the money for health care.

— The Bill Could Roil The Individual Insurance Market In Some States By Banning Abortion Coverage In Private Health Plans.

In keeping a promise to anti-abortion lawmakers, the bill would prohibit all private insurance plans receiving any federal funds from providing abortion coverage.

As part of a delicate compromise that got the ACA enacted in 2010, states were given the option to ban abortion coverage in plans on their health exchanges. Half of them did.

But some states, notably California, New York and Oregon require plans they regulate to offer coverage of elective abortions.

The problem is that the deadline for insurers to opt into coverage under the ACA is next Wednesday. If Congress were to pass the bill after that, it is unclear what would happen to those plans. In California, the requirement for abortion coverage is based on the state’s Constitution, so it would be possible that no plans could be offered to people who are eligible for federal help.

“There aren’t clear answers” to what would happen if the bill becomes law in its current form and takes effect in January, said Debra Ness, president of the National Partnership for Women and Families, a reproductive rights advocacy group. “I think it’s going to create chaos.”

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Graham-Cassidy — The Last-Ditch Effort By Republicans To Replace ACA: What You Need To Know

David Posnett — Wed, 20 Sep 2017 15:31:43 +0000

By Julie Rovner September 19, 2017

Sen. Lindsey Graham (right), stands with Sen. Bill Cassidy (left), Sen. Dean Heller and Sen. Ron Johnson (second from right), as well as former senator Rick Santorum (center), to announce their legislation to repeal and replace Obamacare through block grants. (Jim Watson/AFP/Getty Images)

While the chances for this last-ditch measure appear iffy, many GOP senators are rallying around a proposal by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), along with Sens. Dean Heller (R-Nev.) and Ron Johnson (R-Wis.)

They are racing the clock to round up the needed 50 votes — and there are 52 Senate Republicans.

An earlier attempt to replace the ACA this summer fell just one vote short when Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and John McCain (R-Ariz.) voted against it. The latest push is setting off a massive guessing game on Capitol Hill about where the GOP can pick up the needed vote.

After Sept. 30, the end of the current fiscal year, Republicans would need 60 votes — which means eight Democrats — to pass any such legislation because special budget rules allowing approval with a simple majority will expire.

Unlike previous GOP repeal-and-replace packages that passed the House and nearly passed the Senate, the Graham-Cassidy proposal would leave in place most of the ACA taxes that generated funding to expand coverage for millions of Americans. The plan would simply give those funds as lump sums to each state. States could do almost whatever they please with them. And the Congressional Budget Office has yet to weigh in on the potential impact of the bill, although earlier estimates of similar provisions suggest premiums would go up and coverage down.

“If you believe repealing and replacing Obamacare is a good idea, this is your best and only chance to make it happen, because everything else has failed,” said Graham in unveiling the bill last week.SIGN UP

Here are five things to know about the latest GOP bill:

1. It would repeal most of the structure of the ACA.

The Graham-Cassidy proposal would eliminate the federal insurance exchange, healthcare.gov, along with the subsidies and tax credits that help people with low and moderate incomes — and small businesses — pay for health insurance and associated health costs. It would eliminate penalties for individuals who fail to obtain health insurance and employers who fail to provide it.

It would eliminate the tax on medical devices.

2. It would eliminate many of the popular insurance protections, including those for people with preexisting conditions, in the health law.

Under the proposal, states could “waive” rules in the law requiring insurers to provide a list of specific “essential health benefits” and mandating that premiums be the same for people regardless of their health status. That would once again expose people with preexisting health conditions to unaffordable or unavailable coverage. Republicans have consistently said they wanted to maintain these protections, which polls have shown to be popular among voters.

3. It would fundamentally restructure the Medicaid program.

Medicaid, the joint-federal health program for low-income people, currently covers more than 70 million Americans. The Graham-Cassidy proposal would end the program’s expansion under the ACA and cap funding overall, and it would redistribute the funds that had provided coverage for millions of new Medicaid enrollees. It seeks to equalize payments among states. States that did not expand Medicaid and were getting fewer federal dollars for the program would receive more money and states that did expand would see large cuts, according to the bill’s own sponsors. For example, Oklahoma would see an 88 percent increase from 2020 to 2026, while Massachusetts would see a 10 percent cut.

The proposal would also bar Planned Parenthood from getting any Medicaid funding for family planning and other reproductive health services for one year, the maximum allowed under budget rules governing this bill.

4. It’s getting mixed reviews from the states.

Sponsors of the proposal hoped for significant support from the nation’s governors as a way to help push the bill through. But, so far, the governors who are publicly supporting the measure, including Scott Walker (R-Wis.) and Doug Ducey (R-Ariz.), are being offset by opponents including Chris Sununu (R-N.H.), John Kasich(R-Ohio) and Bill Walker (I-Alaska).

On Tuesday 10 governors — five Democrats, four Republicans and Walker — sent a letter to Senate leaders urging them to pursue a more bipartisan approach. “Only open, bipartisan approaches can achieve true, lasting reforms,” said the letter.

Bill sponsor Cassidy was even taken to task publicly by his own state’s health secretary. Dr. Rebekah Gee, who was appointed by Louisiana’s Democratic governor, wrote that the bill “uniquely and disproportionately hurts Louisiana due to our recent [Medicaid] expansion and high burden of extreme poverty.”

5. The measure would come to the Senate floor with the most truncated process imaginable.

The Senate is working on its Republican-only plans under a process called “budget reconciliation,” which limits floor debate to 20 hours and prohibits a filibuster. In fact, all the time for floor debate was used up in July, when Republicans failed to advance any of several proposed overhaul plans. Senate Majority Leader Mitch McConnell (R-Ky.) could bring the bill back up anytime, but senators would immediately proceed to votes. Specifically, the next order of business would be a process called “vote-a-rama,” where votes on the bill and amendments can continue, in theory, as long as senators can stay awake to call for them.

Several senators, most notably John McCain, who cast the deciding vote to stop the process in July, have called for “regular order,” in which the bill would first be considered in the relevant committee before coming to the floor. The Senate Finance Committee, which Democrats used to write most of the ACA, has scheduled a hearing for next week. But there is not enough time for full committee consideration and a vote before the end of next week.

Meanwhile, the Congressional Budget Office said in a statement Tuesday that it could come up with an analysis by next week that would determine whether the proposal meets the requirements to be considered under the reconciliation process. But it said that more complicated questions like how many people would lose insurance under the proposal or what would happen to insurance premiums could not be answered “for at least several weeks.”

That has outraged Democrats, who are united in opposition to the measure.

“I don’t know how any senator could go home to their constituents and explain why they voted for a major bill with major consequences to so many of their people without having specific answers about how it would impact their state,” said Senate Minority Leader Chuck Schumer (D-N.Y.) on the Senate floor Tuesday.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Letter to Sen. McCain

David Posnett — Tue, 19 Sep 2017 18:50:08 +0000

From Max Plesset MD (Springs, East Hampton)

Dear Senator McCain,

I have always respected your independence, judgement and thoughtful decision making. Now you have a serious malignancy and I am sorry for that. Undoubtedly you are receiving the best of care that the American health system has to offer. However, it is clear that the Graham-Cassidy bill will jeopardize the kind of care you are getting for a large number of our citizens and your constituents in Arizona. By transferring most if not all of the current federal health care dollars to block grants to the states many people, especially medicaid patients, will be at the mercy of the state spending priorities. Please uphold your integrity as you did before by voting no on this bill. Thank you for considering my email.

to send email to Sen. McCain:

https://www.mccain.senate.gov/public/index.cfm/contact-form

Graham Cassidy Obamacare Repeal Bill May Pass

David Posnett — Sun, 17 Sep 2017 18:18:34 +0000

Senator says Obamacare repeal bill close to enough votes to pass, but there’s reason to be skeptical

The Graham-Cassidy bill would strip away $80 billion in federal funding support for health coverage.
Prior bills that were likewise expected to lead to big increases in the number of uninsured Americans failed in the Senate.
Obamacare defenders started rallying Thursday to defeat the latest bill.

Dan Mangan | @_DanMangan

Published 11:37 AM ET Fri, 15 Sept 2017 | Updated 8:13 PM ET Fri, 15 Sept 2017 CNBC.com

Senator says Obamacare repeal bill close to enough votes to pass, but there’s reason to be skeptical. A leading Senate sponsor of another bill that seeks to repeal and replace key parts of Obamacare claimed Friday that it has almost enough votes from fellow Republicans to pass. But the so-called Graham-Cassidy bill continues to face the same kind of hurdles that doomed previous GOP efforts in the Senate to undo major provisions of the Affordable Care Act.

And there is a new hurdle: Republicans have just 15 days to pass the bill under the reconciliation process being used to grease the skids for repeal of the ACA.

That is a very tight procedural timeline — but the chance that it can be done led Obamacare supporters to mobilize Thursday.

Sen. Bill Cassidy, R-La, told reporters that the bill now has the support of up to 48 or 49 Republicans. That is just one vote shy of the 50 senators that the bill needs to win passage, given that Vice President Mike Pence would break any tie in his fellow Republicans’ favor.

“I’m confident we’ll get there on the Republican side,” Cassidy said, according to the Washington Examiner. “People are coming out and saying they are for it, either publicly or privately.”

“Talking to a few more,” Cassidy said, according to Vox.com

But similar optimistic comments by other senators in recent months about the prospects of previous Obamacare repeal bills have been proven wrong, badly.

Sen. John McCain, R-Ariz., in July dramatically voted no against a last-ditch, early morning effort by the GOP to pass a version of repeal.

Sen. Rand Paul, R-Tenn., had voted for that prior bill. But the libertarian Paul on Friday cast cold water on the Graham-Cassidy bill.

Graham-Cassidy also could face the same opposition from two moderate Republicans, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, that with McCain’s vote doomed late July’s bill.

The latest bill, released Wednesday, would eliminate Obamacare’s requirement that most Americans have some kind of health insurance or face a fine, and that large employers offer affordable health coverage to workers or pay a penalty.

And it would wipe out Obamacare funds that now subsidize the purchase of private health plans by millions of low- and middle-income people, and eliminate the expansion of Medicaid benefits to millions of poor adults.

In its place, Graham-Cassidy would award individual states block grants of money to craft their own health insurance system. But net federal spending related to support of health coverage would drop by many billions of dollars.

The bill has yet to receive an analysis by the Congressional Budget Office.

Previous CBO “scores” of the other Obamacare repeal bills found that they would lead to 20 million or more people lacking health insurance by 2026.

That big number spooked several GOP senators, and led to a widespread public backlash against the bills.

Graham-Cassidy is likely to receive a similar, or perhaps even worse CBO score in terms of the number of newly uninsured, given its design.

In an analysis posted Wednesday, the Center on Budget and Policy Priorities wrote that the bill “would have the same harmful consequences as those prior bills.”

“It would cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid, and increase out-of-pocket costs for individual market consumers,” said the liberal think tank.

CBPP also noted that there would be an $80 billion reduction in the amount of federal money spent nationally on insurance support, and published a chart detailing the funding losses per state.

Despite that, defenders of Obamacare were taking very seriously the chance that the bill could pass, and sought to remobilize the kind of public opposition that helped defeat prior bills.

Among them was Andy Slavitt, who ran the federal Centers for Medicare and Medicaid Services under President Barack Obama.

Brad Woodhouse, director of the Protect our Care Campaign, in an email Friday blasted the Graham-Cassidy bill, but noted Republicans “are only a handful of votes away from passing it.”

“Given Republicans will have to ram this partisan repeal bill through the Senate in the next two weeks in order to meet this September 30 deadline there will be no time for a regular process for the public to fully understand the impacts on their health care — with no time for adequate hearings, consultations with experts, constituent input, and amendments,” Woodhouse wrote.

“Republicans in the Senate are resorting back to a secret, partisan process to force through health care repeal out of public view. The American people need to know the facts about how this bill will impact them. ”

Sen. Ron Wyden, D-Ore., also took to Twitter to rally people to oppose the bill.

If the GOP does not pass the Graham-Cassidy bill, it is extremely unlikely that they will be able to approve any Obamacare repeal legislation before the midterm elections in 2018.

That fact could add some momentum to the latest repeal effort.

SENATORS TO CALL/OR EMAIL:

JOHN MCAIN ph: (928) 445-0833. https://www.mccain.senate.gov/public/index.cfm/contact-form

LISA MURKOWSKI https://www.murkowski.senate.gov/contact/email

SUSAN COLLINS https://www.collins.senate.gov/contact

New Senate health bill shows no love for New York

David Posnett — Mon, 17 Jul 2017 12:13:58 +0000

http://buffalonews.com/2017/07/15/new-senate-health-bill-shows-no-love-new-york/

By Jerry Zremski | Published July 15, 2017 | Updated July 15, 2017

WASHINGTON – To hear New York health care experts tell it, the Republican senators’ new plan to replace Obamacare is the legislative equivalent of a grave pre-existing medical condition, made worse through a haphazard quack treatment.

They say the bill is largely a status quo measure that preserves the quadruple whammy that could cost the state billion dollars more per year than a House-passed measure that leaves the state $7 billion short annually. But they also say the new Senate bill is worse in one way in that it threatens to eat away at a key consumer protection provided under state law.

Higher-income New Yorkers would be losers, too, under the measure, as the bill restores some of the taxes that would have been eliminated under the earlier version of the bill. That tax money would go instead to expanded health care subsidies for lower- and middle-income people who buy health insurance on their own.

One unlikely New Yorker emerges as a winner in the new legislation: Rep. Brian Higgins, a Buffalo Democrat who waged a lonely battle against tax breaks for insurance executives – and saw Senate Republicans drop those tax breaks in the revised bill.

Overall, though, the new bill is much more similar to the Senate’s previous version than it is to the law it aims to replace: the 2010 Affordable Care Act, commonly known as Obamacare.

“So far, I’m not seeing much that changes for New York,” said Bill Hammond, health-care analyst at the conservative-leaning Empire Center, an Albany think tank.

Just like its predecessor, the new Senate bill whacks New York’s Medicaid program – which serves everyone from poor children to seniors in nursing homes who spent all their assets on health care – in four ways. It would:

Reduce federal Medicaid payments to states over time by changing the way they are tied to inflation.
Trim payments to states with expensive Medicaid programs by including an “equity adjustment.”
Curb federal funding for states such as New York that expanded Medicaid under Obamacare in a way that will cost New York more than $7 billion more annually starting in 2024.
Keep in place the House’s controversial Collins-Faso amendment that ends New York’s practice of charging counties for part of the cost of Medicaid, pushing at least another $2.3 billion in costs annually onto the state.

Not surprisingly, Gov. Andrew M. Cuomo appeared unimpressed with the new Senate legislation.

“The token changes to the Senate health care bill are a thinly veiled attempt to disguise the same cruel bill,” he said. “Far from improving our health care system, the Senate Republican health care bill is still a death trap for New York.”

Cuomo once again made his case against the Collins-Faso amendment, saying it could lead to cuts that would cripple hospitals, nursing homes and home care providers.

But Rep. Chris Collins, the Clarence Republican who sponsored the amendment with Rep. John Faso, R-Kinderhook, has said Cuomo is more likely to try to raise state taxes instead of finding savings in the state’s huge and costly Medicaid program.

“Through the Collins-Faso amendment, we’re on the verge of delivering the largest property tax reduction ever,” Collins said on Facebook. “Instead of making tough decisions, Governor Cuomo has threatened to push for new taxes on New York families.”

Beyond its impact on Medicaid, Hammond said the Senate bill – like the earlier version and the health bill passed by the House – threatens to eviscerate the state’s Essential Plan, which is aimed at state residents who earn just a bit too much to qualify for Medicaid, the state-federal health program for the poor and lower middle class.

And like its predecessor, the new Senate bill conflicts with existing state law in several ways. It bars people from using federal subsidies to buy insurance plans that cover abortion – yet New York law requires health plans to cover abortion. And the new Senate bill allows insurers to charge older people more for insurance, while New York law does not.

The new Senate measure also adds one new conflict with state law that could totally alter the market for individuals who have to buy insurance on their own – or that could amount to nothing.

The bill includes a provision offered by Sen. Ted Cruz, R-Texas, that allows the sale of bare-bones insurance policies with low premiums and gigantic deductibles, all in an effort to make health coverage more affordable for people who probably wouldn’t buy insurance otherwise.

“I am encouraged that the revised bill ensures consumers have the freedom to choose among more affordable plans that are tailored to their individual healthcare needs,” Cruz said.

New York health experts such as Bea Grause are by no means so encouraged. The president of the Healthcare Association of New York State, Grause said the offering of the Cruz-backed cheap insurance plans would start “a race to the bottom for coverage and consumer protection.”

Higgins agreed, saying that those inexpensive plans are “junk health care” that could upend the insurance market. If healthy people flocked to those plans instead of buying more comprehensive insurance, anyone buying more traditional insurance plans would inevitably have to pay more, given that fewer healthy people would be subsidizing the cost of those better plans.

It’s unclear, though, whether such bare-bones insurance plans would be available in New York, given that current state law bans them from sale in the state. Federal law typically supersedes state law, though, which is why Grause and others fear that court action could open New York’s market to those new health plans.

“I think New York, like a few other states, has a robust regulatory infrastructure,” Grause said. “It would be a question of how or whether the Cruz amendment would apply.”

Despite Higgins’ concerns about the Cruz amendment, the new Senate health bill includes one change that the Buffalo congressman was happy to see. The bill no longer includes a provision that would have given health insurance executives tax breaks valued at as much as $500 million in total.

Higgins was one of the strongest voices in opposition to those tax breaks, railing against it in a committee hearing and on the House floor, calling it a giveaway to corporate executives who don’t deserve it.

He said Senate Republicans stripped that provision from the bill knowing that UnitedHealth, one of the nation’s largest insurers, is facing a Justice Department lawsuit accusing the company of Medicare fraud – and knowing that other insurers could end up in the same trouble.

“They’re saving themselves from further embarrassment,” Higgins said.

Then again, Republican senators were also looking for savings in the bill that allowed them to slightly expand the health insurance tax credits the bill will offer to help the lower middle class to buy insurance.

The new version also preserves taxes on high net worth individuals that were instituted under Obamacare but that were set for repeal under the original Senate health bill. But other Obamacare taxes on medical device companies and health insurers would be repealed, just as they would have been under the Senate bill’s first iteration.

Those changes were by no means enough to satisfy Senate Minority Leader Charles E. Schumer, D-N.Y. He urged Republicans to abandon their current health care effort and instead work with Democrats to improve the current health care system.

“Any Republican who votes to proceed on this bill next week will have to look constituents square in the eye and explain why,” Schumer said. “Why did they move forward on such severe cuts to Medicaid? Why did they cut taxes for special interests? Why did you send my out of pocket costs skyrocketing?”

Meantime, though, Senate Majority Leader Mitch McConnell argued that Democrats were making the-sky-is-falling arguments that have no connection with reality.

“I’m sure we can expect many of the same tired and predictable attacks from the defenders of Obamacare’s failed status quo,” McConnell said. “It hardly matters what the draft says, they would launch the same kinds of attacks anyway.”

McConnell also noted that Democrats wrongly said Obamacare would lower costs and expand health care options while allowing everyone to keep their longtime policy if they chose to do so.

“They were wrong before,” he said. “They’re wrong again today.”

Related stories from the Buffalo News:

What’s at risk if Medicaid is scaled back under health bill? By Henry L. Davis | Published July 2, 2017 | Updated July 3, 2017

Senate bill a quadruple whammy to New York Medicaid program. By Jerry Zremski | Published June 24, 2017 | Updated June 26, 2017

See also the following related recent posts on R&R:

Rural hospital association representative: ‘This bill will close hospitals. … People will die’

Health of Suffolk County Hospitals?

Millions More Uninsured Could Impact Health Of Those With Insurance, Too

Senate’s health care bill will cost New York’s Medicaid program billions

Medicaid Cuts Will Drive Up Cost Of Private Coverage, Montana Insurers Say

Report: BCRA would mean more than 900K healthcare jobs lost

Zeldin’s Approval of Senate Healthcare Bill Reveals His Lack of Concern for Veterans

CONGRESS: KEEP AMERICANS COVERED

The new Senate health care bill — and the return of preexisting conditions — explained

David Posnett — Fri, 14 Jul 2017 13:14:09 +0000

Posted on Vox.com

Updated by Sarah Kliff sarah@vox.com Jul 13, 2017, 1:18pm EDT

Senate Republicans introduced a revised version of their bill to repeal and replace the Affordable Care Act on Thursday, one that would allow insurers to once again deny coverage based on preexisting conditions, and to charge higher rates to sick people.

The bill would keep most of the Affordable Care Act’s tax increases but repeal one aimed specifically at medical device manufacturers. It would deeply cut the Medicaid program, making few changes to the bill’s first draft.

Even with these new changes, the general structure of the bill stays the same from its original draft, which was itself largely similar to the bill that passed the House in the spring.

Healthier and higher-income Americans would benefit from the changes in the new Republican plan, while low-income and sick Americans would be disadvantaged. It would create a two-track system for health coverage on the individual market. One would offer cheaper, deregulated health plans, which healthy people would likely flock to. The other would include comprehensive plans governed by Obamacare’s regulations, which would cost more and mostly be used by less healthy people and those with preexisting conditions — a system experts expect would function like a poorly funded high-risk pool.

Deductibles would almost certainly rise under the Republican plan, as would overall costs for low- and middle-income Americans. Individual market participants would have more options to purchase catastrophic coverage, an option likely to appeal to those with few health care costs.

Experts expect the changes will do little to change the Congressional Budget Office’s estimates that 22 million Americans would lose coverage under the proposal.

You can see a full explainer on the Senate bill here, which will be updated shortly with the latest information. This post focuses on the changes made in the July 13 revision.

Health insurers could bring back preexisting conditions, offer skimpy health plans

Perhaps the biggest policy change in this revision is an amendment to allow health insurers to deny coverage based on preexisting conditions and cover few benefits, so long as they offer a comprehensive plan that covers the Affordable Care Act’s mandated benefits.

These deregulated health plans would be allowed to charge sick people higher premiums or simply deny them coverage. They would not have to pay by the rules of the preexisting condition ban that the Affordable Care Act sets up (Phil Klein at the Washington Examiner has a summary of the rules they’d be exempted from here). Instead, they would operate much like health plans in the pre-Affordable Care Act market, offering cheap rates to consumers they believe would have low medical bills.

Health policy experts know exactly how this would play out: Healthy people would pick the skimpier plan, while the comprehensive plan would essentially become a high-risk pool for sicker Americans.

Individual market enrollees would likely game the system too. A couple expecting a baby, for example, would be expected to upgrade to the plan that covers maternity care for one year before returning to the cheaper plan they had before.

“Someone with chronic illness, they’re going to end up wanting to buy the more comprehensive coverage,” says Joe Antos, a health policy expert with the conservative American Enterprise Institute. “This means that people with those kinds of illnesses will end up paying more. Even if they receive a federal subsidy, they will likely see higher cost sharing.”

As Antos notes, individuals who want to buy the comprehensive plan would receive federal tax credits to do so. They could not use the tax credits for the deregulated plans.

But even after that financial help, these people would still face significant out-of-pocket costs, including high deductibles and premiums. The Congressional Budget Office estimates, for example, that a 64-year-old individual earning $11,500 and receiving tax credits would still need to pay $4,800 to purchase that plan.

The updated Senate bill also allows individuals to use tax credits to purchase catastrophic coverage

There is a quieter way the Senate bill lets people buy skimpier plans: by using their tax credits to purchase catastrophic plans.

This is a practice the Affordable Care Act barred, as the law’s drafters wanted to encourage enrollment in more generous options. But the Senate bill would allow the tax credits to be used for these high-deductible plans. These plans would only include three primary care visits before individuals hit their deductibles and have to pay their medical bills out of pocket. The plans could cover a wide array of health benefits, including maternity and mental health, but, again, coverage would only kick in after paying a large deductible.

The updated bill would let individuals use pre-tax dollars to pay for their premiums

An estimated 29 percent of American workers are enrolled in tax-advantaged health savings accounts (HSA), that allow them to use pre-tax dollars to cover things like copayments and coinsurance.

The Senate bill would allow HSA dollars to go toward premiums as well, meaning someone in the individual market could use pre-tax dollars to pay their monthly bill. This practice was not allowed under the Affordable Care Act.

Liberals have typically opposed this provision, which they argue would mainly benefit wealthy Americans who have the money to contribute to an HSA in the first place. This provision would have fewer benefits for low-income Americans, who rely on tax credits to finance the lion’s share of their premium.

The Senate bill gets rid of most Obamacare tax cuts — but keeps two on high earners in place

The Senate’s revised health care bill still includes an estimated $657 billion in tax cuts by eliminating the health law’s taxes on the medical industry and its individual mandate penalty for not carrying coverage, among other changes.

It does continue two taxes aimed at wealthy Americans: a 0.9 percent investment tax and a 3.8 percent Medicare payroll surtax. Keeping these two taxes in place would net the government an estimated $231 billion in revenue over the next decade, and eliminate some of the benefits high-income Americans would have received under the first draft.

These new taxes, however, do not seem to be fully spent on enhancing the law’s benefits. The new bill includes a $45 billion program to combat opioid abuse as well as $70 billion to offset the costs of expensive patients (this is in addition to the $112 billion already appropriated for that purpose in the first version of the bill). The inclusion of these taxes does not appear to lead to any additional funding of the Medicaid program or offset any of the cuts to the tax credits in the individual market.

The Senate bill still makes very deep cuts to Medicaid

The Senate bill is notable in what it doesn’t change: namely, significant cuts to the Medicaid program. While moderate senators have protested these cuts (particularly those who represent Medicaid expansion states), these provisions of the Senate bill remain largely intact.

One of the main ways Obamacare increased insurance coverage was by expanding the Medicaid program to cover millions more low-income Americans. Prior to the health law, the entitlement was restricted to specific groups of low-income Americans (pregnant women, for example, and the blind and disabled).

Obamacare opened up the program to anyone below 138 percent of the poverty line (about $15,000 for an individual) in the 31 states (plus the District of Columbia) that opted to participate.

The Medicaid expansion gave states generous funding to cover this particular population. Typically, the federal government picks up about half the cost of the Medicaid program and states cover the rest.

For Medicaid expansion, however, the federal government currently pays 95 percent of the costs — an especially good deal for states meant to assuage their budget concerns during the original Obamacare debate.

The Senate bill would begin ratcheting down that Medicaid expansion funding in 2021. By 2024, states would get that same match rate they typically get to cover other populations. In 2021, for example, the match rate would fall to 90 percent, then decline in steps to 75 percent by 2023.

The Congressional Budget Office has projected in a separate analysis that this policy change would mean no additional states expand Medicaid — and that some current expansion states would drop out of the program, resulting in millions losing coverage.

“CBO anticipates some states that have already expanded their Medicaid programs would no longer offer that coverage,” the agency wrote in its analysis of the House bill, which makes a similar change.

The Senate bill would cut the rest of the Medicaid program too

There are significant changes to Medicaid in the Senate bill outside of the expansion too. This bill would convert Medicaid to a “per capita cap” system, where states would get a lump sum from the federal government for each enrollee. Or states would have the opportunity of a block grant — a sum of money untethered from the number of people involved.

This is very different from current Medicaid funding. Right now the federal government has an open-ended commitment to paying all of a Medicaid enrollee’s bills, regardless of how high they go.

The Senate bill would set different amounts for different groups of people. It envisions, for example, higher payments to cover Medicaid enrollees who are disabled (and tend to have higher costs) than for Medicaid enrollees who are kids (generally healthy with lower costs).

The rate at which these payments grow is also important. The Senate bill would have the funding growth tethered to the Medical Consumer Price Index plus 1 percentage point through 2025, and then switch to the urban Consumer Price Index. Analysis of this type of proposal suggests this change would amount to funding cuts for Medicaid, as the program’s spending typically goes up faster than these growth rates.