AHCA – R&R – Reachout and Rebuild

Do or Die on Trumpcare

David Posnett — Tue, 13 Jun 2017 15:54:17 +0000

Senate Republicans want to rush a vote on Trumpcare in JUNE, whether they have the votes or not. The deciding moment may be near. Since much of this is behind closed doors and interest groups such as doctor associations, hospital associations, patients advocates, apparently represent a “half hearted opposition“….well it is up to us, the public, to raise all hell.

here are some breaking stories:

Nationwide blitz launched, in Forbes

The Senate Trumpcare bill

Senate Trumpcare behind closed doors

Sen. Tom Cotton, Sen. Mike Lee and Sen. Rand Paul, all Republicans, have said in the past that they oppose the American Health Care Act and will vote against it.

AARP is targeting Sens. Lisa Murkowski and Dan Sullivan of Alaska, Jeff Flake of Arizona, Cory Gardner of Colorado, Joni Ernest and Chuck Grassley of Iowa, Dean Heller of Nevada, Rob Portman of Ohio, Lamar Alexander and Bob Corker of Tennessee, and Shelley Moore Capito of West Virginia, with aggressive TV advertizing.

Kaiser Family Foundation lists 6 senators that could kill the Senate bill:

Senate Republicans who could stop the Obamacare repeal
SENATOR	STATE	STATE TRUMP MARGIN	STATE EXPANDED MEDICAID
Shelley Moore Capito	West Virginia	+42	✓
Bill Cassidy	Louisiana	+20	✓
Susan Collins	Maine	-3
Dean Heller	Nevada	-2	✓
Lisa Murkowski	Alaska	+15	✓
Rob Portman	Ohio	+8	✓

Here is a useful list with phone numbers:

We All Have Pre-existing Conditions

David Posnett — Tue, 30 May 2017 16:33:29 +0000

If 1/7 people were turned away on medical insurance applications prior to Obamacare (before 2009), then you probably know someone in your circle of friends with a pre-existing condition, who was denied insurance in those “dark ages”. Call or visit your congressperson and give them a piece of your mind. D Posnett MD

Add your stories to those compiled by Elizabeth Rosenthal in her excellent OpEd.

Re-printed from the NY Times Opinion Pages.

By ELISABETH ROSENTHALMAY 29, 2017

Lisa Solod, photographed in 2013, was turned away by four insurers because she was on thyroid replacement, an asthma inhaler, and hormone replacement. Greg Kahn for The New York Times

The Republican health care plan recently passed by the House would hollow out one of the most popular provisions of the Affordable Care Act: a prohibition on charging higher prices to people with pre-existing medical conditions. States, under the plan, could waive that rule, provided they offer publicly funded alternatives for coverage.

The Republican plan raises questions, including about cost: Many experts believe the more than $100 billion earmarked for alternative programs, such as “high-risk pools,” would be inadequate. According to the Congressional Budget Office, many patients with pre-existing conditions would be priced out of the market.

But the Republican proposal also raises a more basic issue: Who will decide what constitutes a pre-existing condition?

Before the Affordable Care Act, profit-taking insurers had lowered the bar for what was considered a pre-existing condition to include nearly every malady, making it difficult for many healthy patients to get affordable insurance.

I have interviewed many such people. Renée Martin was thrown into an unaffordable high-risk pool because of an abnormal Pap smear. Lisa Solod got turned away by four insurers because she was on thyroid replacement, an asthma inhaler and hormones — a not uncommon trifecta for women in their 50s. Wanda Wickizer was priced out of having insurance because she had taken Lexapro for depression. Jesse Albert found that he and his family were uninsurable because he had once had a benign skin cancer and a bout of hepatitis C, even though his immune system had cleared the virus.

Turning away people with just a hint of illness is a reasonable business strategy. But as so often occurs in the profit-oriented health system, what is best for business is not necessarily good for patients.

When the House Committee on Energy and Commerce studied insurance denials and exclusions for pre-existing conditions by the four largest for-profit insurers in 2010, it found plentiful evidence that “each company had business plans that relied on using pre-existing conditions to limit the amount of money paid for medical claims.” In documents reviewed by the committee, one company listed “improved pre-existing exclusion processes” as an opportunity to increase growth.

The committee report found that the insurance companies turned down one out of every seven applicants with pre-existing conditions. Such denials had jumped by nearly 50 percent between 2007 and 2009, as the apparently successful financial strategy gained sway.

In the pre-Affordable Care Act era, states that ran high-risk pools generally specified pre-existing conditions that automatically qualified patients for admittance — generally serious diseases like AIDS, diabetes or epilepsy. The determination was based on health, but patients who could show they had been turned down by insurers were also generally eligible. Insurers, with different motivations, draw very different boundaries. In interviews with Dr. Hall before the A.C.A., some Kansans said that merely having hay fever or being fat were enough to be placed in the pools.

Indeed, if insurers make the call about who to exclude, almost anyone who needs insurance would seem vulnerable. I’m by all measures really healthy but I, too, once had an abnormal Pap smear, have taken Lexapro for short periods of my adult life and very occasionally use an asthma inhaler before I exercise in winter. Since an orthopedist removed the cartilage in my right knee after a soccer injury in college (an operation that has since been deemed useless or harmful), odds are that I will someday need a knee replacement. Dr. Hall told me that surgery alone could throw me into a high-risk pool, by many insurers’ standards.

And what of the much-vaunted benefits of cancer screening? With the possibility of a poorly financed high-risk pool looming, a rational person might avoid a colonoscopy. A polyp removal might prevent cancer but could mean paying higher insurance rates, because patients who get polyps are at risk for developing more polyps, which can be precursors to cancer.

We all have — or will have — some kind of a problem in our medical history.

Today, Mr. Albert, 52, is not happy with the price of his family’s high-deductible Obamacare policy: $2,000 a month. Even so, he said: “The A.C.A. was a lifesaver for us. Everyone in my family has something that could be defined as a pre-existing condition. It’s expensive but I don’t have to worry about being excluded from insurance or about bankruptcy anymore.”

Take The KHF AHCA Quiz

David Posnett — Sat, 27 May 2017 22:19:39 +0000

http://kaiserf.am/2s8pLAT

Shame on Zeldin Rally

David Posnett — Tue, 23 May 2017 01:37:40 +0000

About 1 week ago, CD-1 citizens held a rally in front of Rep. Zeldin’s Patchogue offices. “Shame on Zeldin” was the battle cry referring to LZ’s vote for Trumpcare (AHCA). By my estimate 150 people attended. There were 4 speakers: 2 physicians, one hospital administrator and one nurse. In striking contrast to Zeldin, these were people with hands on and life long experience in health care delivery. A transcript of their speeches follows below.

D Posnett MD:

AHCA can be summed up as follows:

Preexisting Conditions. We have them and the AHCA will make it possible for insurance companies to refuse to cover people with preexisting conditions.
AHCA weakens Medicare by reducing it’s solvency to 2025 from 2028
The Affordable Care Act has the Medicare Part D “donut hole” on schedule to close in 2020. Repealing the Affordable Care Act could force Medicare participants to cover much of the prescription medication needs out of their own pockets.
The AHCA is bad for women in ways too numerous to name. The Kaiser Family Foundation does an excellent job of spelling out the problem in Ten Ways That the House American Health Care Act Could Affect Women:
- decreased Medicaid Eligibility
- Capping Federal Medicaid Spending
- no more Medicaid funds for Planned Parenthood
- no Abortion Coverage
- Tax Credits, Premium and Cost-Sharing Subsidies based on age not income
- Insurance Reforms: permit insurers to charge higher premiums to individuals with health problems if they have a lapse in coverage.
- Essential Health Benefits waivers for states (automaticallyt approved)
- Preventive Services Medicaid and Medicaid expansion patients at risk
- Contraceptive Coverage gone
- Pregnancy-Related Care potentially gone via state waivers

Mike Anthony (Hospital Administrator, North Brooklyn Health Network):

My knowledge was built on years of reading federal registers and overseeing the filing of financial documents. I wouldn’t presume to tell Lee Zeldin that he lied about his wartime JAG experience.

During the second part of my speech, I condensed 5 or 6 LI healthcare experts into a concern raised by a Stony Brook Health Economist, Professor Debra Dwyer. (GYNHA is the Greater New York hospital Association)

What About the effects of AHCA on Long Island’s Safety Net Hospitals?
Per America’s Essential Hospitals (a group that represents safety net hospitals), “Our hospitals could not sustain such reductions without scaling back services or eliminating jobs.”
Ken Raske from GYNHA: 27 hospitals in NYS are already designated “institutions under fiscal stress.”
By one estimate 250,000 might lose coverage, another estimate says 334,000 on LI
The ACA has resulted in 25,000 more health care workers on LI. What happens to those jobs after ACA is repealed?
Per Stony Brook Univ. Health economist Debra Dwyer:
“We have some hospitals that are going to be hit pretty hard…Stony Brook University Hospital and Brookhaven Memorial Medical Center in particular because they serve Suffolk County’s more vulnerable population and made investments in response to incentives from the Affordable Care Act.”
Per Dr. Victor Politi, president and chief executive officer of the Nassau Health Care Corporation says that, “repeal of Obamacare could ultimately result in his hospital receiving less federal reimbursement for patient care – and they already operate annually on a deficit.”
Per Janine Logan, senior director of communications and population health at the Nassau-Suffolk Hospital Council: “This is bad news for New York.
Congressman Zeldin is intellectually dishonest. He constantly attacks Obamacare’s high premiums, deductibles and co-pays, but Obamacare had three features that enhanced insurance market stability: (1) Risk Adjustment (redistribute funds to plans with higher risk employees); (2) Reinsurance (Provider payment to plans that enroll higher-cost individuals); (3) Risk Corridors (limits losses and gains beyond certain corridors.)
ACA architects understood that risk exposure would be difficult to measure. Even with mandated insurance and community rating, experts were uncertain about the possibility of negative impacts brought by adverse selection (sicker patients signing up faster than healthy persons). Thus, the 3-part risk smoothing. These features were expected to last a few years until markets adjusted to the new reality.

Jeanne Spier RN

As a nurse , mom, wife, daughter, consumer and family health care provider I have had decades to participate in and observe American Health Insurance. It’s a hot mess. While The Obamacare/ Affordable Care Act (and even Bush’s Medicare D ) were a very good start, the ACA was over-diluted in the legislative process, followed by what I can only describe as partisan hatred.

I am adamant we should be pushing our legislative representatives to a Single Payer/ Universal Health care plan. NOW. It is a perfect time to do so. With every American enrolled, just like Medicare, you needn’t sign up, therefore there are no tax penalties, no lapse of coverage penalties, no worry about a pre-existing condition. Premiums, deductables, and copays are REPLACED with a “Medicare” tax deduction. No one makes money off your health. It goes with you, if you move out of state, change jobs, or lose your job, you still have insurance.

It’s cost effective to manage and administer, like our Social Security System. Pharmaceuticals are far cheaper when bartered through a national purchaser. Ask the VA. Ask those that buy meds from Canada on the internet. Ask every other industrialized country.

I hope to debunk some of the hysteria regarding the recalcitrant insurance companies. What they are doing now is no different than what they’ve been doing for decades.

WHAT IS Insurance?- A thing providing protection against a POSSIBLE eventuality. (Derived from Middle Eng and French-) A SENSE OF ASSURANCE: A GUARANTEE
Not one of us knows if we or our loved ones will contract a terrible disease, have a stroke, get cancer, go blind, get addicted, develop mental illness, need emergency surgery. So insurance is our “assurance” that we can remain solvent and cared for. The current legislation is certainly a step backwards. As President Trump said, “It’s complicated.”
We need to realize that health insurance and pharmaceuticals are for profit industries. Shareholders reap a reward from profits on your cancer, your diabetes, your bad heart, your addiction treatment, your end of life care.
Before the ACA most of the lay public never realized how much of the money-iceberg was lying below the water line, (unless we were unlucky enough to need it to pay medical costs. You would be shocked. Before the ACA insurers could and did DROP YOU like a hot potato if you exceeded their “lifetime maximums.” Then followed Medicaid and personal bankruptcy.
In the early 1990’s, during an emergency hospitalization, I got stuck paying a $5000 out of pocket bill to a surgeon’ group because they were “out of network”. We have learned how limited our options are.
In the late 1990’s, Oxford’s “managed care” Medicare HMO, dropped their senior citizen’s coverage like hot potatoes. I had never seen so many older folks in a true panic. SO THIS ISN’T NEW. And Oxford, Cigna, and Aetna are still here, aren’t they? So the only ones hurt were the consumers.
During the 10 years I worked for NYHQueens 2003-2013, the cost of insurance premiums SKYROCKETED- starting YEARS BEFORE OBAMACARE. What do insurance companies think of you? From a very reliable source: A United Health Care executive was overheard telling a fellow employee, “Patients are not our customers. Shareholders are our customers.”
Personal bankruptcies are often initiated by overwhelming Health Care Costs, in some studies up to 50%.
Planned Parenthood: 88%-97% of their services do not include abortion. They are the only source of health care for millions of women.
Hundreds if not thousands of Zeldin’s constituents have been forced into MediCAID, the insurance for poor people. (Not MediCARE which works very well.)

Commercial insurance, commercial addiction facilities and commercial end-of-life facilities are troubling.

Repeal Obamacare’s individual and employer mandates. Fine. Replace it with a single payer program!

Viral Patek MD

Recounted stories of several patients that had been saved by ACA or suffered because of lack of health care insurance.

Thanks for Voting for Trumpcare, Mr. Zeldin!

David Posnett — Mon, 22 May 2017 23:23:33 +0000

Printed in the Three Village Times Herald this week:

Thank you Rep. Lee Zeldin for voting “yes” for Trumpcare in the U.S. House of Representatives. This bill slashes insurance subsidies, makes drastic cuts to Medicaid, guts pre-existing condition protection, de-funds planned parenthood and makes insurance less comprehensive. The bill was passed without holding any hearings or giving the bi-partisan Congressional Budget Office time to do an analysis. Thank you for stripping health insurance from at least 24 million Americans. Thank you because you will be held to your unconscionable vote when voters go to the polls in 2018 and vote against Trumpcare and the Republicans who voted for it. The voters will not forget.

Terry S. Shapiro, D.M.D., East Setauket, NY 11733

Zeldin’s Deception on Health Care

David Posnett — Sat, 18 Mar 2017 15:25:04 +0000

Email to Rep. Lee Zeldin from Bruce Colbath:

Mr. Zeldin: I just read an article in the Riverhead press concerning your position, or lack thereof, on the AHCA. Why are you repeating the GOP mantra that the CBO opined that premiums would go down by 10% by 2026? The premium decrease is based on what the CBO predicts the premiums would be under “existing law”, namely the ACA. You’re practicing deception, pure and simple.

Fundamentally, there is no humane reason for any elected official to support this bill. It will devastate health care in this country, and particularly in CD1. If you will not vote your conscience and protect your constituents, but plan to do as Mr. Trump and Mr. Ryan ask, I can only hope that you pay for this in November 2018.

This added by David Posnett MD as per this link.

Rep. Zeldin Requesting your Opinion!

David Posnett — Sun, 12 Mar 2017 03:15:34 +0000

Contributed by Max Plesset MD – retired physician

Mr. Zeldin’s email:

This week, the American Healthcare Act was introduced in the House to repeal and replace the Affordable Care Act, commonly known as Obamacare. You can read the bill here…

I want to know your thoughts on the bill just released. Please let me know what you think of the bill here.

I will continue to monitor the progress of this bill as it goes through the markup process in committee. One of my top priorities in Congress is to improve healthcare in America.

With Best Regards, Lee Zeldin
Member of Congress

My response to Mr. Zeldin:

Why the Republican changes to the ACA will not work:

1. Tax credits will not cover the ever-rising premiums, particularly for older people up to age 64. Many have modest incomes and will face a 5 fold increase in premiums that they will not be able to afford.

2. Health Savings Accounts (HSA) are only for those who have enough discretionary income to fund one. Also, many will be unable to manage an HSA along with their catastrophic insurance plan. People on limited incomes faced with a choice between funding the HSA and buying food (or other necessities) will choose the latter.

3. Without the mandate healthy young people will not buy insurance, which will lead to an insurance pool with adverse selection (only sick people) and the pool will fall apart due to sky-high premiums (the so-called death spiral).

4. The block Medicaid grants will be limited to those currently enrolled in the state’sMedicaid program and will not be expanded after 2020. As health care costs inevitably increase, the states will not be able to fund the care for the Medicaid recipients since the grants will not increase as more people become eligible and costs rise.

5. Most state high-risk pools historically have had great difficulty being sustained due to extremely high medical costs and unaffordable premiums for these patients.

In summary, all this will probably lead to many more uninsured people who will be showing up in ERs without insurance, and with unattended chronic medical problems. Many of them will cost the health care system much more due to the uninsured patient not having regular preventive services and a lack of management of serious chronic diseases. This leaves hospitals with bad debt and ultimately will raise the cost of services and the cost of health insurance premiums for everyone. We will be left with the myriad problems that existed before the passage of the ACA or even worse.

You too can send your thoughts to Mr. Zeldin here!

Respond to Mr. Zeldin and send us your response to be posted on this site!