Category Archives: Healthcare

Kabuki theater: budget vote-a-rama in the Senate today

The U.S. Senate is voting on the GOP’s budget resolution today, which is really not about the budget at all, but rather, rigging the procedural rules in the Senate so that the GOP can vote on its so-called “tax reform” (tax cuts for Plutocrats) bill at some point with a simple majority vote of 50 senators plus the Vice President, and bypass the Senate cloture rule of 60 votes to forestall a Democratic filibuster through adoption of reconciliation rules.

The Senate’s budget process allows votes on any politically charged issue during a so-called vote-a-rama session. This is  all Kabuki theater to get senators to take votes on amendments to be used in campaign ads against them later.

Roll Call reports, When the Budget Resolution Isn’t About the Budget:

When Sen. John McCain removed the suspense by announcing he would vote for the budget resolution moving through the Senate, the Arizona Republican made clear the ridiculousness of the exercise.

At the end of the day, we all know that the Senate budget resolution will not impact final appropriations,” he said in a statement. “To do that, Congress and the White House must negotiate a budget agreement that will lift the caps [sequestration] on defense spending and enable us to adequately fund the military.”

McCain said he was supporting the budget resolution because it includes instructions that provide the path forward for overhauling the federal income tax code without the risk of filibusters, rather than because of the funding levels it would provide.

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President Trump sabotages ‘Obamacare,’ will blow up health care markets out of spite

President Donald Trump, who promised to repeal and replace “Obamacare” on day one in office — “it will be easy” — suffered humiliating deafeats after several failed attempts by Congress. For a man fixated on erasing any legacy of Barack Obama out of jealousy and spite, he has been stewing about ways he can sabotage “Obamacare,” and with it the health care of millions of Americans, outside of congressional action. It is purposeful, malicious and amoral.

The New York Times reports that, as I predicted, Trump has gone nuclear in House v. Price, ending the Cost Sharing Reduction subsidies (CSRs) to insurers for low income Americans. Trump to Scrap Critical Health Care Subsidies, Hitting Obamacare Again:

President Trump will scrap subsidies to health insurance companies that help pay out-of-pocket costs of low-income people, the White House said late Thursday. His plans were disclosed hours after the president ordered potentially sweeping changes in the nation’s insurance system, including sales of cheaper policies with fewer benefits and fewer protections for consumers.

The twin hits to the Affordable Care Act could unravel President Barack Obama’s signature domestic achievement, sending insurance premiums soaring and insurance companies fleeing from the health law’s online marketplaces. After Republicans failed to repeal the health law in Congress, Mr. Trump appears determined to dismantle it on his own.

Without the subsidies, insurance markets could quickly unravel. Insurers have said they will need much higher premiums and may pull out of the insurance exchanges created under the Affordable Care Act if the subsidies were cut off. Known as cost-sharing reduction payments, the subsidies were expected to total $9 billion in the coming year and nearly $100 billion in the coming decade.

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Twitter-troll-in-chief threatens to abandon Americans in Puerto Rico

This is worse than George W. Bush’s clueless neglect of New Orleans after Hurricane Katrina. This is purposeful, intentional abandonment of Americans out of pure spite for having criticized the “Dear Leader” and his relief efforts in Puerto Rico and the U.S. Virgin Islands. Who does this? Trump threatens to abandon Puerto Rico recovery effort:

President Trump served notice Thursday that he may pull back federal relief workers from Puerto Rico, effectively threatening to abandon the U.S. territory amid a staggering humanitarian crisis in the aftermath of Hurricane Maria.

Declaring the U.S. territory’s electrical grid and infrastructure to have been a “disaster before hurricanes,” Trump wrote Thursday that it will be up to Congress how much federal money to appropriate to the island for its recovery efforts and that recovery workers will not stay “forever.”

In a trio of tweets, Trump wrote” “We cannot keep FEMA, the Military & the First Responders, who have been amazing (under the most difficult circumstances) in P.R. forever!”

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This week in the GOP’s war on the civil rights of women and LGBTQ

The House on Tuesday approved a bill banning most abortions after 20 weeks of pregnancy, advancing a key GOP priority for the third time in the past four years — this time, with a supportive Republican president in the White House. The purpose of the bill is to create a direct legal challenge to Roe v. Wade, which provides for access to abortion in the first 24 weeks.  With Trump’s backing, House approves ban on abortion after 20 weeks of pregnancy:

The bill, known as the Pain-Capable Unborn Child Protection Act, is not expected to emerge from the Senate, where most Democrats and a handful of moderate Republicans can block its consideration. But antiabortion activists are calling President Trump’s endorsement of the bill a significant advance for their movement.

The White House said in a statement released Monday that the administration “strongly supports” the legislation “and applauds the House of Representatives for continuing its efforts to secure critical pro-life protections.”

The bill provides for abortions after 20 weeks gestation only when they are necessary to save the life of the mother or in cases of rape or incest. Under the bill, abortions performed during that period could be carried out “only in the manner which, in reasonable medical judgment, provides the best opportunity for the unborn child to survive” — note, not the life of the mother — and would require a second physician trained in neonatal resuscitation to be present.

How Arizona’s congressional delegation voted:

Stricter Abortion Ban: The House on Oct. 3 voted, 237-189, to outlaw abortions after 20 weeks of fertilization on the belief that the fetus can feel pain by then. This repudiates Roe v. Wade’s ruling that abortion is legal up to viability that occurs at about 24 weeks or later. A yes vote was to pass HR 36

Voting yes: Martha McSally, R-2, Paul Gosar, R-4, Andy Biggs, R-5, David Schweikert, R-6, Trent Franks, R-8

Voting no: Tom O’Halleran, D-1, Raul Grijalva, D-3, Ruben Gallego, D-7, Kyrsten Sinema, D-9

Women’s Health Exemption: The House on Oct. 3 defeated, 181-246, a bid by Democrats to add an overall woman’s health exemption to HR 36 to go with exemptions already in the bill in cases of incest or rape or to save the mother’s life. A yes vote was to permit abortions after 20 weeks if necessary to protect the mother’s health.

Voting Yes: O’Halleran, Grijalva, Gallego, Sinema

Voting No: McSally, Gosar, Biggs, Schweikert, Franks

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Suffer the Children: do nothing Tea-Publican Congress let’s CHIP program funding expire

While the Trump administration continues its unrelenting sabotage of “Obamacare,” our do nothing Tea-Publican Congress failed to get around to reauthorizing funding for the Children’s Health Insurance Program (CHIP), cutting off federal funding for some 9 million children as of midnight on September 30.

Steve Benen explains, Congress fails to follow through on key children’s health program:

Now that legislating has wrapped up for the month – lawmakers left town yesterday – September wasn’t quite “the month from hell” as originally feared, largely because Democrats and Donald Trump struck a deal to punt questions over government funding and the debt ceiling a few months  [until early December].

But perhaps more interesting than what Congress did in September is what it didn’t do. One of the tasks members were supposed to tackle this month was reauthorizing the Children’s Health Insurance Program (CHIP), and as TPM explained yesterday, that didn’t happen.

Sen. Claire McCaskill (D-MO), who sits on one of the key committees in charge of health care, confirmed to TPM that Congress will likely allow CHIP to lapse by Saturday’s deadline, putting the health insurance of millions of children in jeopardy.

“I’m confident the money will come but obviously it’s not going to come on time,” she said wearily.

Funding for CHIP, which provides health insurance for nearly 9 million children nationwide, expires this Saturday. The Senate Finance committee has worked for months on a bill to reauthorize it for the next five years, but the work was pushed to the back burner as Republicans chose instead to spend weeks taking one last unsuccessfully run at repealing Obamacare.

I’ll confess, when Sens. Orrin Hatch (R-Utah) and Ron Wyden (D-Ore.) struck a bipartisan deal on Sept. 12 to extend CHIP for five years, I more or less assumed everything would work out. After all, that’s usually what happens: Congress approaches a deadline, some bipartisan pairings work on an agreement, and it passes in the 11th hour.

Except, this time, it didn’t work out at all. Senate Republicans focused their energies on yet another ACA repeal gambit, and reauthorizing CHIP was pushed to the back-burner.

Now, my point is not that 9 million children will lose their coverage over the weekend. If that were poised to happen, you’d probably be hearing a lot more about this. There have been previous instances in which CHIP wasn’t reauthorized in time – if you’ve been reading me forever, you might recall George W. Bush twice vetoed a CHIP bill 10 years ago around this time – without triggering an immediate crisis.

But The New Republic’s Clio Chang wrote a good piece explaining why this shouldn’t be dismissed, either.

[M]ost states have enough funding to maintain the program for a few months. But ten states would run out of funding by the end of the year and Minnesota would run out by the end of October. According to an analysis by the Center on Budget and Policy Priorities, “When their federal funding runs out, states with separate CHIP programs (rather than CHIP-funded Medicaid expansions for children) may be forced to impose enrollment caps or freezes, or shut their programs entirely.”

Furthermore, there would be numerous adverse consequences that would begin immediately. States would have to start shifting costs to cover administrative tasks necessary for ending the program, such as sending parents notices in the mail. And the lack of assurance that the program will exist in the future makes it impossible for states to budget and plan. Basically, states would have to focus on a variety of things completely unrelated to the program’s intent of expanding access to and improving children’s health care.

Chances are, Congress will circle back to this in the near future, but there’s no good excuse for lawmakers missing this deadline in the first place. The actual reason – Republicans were too busy with a failed attempt to take coverage from millions – only adds insult to injury.

Chang added that this is “the latest evidence that the GOP has become incapable of governing responsibly,” and under the circumstances, it’s hard to imagine anyone seriously arguing otherwise.

One of the reasons this bill was not brought up for a vote is because leadership did not want dead-ender Tea-Publicans to offer amendments to the CHIP authorization bill seeking to repeal “Obamacare” before the reconciliation rules expire on September 30. They would rather let the CHIP funding expire without drawing attention to it, and hope that no one really notices before they can bring up the agreeed upon authorization bill, hopefully before states start running out of funds.

UPDATE: The Arizona Republic reports, Insurance coverage for more than 22,000 low-income Arizona kids in jeopardy:

KidsCare, Arizona’s version of the federal program, covers 22,389 children, according to September figures of the Arizona Health Care Cost Containment System (AHCCCS).

Arizona was the only state without an active CHIP program when Arizona froze enrollment in 2010 due to Great Recession-triggered budget cuts.

The Arizona Legislature last year passed a bill, signed by Gov. Doug Ducey, that allowed new signups. A family of three that earns between $28,180 and $40,840 would be eligible for KidsCare in 2017. Similarly sized families that earn less than $28,180 could still be eligible for Medicaid if KidsCare funding disappeared.

Last year’s legislative action helped lower Arizona’s uninsured rate among children to 7.3 percent in 2016, down 1 percentage point from the year before, according to a report from Georgetown University’s Center for Children and Families.

With more than 12,000 Arizona children signing up for KidsCare since December 2016, it’s likely Arizona’s uninsured rate is now even lower.

But the Arizona legislation passed in 2016 required AHCCCS to initiate steps to halt new enrollment if the federal government eliminates funding.

State law requires AHCCCS to notify the governor and state legislative leaders if there is insufficient program funding, and to stop processing new applications.

Arizona should have enough money to cover KidsCare expenses through the end of the calendar year, even if Congress does not extend the CHIP program, said Heidi Capriotti, an AHCCCS public information officer.

But AHCCCS might need to consider other actions should Congress not act in a timely manner, according to Capriotti.

“If federal funding is exhausted, then it would be up to policymakers to decide how to proceed,” Capriotti said.

* * *

The House Energy and Commerce Committee is expected to consider a CHIP bill next week, although details of the legislation have not been released.

U.S. Rep. Tom O’Halleran, D-Ariz., sent a letter last month to Speaker Paul Ryan urging swift action by the House on CHIP. U.S. Rep. Martha McSally, R-Ariz., and Arizona’s three other House Democrats, Kyrsten Sinema, Ruben Gallego and Raul Grijalva, also signed the letter.

“Our providers and state officials need certainty to effectively plan for providing care to those enrolled and eligible for coverage,” the letter stated. “Parents need peace of mind to make sure their children will not experience disruptions in their health care.”

The Price is Right: Tom Price resigns over use of charter flights

The New York Times breaks the Friday news dump story that embattled Health and Human Services Secretary Tom Price has resigned under pressure on Friday after racking up at least $400,000 in travel bills for chartered flights. Don’t let the door hit you in the ass on your way out. Health Secretary Tom Price Resigns After Drawing Ire for Chartered Flights:

Already in trouble with Mr. Trump for months of unsuccessful efforts to repeal and replace President Barack Obama’s health care program, Mr. Price failed to defuse the president’s anger over his high-priced travel by agreeing to pay a portion of the cost and expressing “regret” for his actions.

In a statement, the White House said that Mr. Price “offered his resignation earlier today and the president accepted.”

It said Mr. Trump will tap Don J. Wright of Virginia to serve as acting secretary at midnight Friday. Mr. Wright currently serves as the deputy assistant secretary for health and as director of the Office of Disease Prevention and Health Promotion.

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