Friday, October 13, 2017

Introducing America's new health care system: Trumpcare

Updated 10/15/17 A version of this was published in the Sky Hi News, Oct 18, 2017 http://www.skyhinews.com/news/muftic-welcome-your-new-health-system-trumpcare/
Introducing America’s new healthcare system: Trumpcare.  Donald Trump just  broke the old one; he owns the new one.   He can no longer blame Congress that  also tried to break it and failed.  He is the one who broke it all  by himself with his own executive orders. It gives some the choice of cheaper policies, but their new choice is between bad, worse and useless. All premiums in and out of exchanges will rise. The financial impact will be felt immediately in everyone’s pockets. Trump has opposed any  suggested fixes that would make his orders unnecessary.


However, facing 2018  Congressional elections, he claims he is ready to make a deal with Democrats , it appears . No wonder. The political repercussions will be felt in time for the 2018 midterms when the  millions of lower income and middle class voters will feel the pain in their pockebooks and realize  in real time  they  just  been taken to the cleaners by Trumpcare. Given insurance policies fine print, most will only learn the consequences when they get sticker shock, paying full price for needed services not covered by terms, deductibles, and lifetime and annual caps. The most affected are red states that use more of the subsidies he just halted and who voted for Trump Alternatives such as single payer and Medicare for All will begin to look better and better to more. If Trump blames greedy insurance companies, then single payer solves that problem: it cuts out private health insurance participation.  Congressional  Democrats in the short term are united in support of fixing Obamacare in contrast to Trumpcare. Deal with Trump? Chuck and Nancy have already been bitten with DACA's deal with him over that. They were double crossed later . Don't blame them if they do not take him up with his offer.


Trump’s  threats to stop payments to insurance companies who help low income pay insurance premiums (not to prop up their stock prices as Trump claims)  have already caused exchange premium prices  to rise 20-25% in some states since  insurers anticipated his move. October 12 he made good on that threat with his order.  Per a recent Congressional Budget Office score , the impact on all  premiums  of the payment stop will  be an average increase of  20-25%..  An estimated seven million who buy insurance through the insurance exchanges  will find premiums hiked, but so will the subsidies increased to help them pay.  This order   will raise the deficit by $194 billion over ten years since the government will make up the difference in subsidies and insurance companies will pas on costs to everyone else in higher premiums, or the insurance companies will just drop out of the program.
Trump’s order includes a creation of a parallel system of  cheap association plans. There  will be no  requirements for  them  to cover anything so essential to many: prescription drugs, hospitalization, low co pays or affordable deductions, maternity care, cancer screenings including prostate and mammograms,  annual physicals,  pre-existing conditions, mental health care and drug rehab. Consumers buying into association plans  wanting  to make up the the unanticipated loss of uncovered benefits  would pay extra  from their pockets at  full  market price or go without. That is Trump's definition of "great care".

Currently fourteen million buy their insurance through the exchanges. The only ones who benefit from Trumpcare will be the two million  buying  insurance through the exchanges who make too much money now  to get subsidies. Even then, Trumpcare  will  bait and switch them  to accept his "great care"  association plans that resemble  a hamburger with   two buns but with  little meat and condiments .

The eventual   financial failure  of Obamacare is not the death spiral caused by Obamacare,  but it a death spiral engineered by the Trump administration on purpose as part of their plan to de facto repeal  it.  In time, the entire  Obamacare private insurance  based exchange system will collapse as the  parallel  association system will destroy the ACA’s “pool” comprised of  both those  with the healthy  who lightly place claims and  those with pre-existing conditions or with health problems.The  healthy will be  lured into cheaper stripped down plans. The result will be virtual high risk pools left to the sicker who   will see their premiums soar to become unaffordable.


This executive order  is such a fundamental change to the intent and financing of Obamacare, that it is the mother of all executive overreach.  resulting in court challenges which will further drag out uncertainties and  will cause continued premium increases  for everyone as the market is destabilized.

______________________________________________________________________________
Footnotes: A bipartisan "fix" to the subsidies has emerged from a Senate committee, but its fate is unknown.  GOP Senate leadership may refuse to bring it to the floor. Then it must pass the Senate and go to the House and require the President's signature.  Trump has issued various conflicting views on his support. http://www.cnn.com/2017/10/17/politics/health-care-csr-payments-deal-reached/index.html

Trump  may want to pay attention to the following impact on his core base of supporters and red states:
Criteria: access, quality, numbers applied for financial aid to afford health care in a recent study revealing 15 worst states to get health care. https://www.cheatsheet.com/culture/worst-states-live-want-decent-health-care.html/
All but one (Nevada) voted for Trump in 2016. The 5 worst: in order of the worst first
Arkansas, Mississippi, Oklahoma, Alabama. W. Virginia.

According to the Associated Press. Nearly 70 percent of those benefiting from the so-called cost-sharing subsidies to insurance companies live in states Trump won last November. https://twitter.com/AP/statuses/919246698081288192



https://www.forbes.com/sites/brucejapsen/2017/10/08/how-narrow-networks-doom-trumps-insurance-sales-across-state-lines/#7e4ea38a35f9.


"Blog posting: 9/271/17 Heads up: GOP's Repeal/replace Obamacare is a cat with 9 lives
ies https://www.pbs.org/newshour/amp/bb/trump-ending-obamacare-subsidies-health-insurers-heres-ends-paying

http://www.chicagotribune.com/news/nationworld/politics/ct-trump-health-care-executive-order-20171012-story.html

https://www.yahoo.com/news/pro-trump-states-most-affected-health-care-decision-134810734.html

https://www.usatoday.com/story/news/politics/2017/10/12/trumps-health-insurance-order-pushes-association-plans-drive-down-costs-some/752816001/

https://www.washingtonpost.com/powerpost/key-senators-reach-bipartisan-health-care-subsidy-deal-and-trump-expresses-support/2017/10/17

Thursday, October 12, 2017

Why Trump's order to allow cross state health insurance sales won't work

Trump's executive order to change Obamacare today is a hamburger bun without the beef, no condiments,  laced with  no taste and  a chunk of poison.

Obamacare has already allowed cross state insurance sales.
It never took off and there are many reasons for it.There are many reasons for it and those same reasons would apply with Trump's executive order.

There is a dirty little secret as well: allowing  small business  and  associations to join together  offer insurance is a sneaky way to offer employees empty insurance without including essential benefits.  The purpose of his plan is to knock the props out of pool of both healthy and the sick and leaving the pool full of the sick.  It is a nasty way to exploit employees as well, leaving them without essential benefits, prescription drug coverage, annual physicals, cancer screenings, blue and pink pills, etc.  This is an executive order that does more than extend cross state purchases.  It is an attempt to change the purpose of the ACA (Obamacare), jacking up the cost of premiums for everyone else who needs it since who would be left are the ones expensive to treat.  It is such a fundamental attack on Obamacare's structure, expect law suits to fly.

The cross state sales portion will probably not be challenged since it is already permitted in Obamacare.  It just won't do much. From a Forbes opinion piece, the industry itself wants to narrow networks and not expand them.   https://www.forbes.com/sites/brucejapsen/2017/10/08/how-narrow-networks-doom-trumps-insurance-sales-across-state-lines/#7e4ea38a35f9.

From my prior blog posting:

 " Buying insurance across state lines is a mirage. The CBO has already scored it as only helping 3 million people more to afford insurance under Obamacare. . Furthermore, under Obamacare, multi- state group plans were permitted, and they never took off. There are reasons. Consumers lose easy appeal if they have a complaint about of state insurers since they would have to register and fight for appeal in the insurer's home state. . Furthermore, big insurers with affiliates in many other states like Blue Cross and United can collude to set prices across state lines since insurance companies are exempted from federal anti trust laws. They could hike prices in other states . Without essential benefits being required, there would be .a full out race to the price bottom of useless, deceptive insurance with few benefits.Expect, too, that the political problem of doing end runs around each state insurance commissions may create another potential opposition group. State Insurance Commissions are long, old political plums and state by state control would be lost. "

Blog posting: 9/271/17 Heads up: GOP's Repeal/replace Obamacare is a cat with 9 lives

http://www.chicagotribune.com/news/nationworld/politics/ct-trump-health-care-executive-order-20171012-story.html

Sunday, October 8, 2017

Islamphobia in Grand County


The third version of Donald Trump's Muslim ban has been ruled unconstitutional by two lower court federal judges(Hawaii and Maryland). The judges ruled it was too similar to the ones before.Judges are ruling the orders run afoul of the US Constitution because it was caused by animus against one religion, Islam. The Supreme Court considering the first two ban versions delayed oral arguments pending lower court rulings on the new version that added a few non Muslim countries to the ban list of countries. The third version ban was in effect allowed to go into effect, but the lower courts' ruling on the third put that one on hold, as well.

The root of the Muslim ban goes back to the 2016 campaign and it reflected fear of anything Muslim and Islam that has been brewing among a segment of our population . Fear of terrorism is one factor. But since at least 2004 a wave of fear spread across the South that Islam's religious Sharia law would soon be coming to their state.. That has been one element feeding that blanket hatred of anything Muslim and a desire to keep their followers out of the US. Fear of Sharia is a form of  Islamphobia that cropped up again in Grand County with a controversial speaker recently at Constitution Week in Grand Lake. as reported in the Sky Hi News (http://www.skyhinews.com/news/controversial-speaker-during-constitution-week-talks-islam-sharia-law/) The story resulted in a heated exchange of letters to the editor, attacking and defending the point of view expressed at the event.

Those raging against Islam and Muslims often  promote  fear that Sharia law will become the law of the US, or they ask it  in terms, "do you want your neighbor to practice Sharia law and be able to beat their wives ".
Practically speaking  we are in no danger of having Sharia law  imposed on Americans.  American  Muslims have little  political clout since adult Muslims comprise  2% of our population. 58% of those are immigrants. 42% are US born.


There is also a constitutional angle to the Sharia law issue  Thanks to our Constitution, we cannot establish any state religion."  In 1791, the First Amendment was adopted. The "Establishment Clause" forbade Congress (and later, the states) from passing laws which adopt a state religion or to favor one religion over others. In Everson v. Board of Education (1947), the U.S. Supreme Court explained:
The "establishment of religion" clause of the First Amendment means at least this: Neither a state nor the Federal Government can set up a church. Neither can pass laws which aid one religion, aid all religions, or prefer one religion to another "... That decision works two ways: Sharia laws clearly cannot be established as the law of our land and  state laws attempting to ban Sharia law have been ruled by courts as  unconstitutional because they harm Muslims or are redundant.

 Banning Sharia law has been a hot topic in legal and political circles, and often fueled by fear of Muslims. Anti Muslim sentiment erupted in the 2016 election in the form of Trump's Muslim ban. Its chief anti-Muslim fear and cheer leader was Mike Flynn, the general who briefly served as Pres. Trump;s national security advisor, but was fired for not being truthful about conversations with Russians. It later was learned that he was working for the Turkish government, ironically a Muslim country.


Ignorance of the practice of Islam fuels much of the anti Muslim hysteria.. Sharia law is interpreted and applied  many different  ways in many different countries. Physical   spousal abuse  is not condoned by all Muslims and clerics, and Islamic scholars, either.  The practice of Islam varies from country to country and cultural and customs are as much an influence as the interpretation of their  theology.  Attitudes toward Sharia law as official law  also vary widely per a PEW research poll. Even in the Middle East, less than 30% of Muslims in Lebanon support Sharia law. In Bosnia, 15% support Sharia law; Turkey 12%. Highest support of Sharia law outside the Arabian peninsula   is in Iraq, Afghanistan, and Pakistan and to lesser extent in some Southeast Asian and  African countries..


The Sky Hi News reported  that the speaker felt confident she could be  safely outspoken against Islam  because there were no Muslims in Grand County. She feared for her life because she  was  working  undercover  for a Christian ministry. I wonder how many in Grand County have ever met a Muslim. Such one sided, extreme  opinions can easily  find  fertile ground to grow here.


I have spent a good part of my life interfacing with Bosnian Muslims beginning with  my travels in their region with them in the late 1950's, influencing  my academic studies and a lifetime fascination with the history and impact of Christian/Muslim interface. What I have learned over the years  is that those who practice Islam are  diverse in their application of their theology. 


The danger of a blanket indictments of all Muslims based on  experience with immigrants limited to those from more extreme traditions  is that it feeds divisive  bigotry . It makes us look like hypocrites who do not practice what we preach  about democracy nor do we understand the concepts  of freedom of religion and anti discrimination  protected by our Constitution. It weakens our ability to get along with a major part of the rest of the world and our own Muslim neighbors.  

Our Islamphobia makes us vulnerable to being duped by adversaries such as Russia. .As we have learned through news reports and Congressional hearing testimony ,  Russians saw  an opportunity to weaken  US world influence, sow internal dissent and hatred, and interfere in our elections by  hyping  anti- Muslim hysteria that supported Donald Trump's anti Muslim oratory. One tool the Russians used was social media to organize a Muslim hate rally in Twin Falls, Idaho in 2016. A Russian originated Facebook site promoted an anti Muslim rally in Houston, last year, as well, posing as a Texas organization.

For more on the subject, visit www.mufticforumblog.blogspot.com and search Sharia law.

The PEW poll can be found at  http://www.pewresearch.org/fact-tank/2017/08/09/muslims-and-islam-key-findings-in-the-u-s-and-around-the-world/

http://www.skyhinews.com/news/controversial-speaker-during-constitution-week-talks-islam-sharia-law/

http://www.washingtontimes.com/news/2017/oct/18/second-judge-issues-halt-revised-travel-ban/?utm_source=onesignal&utm_campaign=pushnotify&utm_medium

http://www.politico.com/story/2017/10/17/judge-blocks-trumps-latest-travel-ban-order-243875

http://www.cnn.com/2017/09/25/politics/travel-ban-3-0-could-derail-supre

me-court-case/index.html

http://www.khou.com/news/local/report-anti-muslim-rally-in-houston-orchestrated-by,
-russians/481410660

http://fortune.com/2017/09/12/russia-orchestrated-anti-immigrant-rallies-in-the-u-s-via-facebook-last-year/

Everson v Board of Education explanation source: Wikipedia Search Sharia Law in America for more details about States' attempt to ban Sharia law.

Saturday, October 7, 2017

How Trump plans to reboot coal jobs will have little effect

Donald Trump is trying to make good on a campaign promise: to reboot  coal mining jobs by rolling back  the EPA regulations  that favor other fuel sources for  power plant electrical generation.. Does that mean back to dirty air and dirty coal? Not as much as Trump would hope  for jobs  or many  fear for the environment. The horse is mostly  out of the barn. Coal mining technology advancement uses fewer miners.  Market forces are a driver since the cost of natural gas has fallen.  States have their own regulations, such as Colorado, that favor converting plants to gas and increasing wind, thermal, and solar alternatives. Nationally nuclear is nearly 20% of generation. Gas is  already generating more electrical energy (34%) than coal. (30%) That is good news for the environment since natural gas emits 50 to 60% less carbon into the atmosphere than does coal. 1400 local and state government entities, including Colorado,  are pledged to uphold the Paris environment agreements so  policy goals for clean air will continue regardless in parts of the US.

 States such as Colorado,  with a 2010 plan  and regulations that favor  converting plants from coal  to gas, are already  well on their way to completing their plans. Whether  the lifting of regulations  on coal to bring down the cost  will be significant enough to make much of a difference is the question, given the investments already made in the  switch  to gas and alternatives.  Switching back is an expense in itself.  Colorado is unique since it produces both coal and natural gas. within the state,  which reduces transportation costs  of both, unlike other areas of the country .  60& of Colorado's electricity is generated by coal and a quarter is natural gas.   Front range mega cities such as Denver  fueled by Public Service  have already switched  their plants to natural gas.  

The human cost  of loss of coal jobs is not minor,  but it can be  mitigated by retraining skills  for  employment in manufacturing, truck driving, and alternative energy. Coal jobs in Colorado are already down 36% in three years and the state has launched retraining programs for jobs in alternative energy, though such  jobs pay much  less than coal miners once earned. In Appalachia and the west,  mechanized strip mining is replacing labor intensive deep mining. Job retraining may be the key to families at least earning a living wage, if not returning to the glory days of deep coal mining.

FYI: In 2016, the US electricity generation was 4079 TWh (billion kWh) net, 1380 TWh (34%) of it from gas, 1240 TWh (30%) from coal-fired plant, 805 TWh (19.7%)nuclear, 266 TWh from hydro, 226 TWh from wind, and 117 TWh from other renewables (EIA data).

Nuclear Power in the USA - World Nuclear Association

www.world-nuclear.org/information-library/country-profiles/.../usa-nuclear-power.aspx

http://www.denverpost.com/2016/08/14/work-program-trains-unemployed-oil-and-gas-workers-in-solar-technology/

https://www.usnews.com/opinion/economic-intelligence/articles/2017-03-09/abundant-cheap-natural-gas-is-the-real-reason-for-the-demise-of-coal

https://www.forbes.com/sites/timworstall/2017/03/29/mass-employment-in-coal-mining-is-never-coming-back-no-matter-trumps-promises-or-regulations/#7a487eb171e8


 http://www.washingtontimes.com/news/2017/oct/6/epa-poised-formally-repeal-clean-power-plan-major

 http://oilprice.com/Energy/Energy-General/Cheap-Natural-Gas-To-Spark-Another-Wave-Of-Coal-Plant-Retirements.html 

https://www.forbes.com/sites/judeclemente/2016/10/31/coal-to-natural-gas-switching-in-the-u-s-electricity-system/#661ca4b1e34c



http://www.ucsusa.org/clean-energy/coal-and-other-fossil-fuels/environmental-impacts-of-natural-gas

https://www.forbes.com/sites/judeclemente/2016/10/31/coal-to-natural-gas-switching-in-the-u-s-electricity-system/#4226d7311e34


https://www.foreignaffairs.com/articles/2017-05-22/paris-isnt-burning

http://www.summitdaily.com/news/coal-reigns-as-king-in-colorado-but-solar-is-gaining-steam/

http://www.denverpost.com/2010/08/13/xcel-lays-out-natural-gas-conversion-plan-for-metro-area/

http://www.dw.com/en/us-states-form-climate-alliance-vow-to-uphold-paris-agreement/a-39123223