Tuesday, January 17, 2017

Where Trump has it right on health care insurance

Donald Trump announced a worthy goal, that everyone in the US should have health insurance, and it ignited a firestorm in the GOP, with a Congress that seems to be hell-bent in reducing the numbers who have insurance through Obamacare.  They were wringing their hands, too that Trump was planning to take on the powerful lobbyists of the drug industry, since a great deal of the cost of insurance and the health care system in general was due to rising drug prices. Trump also demanded that repeal had to have a replacement nearly simultaneously.

Many GOP politicians ran this year on a platform of repealing Obamacare, they won, and they believe they have a mandate to repeal Obamacare, in spite of polls showing that only 18% favor repeal with no replacement those same politicians could not agree on a replacement. In fact, their plans to repeal but not tell consumers what the replacement would be until after the next election cycle was shot down by Trump. The mandate is to replace it,  and/or  fix it, but with what quality at how many covered at what cost are questions still hanging.  The  legislative challenge  is how can the GOP  get enough Democrats on board to avoid a  Senate filibuster over replacement details.

Trump is closer to the thoughts of the electorate than is the GOP Congresspeople  as their members have found recent town halls and constituent meetings that have become very uncomfortably filled with  angry consumers who fear they will lose their life saving health insurance due to their Congressman/Senator/s vote to repeal Obamacare. Bernie Sanders has been able to rally large masses of voters, even in states like Michigan Trump won to support retaining Obamacare.

There are still those who bought into Sander’s proposal of Medicare for All, a single payer system, though Sander’s is not promoting  that for now. Instead  he is rallying  public pressure to retain the gains made by the ACA (Obamacare) in any form and is willing to work with Trump to achieve it.   Eventually just for economic reasons and known experience with single payers systems elsewhere in the world,  that alternative  will be revisited in the future because  a single payer system it is a far more efficient way to achieve the goal of insuring everyone. But now, given the issues at hand, Sanders is on the right track.

Improving Obamacare or Trumpcare s a goal  that should not get lost in the legislation.. It needs fixing. Aside from the morality of the issue and the life and death health concerns of so many, it has not achieved the goal of making health insurance available to all.    9 %  are still not insured and the high deductibles present their  financial burdens even for those who have insurance.

In the terms of sheer consumer financial worries there is motivation to fix Obamacare. According to the Federal Reserve, 47% of US families have only $400 in personal reserves to cover emergencies. A visit to the ER costs $1000 alone.  Before Obamacare, medical bills caused 60% of all personal bankruptcies. Most of those taking bankruptcy then had health insurance, but the insurance was  so poor with life time caps, high deductibles  and lacking in comprehensive coverage.   In 2016, of those with health insurance under the age 65, that number was reduced to  20%, still not good enough,  and for those without health insurance it was 53%.   The  obvious conclusion from that is that Obamacare standards and consumer protections need to be expanded to cover even more of the uninsured, not shrink the numbers with access to  affordable, quality, comprehensive  health insurance.






Monday, January 16, 2017

Some GOP's proposals to replace Obamacare are baiting and switching consumers

Heads up.  The GOP is about to bait  you with "better health insurance" and switch you to worse coverage. .They want to lure you with  the honey of  lower premiums but  reduce your  benefits and cost you more money from your pocket. All of this is being done in the  ideological name of letting the free market compete.  

News for consumers: There is no true free market in insurance. Exempted from any  federal anti trust provisions, insurers are free to get together set prices and benefits.  The result could be  giving us little choice or a bunch of bad choices unless  minimum standards  of benefits and consumer protections are required by the new law as consumers seek cheapest premiums. You will, however,  always be given a choice between which is nicer to customers, the one with quacking ducks or swimming dogs.

Their proposals strike at the heart of two pillars of Obamacare, comprehensive, quality health insurance, whether employer or public provided.. Many eliminate subsidies that make insurance affordable to millions and offer controversial , inadequate substitutes. Mandating standards and consumer protections have not been any part of their proposals.

The Trump administration, probably reflecting Donald Trump's  nominee for cabinet head of Health, Education and Welfare, Rep. Tom Price, has yet  to propose a replacement  plan, but Price's past positions give consumers a slap in the face. His plan evaluated by the Congressional Budget Office would result in 18 million losing insurance now, 27 million in a few years. Premiums would rise 20to 25%. Price has advocated for total repeal of the ACA, eliminating subsidies and replacing  them with tax credits ($1200 per year for everyone), and increasing tax savings plans,  setting up pools for those with pre-existing conditions, and eliminating Medicaid expansion.  Left blank are any  consumer protection provisions now in Obamacare.  High risk pools have failed as uneconomical wherever they have been tried, tax credits require up front expenses paid back at filing of income tax (with no indication of how much the credit will be  or what it will based upon who will be covered or the amount of  deductibles) , and there are no standards for what should be included in benefits, leaving it up to the market to provide the worst possible benefits , reverting to installing life -time caps, kicking the sick off the plan.  Health savings account are just another way to force consumers to pay more for their own insurance out of their own pockets and  it only works for those who have a large enough paycheck to stand the deductions. It is just a substitute with another name for high deductibles.

Obamacare mandates are also being targeted by the GOP.  One complaint  is that men have to pay for services they will never use such as pre- natal care and delivery or birth control or mammograms. Before Obamacare, women were charged more for insurance than men because of the higher expenses of their services.  The answer in some GOP proposals: Remove the men paying in means women get to pay more.

Other GOP proposals would  allow consumers  to opt out of having health insurance. Removing this mandate will allow the  irresponsible healthy to  gamble they will never get sick,  resulting in much higher costs for those who want and need  quality, comprehensive health insurance. Why? Because that is who will be left to pay into the insurance pool, the sicker and responsible. Soundness  and affordability depends on the largest pool of healthy and sick possible all paying in and lifting mandates will shrink the pool.


Here is what either no affordable coverage or reduced benefits will do to you: Many once again would be in jeopardy of bankruptcy and foreclosure. According to the Federal Reserve, 47% of US families have only $400 in personal reserves to cover emergencies. A visit to the ER costs $1000 alone. Before Obamacare, medical bills caused 60% of all personal bankruptcies. Most of those taking bankruptcy then had health insurance, but the insurance was so poor with life time limits , high deductibles and lacking in comprehensive coverage. In 2016, of those with health insurance under the age 65, that number was reduced to 20%, still not good enough, and for those without health insurance it was 53%. The obvious conclusion from that is that Obamacare standards and consumer protections need to be expanded to cover even more of the uninsured, not shrink the numbers with access to affordable, quality, comprehensive health insurance. Note, Tom Price, Trump's nominee to lead Health and Human Services prievious proposal of $1500 annual tax credit would only cover one visit to the ER but it would meet the Trump standard of insurance for all in a very cynical way.








Saturday, January 14, 2017

A turn around school turns around and gets closed anyway

The turnaround school turned around and got closed anyway. For those concerned about public education, be aware that Denver Public Schools mysteriously changed a critical score from the consultant's score to a lower one, resulting in closing the only self integrated walk to neighborhod elementary school in 5 Points, Gilpin Elementary Montessori, replacing it with DPS administration offices and a smaller charter school. In 5 months Gilpin increased its score by 8 points reaching the score needed to keep it open by DPS' own criteria....until DPS changed the score on its own.  Attempting to placate angry parents, DPS proposes a consolation prize: opening a small Montessori school within another at risk school.  There is strong evidence that DPS planned to use the upper floors for their own admin space and turn over the lower floor to a charter school. That Gilpin's scores improved so much to meet the criteria for non closure appears to have become an inconvenient truth for DPS.
 a mile away  http://www.chalkbeat.org/posts/co/2017/01/13/new-montessori-program-to-launch-at-northeast-denver-elementary-offering-home-for-students-at-school-slated-to-close/


Parents meet with 3 DPS school board members to present data against Gilpin Closure

Friday, January 13, 2017

67,000 Coloradoans just got a big screw from the GOP Congress.

67,000 Coloradoans just got a big screw from the GOP Congress. They are in danger of  getting GOPCare from a party that cares less about those numbers who would lose their affordable insurance no acquired through Obamacare (Affordable Care Act). The House of Representatives has just joined the Senate with a maneuver to strip Obamacare of all subsidies which were used to make health care premiums affordable for 11 million Americans and to remove any requirement that those eligible to get Obamacare to pay for their insurance. .which was the funding mechnism to cover pre-existing conditions.The effect will not happen this year, but stay tuned for the next year. 
This was done on a strictly partisan vote using a trick called budget reconcilliation that can be passed by 51 votes in the Senate and therefore is filibuster proof. Where the Democrats will play a role is the vote on the replacement, which will be subject to filibuster, requiring the GOP to be more bi-partisan. This is where the rubber meets the road and is the chance for Democrats to shape any replacement.

Pres. Trump is advocating "health insurance for everyone". The question is: what kind of insurance?
Obamacare provides standards of what should be covered that have many benefits and provides financial stability to the program because it spreads the cost around by enlarging the pool of healthy paying into the entire system. The requirements that health care insurance in the Obamacare (ACA) law must provide comprehensive coverage is going to be under attack by the GOP and even Donald Trump. With some derision, this comprehensive approach is being called "cadillac" insurance (not to be confused by "cadillac" insurance provided by some unions). That is a code word for reducing benefits, weakening your coverage, and making you pay more from your own pocket.
Saving Obamacare is personal to me and my family . See if you fit into any of these situations:
A partially disabled friend for the first time could get proper medical attention for a chronic medical problem since he qualified for expanded Medicaid provided by Obamacare. My self employed son whose income level was too high for a subsidy still got coverage at much lower cost than before Obamacare and much better coverage with free annual checkups and cancer screenings. My daughter is contemplating leaving employment with employer insurance and will not have to go health insurance naked when she enters the private sector and starts a new business. She can get affordable health care coverage via Obamacare, probably made affordable by a subsidy because of her greatly reduced income while starting up the business. A daughter, breast cancer survivor with employer insurance, can now get mammograms and annual checks ups without high copays, and she does not have to worry anymore about life time caps on benefits. Before Obamacare, her out of pocket life-saving treatments were $20K. Even only one follow-up mammogram was covered. Obamacare relieved much of that burden. Because of the cost savings and the ACA to Medicare resulting my drug donut hole is covered and my Medicare has a 12 year extended life to 2029 and I, too, do not have copays for annual physicals and cancer screenings as I once did.

The question will be how many of these benefits will become part of Trumpcare? Would removing these standards and benefits required now of all insurance, public or private, give you "better" insurance? Or will you be back to the financial hardships of inadequate insurance and having to pay more out of your own pocket. The latter is most likely.