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The Gutting of the Affordable Care Act

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Edited: Jan 21, 5:36am Top

Congress takes first step toward dismantling the Affordable Care Act

Trump signs executive order that could effectively gut Affordable Care Act’s individual mandate


Health Law Repeal Could Cost 18 Million Their Insurance, Study Finds

Not only CBO, alarm sounded by AMA, RC church, hospitals...


Not to worry, though,

Paul Ryan wants you to know that everything is going to be okay. Once he and the rest of the congressional Republicans repeal the Affordable Care Act, a.k.a ObamaCare, he says, "We will give everyone access to affordable health-care coverage." And he'll make sure that "no one is left out in the cold" and "no one is worse off."

If you're not sufficiently comforted, Trump whisperer Kellyanne Conway is here to assure you that "we don't want anyone who currently has insurance to not have insurance." So there's really nothing to worry about...


Jan 21, 2:23pm Top

I believe the least likely person to worry about my health is a republican millionaire/billionaire, not that anyone else is that concerned.

Jan 21, 4:36pm Top

I'm just hoping the Republicans are forced to back down, when their promises that everything will be okay fall on disbelieving ears and voters loudly explain that nobody is going to take their health insurance from them. It's actually pretty reliable in American politics; they expand some program that helps the middle class, like Social Security, and then anyone trying to reduce it gets hell.

I'm not expecting, though. If I can't have that, I may have to settle for it blowing up in the Republicans' faces and come 2018 it being fixed.

Jan 22, 11:53am Top

Republican Plan To Replace Obamacare Would Turn Medicaid Over To States (=block grants)
...Conway said voters can also expect an Obamacare replacement to include wider use of health savings accounts, which allow people to save money tax-free to help pay for their medical costs...

(Michigan's Republican Governor Rick) Snyder defends Healthy Michigan:
Snyder was in Washington, D.C. on Thursday, where he met with members of Congress to promote the state's Medicaid expansion under the Affordable Care Act.
The governor voiced concerns that a repeal of the ACA would affect thousands of low-income Michiganders who receive health care through the program.
(MI political commentator Jack) Lessenberry says Healthy Michigan, the state's version of the ACA, is "probably the best accomplishment of the Snyder administration."
"Over 600,000 people are now insured who weren't insured before ... and the federal government pays for almost all of this," Lessenberry said.

Jan 23, 4:04pm Top

Short sighted, pandering to a small portion of the electorate, politicizing without a conscience that even the Pope would probably not agree with:

Trump Reinstates Reagan-Era Anti-Abortion Policy: http://www.cnbc.com/2017/01/23/trump-reinstates-reagan-era-anti-abortion-policy....

"With the stroke of a pen, President Donald Trump reinstated a controversial rule that blocks foreign aid for family planning services.

Known as the "Mexico City policy" or the "Global Gag Rule," the policy bars foreign aid or federal funding for international programs that provide abortions — or even information about the procedure.

Under the rule, USAID would be unable to provide funds to non-governmental organizations that provide referrals or counseling for abortion services, or advocate for the same. NGOs that provide abortions — except in the case of rape, incest or life endangerment — would also be ineligible for aid. "

Jan 23, 4:34pm Top

>5 DugsBooks:

Is Pope Francis on record as being opposed to the Mexico City Policy?

Jan 23, 5:15pm Top

>5 DugsBooks: How is that different from the Helm's amendment, which I thought was still active?

Edited: Jan 24, 10:58pm Top

>6 cpg:. >7 jjwilson61:. If you are implying I am spouting off with a tenuous grasp of the issues you are right. I am no expert on Catholicism but I did read recently where the Pope gave the boot to some lesser official who (pardon me for no links can't track them down at at the moment) bucked his official stance on forgiveness for women who have had to have abortions.

And how the hell could that even be an issue with isis & others going medieval and murdering all the males of cities and using the women for sex slaves?


Jan 25, 12:54am Top

>8 DugsBooks: I looked up the difference and the Mexico City Policy is a more extreme version of the Helm amendment. Helm's amendment says that we won't fund abortions and the Mexico City Policy says that we won't fund any group that even talks about abortion.

Jan 25, 5:59pm Top

>9 jjwilson61: Thanks for doing the grunt work on that, blissfully ignorant here. Trump one upped the process today by tying in our participation in the United Nations to their position on abortion.


Jan 26, 8:12am Top

GOP governors fight their own party on Obamacare
Several who expanded Medicaid look to protect health coverage for residents.

...Sixteen of the 31 states that expanded Medicaid are led by Republicans.

“We are now able to provide health insurance to 700,000 people,” said Kasich (Ohio Governor), who circumvented his state Legislature to enact expansion in 2013 and who was the sole GOP presidential candidate in 2016 to defend that portion of Obamacare.

“Let’s just say they just got rid of it, didn’t replace it with anything,” he said. “What happens to the 700,000 people? What happens to drug treatment? What happens to mental health counseling? What happens to these people who have very high cholesterol and are victims from a heart attack? What happens to them?”

Arkansas’ Hutchinson told House GOP leaders Wednesday that he wants to keep Obamacare’s federal funding boost for expanded Medicaid — but have more flexibility to run the program as he’d like.

Michigan’s Snyder says he defended his state’s Medicaid expansion to Trump’s team and the state’s congressional delegation.

"Massachusetts believes strongly in health care coverage for its residents," Baker wrote in a letter to House Republican leadership on Wednesday.

And Nevada's Sandoval, in a letter that outlined at great length how Obamacare has benefited his state, warned Republicans about gutting the law.

“You must ensure that individuals, families, children, aged, blind, disabled and mentally ill are not suddenly left without the care they need to live healthy, productive lives,” Sandoval said...

...many Republican governors took the cash, saying it would benefit their citizens, hospitals and budgets. That includes Vice President-elect Mike Pence, who as Indiana governor enacted a Medicaid expansion model with some conservative tweaks, like requiring beneficiaries to pay into health-savings accounts...


Jan 26, 8:49am Top

Repeal of ACA could also harm veterans. Overtaxed VA unable to fill 40K jobs due to hiring freeze.


Feb 13, 7:16am Top

Today in Obamacare: 17 ways Tom Price can start dismantling the ACA
Sarah Kliff Feb 10, 2017

Decline to enforce the individual mandate.

Expand or curtail hardship waivers from the individual mandate.

Striking contraception from the list of women’s preventive services, or eliminating women’s preventive services altogether.

Expand the reach of the contraceptive mandate accommodation (currently available to religious nonprofits and closely held for-profit companies).

Narrow the essential health benefits rule.

Limit special enrollment periods.

End the “like it, keep it” fix.

Alternatively, expand the “like it, keep it” fix to exempt a wider range of plans from insurance rules.

Reduce insurer assessments for participating on Healthcare.gov.

Make it easier for online brokers like eHealthInsurance to sell subsidized coverage.

In Medicaid, allow work requirements, premiums, and more cost sharing under 1115 waivers.

In Medicaid, allow states to limit how long beneficiaries can be continuously enrolled in the program under 1115 waivers.

Permit more states to use Medicaid dollars to subsidize private exchange coverage.

Delay enforcement of the “Cadillac tax” in 2020.

Adjust the guidelines for 1332 waivers.

Adopt rules under section 1333 to enable more flexible cross-state insurance sales.

Pull the plug on mandatory (or voluntary) demonstration projects through the Innovation Center.


Edited: Feb 23, 9:13am Top

Find a Congressional Recess Event Near You
Tell Congress our health care matters, and repealing puts millions of lives at risk.


Send a hospital wristband to Congress
Add your name, and we'll deliver this wristband to members of Congress on your behalf. Send them a message they cannot ignore: Repealing our health care has real consequences.


Feb 24, 10:32am Top

...The most striking outlier (in life expectancy) is America. The world′s biggest economy is among the bottom five countries in expected gains for both men and women. At 77 years for men and 81 years for women in 2010, American life expectancy is already among the lowest in the rich world. That is partly because America is the only country in the OECD that does not have universal health care, meaning poorer health for poorer people. It also has the highest maternal and child mortality rates, so fewer people reach old age. High obesity and homicide rates shorten lifespans as well.

As a result, the study predicts that life expectancies in far poorer countries will eventually overtake America′s. It finds that men born in the Czech Republic will live as long as those born in America by 2030, as will women in Croatia and Mexico. Moreover, projections of life expectancy in America may need to be revised downwards. The researchers use actual American mortality data to 2013, with forecasts beyond that point. In fact, American life expectancy fell in 2015. If Republican plans to repeal Barack Obama′s health law end up reducing access to care, this trend might accelerate...


Feb 24, 4:49pm Top

Exclusive: Leaked GOP Obamacare replacement shrinks subsidies, Medicaid expansion
The replacement would be paid for by limiting tax breaks on generous health plans people get at work.

...The replacement would be paid for by limiting tax breaks on generous health plans people get at work — an idea that is similar to the Obamacare “Cadillac tax” that Republicans have fought to repeal.

...The replacement would be paid for by limiting tax breaks on generous health plans people get at work — an idea that is similar to the Obamacare “Cadillac tax” that Republicans have fought to repeal.

...The Republican plan would also eliminate Obamacare’s Medicaid expansion in 2020. States could still cover those people if they chose but they’d get a lot less federal money to do so. And instead of the current open-ended federal entitlement, states would get capped payments to states based on the number of Medicaid enrollees.

Another key piece of the Republican proposal: $100 billion in “state innovation grants” to help subsidize extremely expensive enrollees. That aims to address at least a portion of the “pre-existing condition” population, though without the same broad protections as in the Affordable Care Act.

It also would eliminate Planned Parenthood funding, which could be an obstacle if the bill gets to the Senate. And it leaves decisions about mandatory or essential benefits to the states.

...The proposal also includes penalties for individuals who fail to maintain coverage continuously. If their coverage lapses and they decide to re-enroll, they would have to pay a 30 percent boost in premiums for a year...


Mar 7, 11:47am Top

Fox News reprints an opinion piece by Erick Erickson critical of the new GOP proposal:


"Gone? Most of the ways Barack Obama paid for his health care plan. In? A death panel for senior citizens. Under the Republican plan, senior citizens can be charged up to five times higher than young people who can enter an insurance plan with a pre-existing condition."

Not that he likes the current ACA, but:

"If the GOP is so convinced ObamaCare is going to collapse on its own, perhaps they should let it instead of repackaging ObamaCare and owning the collapse."

Mar 7, 12:22pm Top

The GOP plan is very concerned that lottery winners will try to stay on Medicaid:


Mar 7, 2:35pm Top

>18 Taphophile13: ....and no doubt have a game plan involving hiring their buddies to seek out those damn lottery winner/welfare queens and spend $5,000 for every $1 recovered!

Mar 7, 3:33pm Top

GOP members want people to have the FREEDOM to die!!!

Mar 7, 4:47pm Top

Chaffetz chimes in with a clunk:

Chaffetz also addressed growing concerns over healthcare costs during the interview Tuesday, saying low-income Americans must make tough choices and sacrifice luxuries in order to pay for coverage.

"Maybe rather than getting that new iPhone that they just love and want to go spend hundreds of dollars on, maybe they should go and invest in their own healthcare," he said.

Mar 7, 5:34pm Top

>21 2wonderY: FFS these people have no idea what health care costs!

Mar 7, 5:52pm Top

>20 Molly3028: No, no. Life is sacred; no GOP member would support assisted suicide. No one is free to choose to die; it's just that if they don't have enough money, they aren't free to stop themselves from dying, either.

Edited: Mar 7, 5:59pm Top

>23 prosfilaes: After all, perhaps they should have lived the sort of life that would have allowed them to afford to be able to live. If someone can't even afford to survive, surely they have some accounting to do! Whatever happened to personal responsibility? Life, liberty, and the pursuit of the requisite means to avoid dying: what more could anyone need?

Mar 8, 12:34pm Top

President Trump’s false promises on healthcare

...“We’re going to have insurance for everybody,” Trump said in press conference Jan. 11. “We’re going to have a healthcare that is far less expensive and far better.”

Or, as he said in a September 2015 “60 Minutes” interview, “I am going to take care of everybody. Everybody’s going to be taken care of much better than they’re taken care of now.”

But the principles the president outlined Feb. 28 throw all those lofty commitments under the bus — and they directly align him with a policy agenda long promoted by the most callous cheerleaders of the “repeal and replace” crowd, that would extinguish coverage and care for tens of millions of Americans and increase the health and economic insecurity of many who voted for this president.

...one alternative favored by pre-candidate Donald Trump just two years ago in an appearance with David Letterman, when he recalled the experiences of a friend who became “very, very sick” in Scotland. After he was treated and released, he was told, “there’s no charge,” recalled an amazed Trump, adding, “not only that, he said it was like great doctors, great care. I mean we could have a great system in this country.”

Yes we could, but it would not look like anything Trump, Price, Speaker Paul Ryan (R-Wis.) or others in their caucus have proposed. It would look like another system we already have — Medicare, if we strengthen our healthcare crown jewel — and expand it to cover everyone.


The Daily 202: Trump will use bully pulpit to counter conservative revolt over Obamacare replacement

Mar 8, 1:18pm Top

President Trump’s false promises on healthcare

The problem is that Trump has no idea how much health care actually costs, and doesn't really know much of anything else about health care policy. He made promises based on ignorance, and now that he's on the spot, he has nothing of value to offer to the discussion.

Mar 8, 4:02pm Top

>26 StormRaven: He made promises based on ignorance, and now that he's on the spot, he has nothing of value to offer to the discussion.

This pretty much sums him up on any given issue.

Mar 8, 4:45pm Top

@Zac_Petkanas 5h5 hours ago

Who opposes #Trumpcare?

-American Hospital Assoc
-American Cancer Assoc
-American Medical Assoc
-Federation of American Hospitals



Mar 8, 5:25pm Top


The American Association of Retired Persons. I think they don't actually use that name anymore, and AARP is their appellation. But that's what they were originally, and who they are supposed to represent.

Edited: Mar 9, 6:29am Top

Whoa--see NYT graphic of economics of Trumpcare by county, age, and income--nice to have now that Congress is moving without benefit of OMB breakdown. Federal money still spent, but beneficiaries tend to earn $75,000 or more.

Who Wins and Who Loses Under Republicans’ Health Care Plan

...Analysts at the Kaiser Family Foundation estimated these subsidies for every county in the United States across these three variables. The result, shown in the maps above, reveals stark contrasts in federal support, particularly for lower-income Americans.

The biggest losers under the change would be older Americans with low incomes who live in high-cost areas. Those are the people who benefited most from Obamacare.

For some people, the new tax credit system will be more generous. The winners are likely to be younger, earn higher incomes and live in areas where the cost of health insurance is low...

...this program still represents a very large outlay of federal money to help Americans buy health insurance. ... tax credits in the Republican bill would go to people regardless of whether they even paid taxes -- another reason conservatives oppose it.


Mar 9, 9:28am Top

>30 margd: It's not clear that we'd be able to trust the CBO breakdown, as it is now run by a Trump appointee. The CBO though has a reputation of being non-partisan which is why Spicer has been bad-mouthing it lately.

Mar 9, 2:22pm Top

I know it's no laughing matter, really, but Sean Spicer patting the paper stacks and comparing the "government" one to the one that "is not!" is a primo circus act.

Mar 9, 6:03pm Top

I think it would be nice if Paul Ryan et al. would bother learning how insurance works before they try to make laws about it.


"Paul Ryan said that insurance cannot work if healthy people have to pay more to subsidize the sick.

This is literally how all insurance works. If someone's house burns down, some of your fire insurance money goes to help that person rebuild. If someone gets sick, some of your premium, healthy person, goes toward that person's coverage. Increasingly, I have come to believe that Paul Ryan is a not particularly bright creature from another world. Let us see if we can explain this to the lad."

Mar 9, 6:09pm Top

I'm thinking Paul Ryan knows exactly how insurance works; but he's trying to appeal to the voter base which doesn't know how it works.

Mar 9, 6:20pm Top

I hate to think that there are that many people who don't understand the basics of insurance, but you're probably right. And I bet Trump is one of them.

Mar 11, 3:41am Top

>33 sturlington:, >34 BruceCoulson:, >35 sturlington: . . . So true. That basic principle of insurance is tough for so many people to grasp . . . "I pay so much money, and what do I ever see?" is as far as too many people go. Well, regardless of if we're talking health insurance, home insurance, car insurance, whatever . . . compare getting through a terrible incident with it and without it. So you pay in and never need it? Be thankful.

As someone who has worked in various aspects of insurance in Canada over the last 4 decades (mainly health related), I have to say that the system you've come up with in the US seems extremely convoluted. But that just may be my unfamiliarity. Having a universal healthcare system that covers catastrophic injury is certainly more streamlined.

Edited: Mar 11, 6:00am Top

>36 2wonderY: Thanks for list. My Congressman had one of those defensive telephone town halls, but I have e-mailed him a couple time about healthcare. Not expecting much, but at least he can't say he didn't hear from constituents! (A knuckle-dragger, our gift from Koch brothers, financial industry, and gerrymandering...)

Mar 11, 8:05am Top

>37 Nickelini: As a self-employed person, I pay a crazy amount for health insurance, and like many people I spent most of my younger life without it. But when I finally signed up for it, (years before the ACA) I did see immediate effects:

--Nominal fees for preventative measures like regular doctor's visits, mammograms, etc, meant I went in for regular check ups and confirmed whether or not all was well.
--Nominal fees for prescriptions meant I did not try to muddle through without, say, pain medication that would make recovery from injuries faster.

But really, the most immediate effect was an instant reduction in stress that I had no idea I was carrying. Just knowing that if something happened -- like last month when I somehow sprained my ankle really badly -- I could go see someone and have it dealt with? That was a HUGE relief. So much so that even though the price of my insurance has more than doubled over the last ten years, I've always made it a priority. I think I'd rather have the peace of mind than have the car, frankly.

But being a fairly healthy person, I've never complained about the coverage I was paying for things I wouldn't use (prenatal care, for example!) because I get that my good health means that someone not so fortunate can get coverage.

Mar 11, 9:02am Top

>37 Nickelini: It is unnecessarily convoluted because of the profit driven middle layer of insurance companies. But rather than replicate successful models from other countries, we have to be stubborn and do it our way, which means higher costs and poorer outcomes. ACA did help with that. People no longer had to go to emergency rooms to get basic care. Republicans would like to return us to those days. Hospitals will go out of business and there will be rural areas without access to health care at all. But they voted for this.

Mar 11, 9:19am Top

>40 sturlington: People no longer had to go to emergency rooms to get basic care. Republicans would like to return us to those days.

And at least one Republican considers ACCESS to emergency care in the Emergency Room because of Federal Law to be COVERAGE, even tho said law doesn't provide funds to pay for the emergency care on behalf of those who can't afford it. Nor does it address preventive nor non-emergency care.


Mar 11, 10:43am Top

>41 rastaphrog: When people go to emergency rooms and can't pay, the rest of us pay for them, which is why a Tylenol at a hospital costs $1000. The other option is to let people die in the street, which unfortunately may be what has to start happening to get meaningful healthcare reform.

Mar 13, 3:13pm Top

It's so frustrating to read stories like this where Trump lies through his teeth and the stories just report what he said as if there is any validity to it. It wouldn't be partisan to just point out that one of the first things he did as President was to issue an executive order that invalidated any penalties for not buying health insurance which by itself is enough to send the exchange plans into a death spiral. So if the exchanges collapse the Republicans own it completely. If the reporters think its too partisan to actually publish the truth, why not find a spokesman for the Democrats or a health care expert who would say the same thing.

Mar 13, 6:59pm Top

>44 RickHarsch: I belive quite strongly it goes back to the confluence of the loss of the Vietnam war and the resignation of Nixon. I don't think citizens of the US were able to handle the truth about the nature of their leaders. Reagan gave them a re-energized myth, people in power learned how to handle reporters, newspapers collapsed--the great independents disappeared or were taken over by experts in making more money by printing more and shorter stories--the best talents seem to have gone to independent magazines like The Nation, and lately The Intercept, but these are still marginalized enough, while all television stations report from the same shallow and small pool of information, primarily fed by a stream from the Whitehouse. And then there is Fox, the demagogue as television. I also think Iran did the US a great favor (even before Iran/Contra) by staging their revolution just when the US needed coherency of any kind for any reason however daft. By all rights that should have been a short affair, the US apologizing for ousting Mossadegh in 1953, supporting SAVAK and their Shah, pointing to flaws in the US system evident from the vicious and unnecessary Vietnam war, the creepy Nixon and the SAVAKworthy Kissinger, and said please give us our hostages back and we'll start acting like a noble people.

Edited: Mar 13, 7:07pm Top

>43 jjwilson61: I forgot to link to the story and now it's gone. It was a story about Trump suggesting that the Republicans could just let the ACA collapse and blame it on the Democrats.

Mar 13, 10:06pm Top

>44 RickHarsch: I belive quite strongly it goes back to the confluence of the loss of the Vietnam war and the resignation of Nixon. I don't think citizens of the US were able to handle the truth about the nature of their leaders. Reagan gave them a re-energized myth,

I think you're on to something.

The thing that I don't understand is that the old farts running things now were young in the 60s and 70s. You know, "peace, love and happiness" hippies, Vietnam war protests, "tune in, drop out," etc. How did they turn in to the worst version of their fathers?

Mar 14, 12:26am Top

>46 Nickelini: The hippies were a very vocal part of the youngsters in the 60's and 70's but there were probably more of them who didn't rebel and quite a few whose preferred way to blow their minds was religion.

Mar 14, 1:53am Top

Well, here's another one, http://www.politico.com/story/2017/03/obamacare-uninsured-white-house-236019. In this one it mentions that the White House is trying to discredit the CBO by pointing out that it forecast more people would be enrolled in exchange plans than actually were enrolled. But it doesn't mention the obvious point that the Republicans governors did whatever they could in their states to sabotage ACA, and the Republican congress did its part by killing a reinsurance program that was supposed to mitigate the risk to the insurance companies in the first few years.

Mar 14, 9:41am Top

Has ANYONE heard ANYBODY address the real issue in our health care system. I have listened to the chatter endlessly and have only heard a couple of people bring up the real problem. They were quickly steered in a different direction. The cost....not the insurance but the entire bloated, money hungry, greed driven system, is outrageous. The average American can not afford a broken arm. How on earth can an individual decide not to pay into the system ? Or to judge themselves "healthy" and take out a policy with minimal coverage ? That is pure folly. Every single tier in the system is out of control, it seems impossible that most American's can not see this. It is an insult to the intelligence for the GOP lawmakers to keep saying that our insurance rates will go down. NO...they will not go down. The insurance has to deal with a system that is out of control and hardly ever (if at all) addressed. Slapping pricing regulations on the components of our health care system is not a capitalistic move but unless it is done, it is not EVER going to change. The cost will not go down. Insurance pays the system, we pay the insurance. How is this so hard to figure out ? Insurance across state lines ? Give me a break.....I don't care where that insurance comes from they still have to pay for a broken arm in Wisconsin or Maine or California....where ever and the cost of one's policy will have to cover it...plus feed the greed within the insurance company. It is such a waste of time and money to keep hammering away at this.

I said from the get go that Obama knew what he was doing. Since it is impossible to legislate against the greed in a system, especially when that system is composed of multitudes of suppliers, the only way forward from the ACA is to a private payer system. Or go backwards. Obama let greed do it's nasty....he had to know it would run into a wall. A lot of people did, unfortunately there are still those out there who think that there is some sort of magic wand that will be waved and we will all be able to afford our medical care. Not going to happen.

Edited: Mar 14, 10:47am Top

>49 sturlington:

I have to say that article's terrible in every respect. The premise--"it's all the boomers' fault"--is totally hackneyed and such truth as there is to it relies on the most trivial chronological coincidence--of course "it" is the fault of the most numerous people mostly in charge. Yes, mom and dad and grandpa and grandma came BEFORE us and whatever they wrought in the "before us" is obviously their doing.

The psychological (or psychobabbly) profile of boomers as entitled, selfish, egocentric etc. is nothing new either--and I think no generalisation is less true and more unjust. Yeah, they (by the way, the author is talking about white people only--will come to that) overall had good childhoods of plenty, better basic education than masses today, and decent chances of secure remunerative employment... but they also lived in the midst of cold war crises, ever-looming nuclear threat, Vietnam and myriad smaller wars. And masses of them did want and imagine a better world, and in the name and on the basis of some collective good, not just private gain. Theirs is the generation that became conscious of and worried about the larger world, and the environment.

The author is a "venture capitalist". It's funny how he first berates the boomers for failing to "save" but then a few paragraphs later the mask slips and the problem becomes the failure "to invest". (Which, btw--total bollocks. Yeah, the big trouble with the 60s/70s/80s/90s/00s USA is that nobody was playing capital.)

But that's the least of it. He diagnoses "the problem" with the entire boomer generation as "sociopathy" and squarely blames for this their "permissive" upbringing, "license", and television.

And did they ever stop beating their grandmothers???

What does he mean by Clinton's "berserk" policies on gays and "transgender showdowns"? Regarding the former, what I remember most vividly from Clinton years is the flap about coming out in the military (don't ask, don't tell), but my overall impression is one of years of general improvement in the rights of the LGBT people. Lots of public coming out, P-FLAG, Gay Pride becoming part of civic celebrations, gay parenting... (It's difficult to recall details with all the state-specific developments.) Clinton disappointed on that front as on every other, but was he worse on these issues than the Republicans? Not my recollection.

On race--he leaves out Obama as someone distant "geographically and socially" from the boomer mainstream. But isn't this true for all American blacks? And immigrants? And, largely, women--who certainly weren't represented in even today's meagre numbers in the American establishment of the 60s/70s/80s/90s etc.?

So what does "generation" even mean when people in the same age group can differ so drastically in political role and impact?

Or, the Koch brothers and the 1 percent being unable to "dictate national policy on its own" because 1 percent is just 1 percent. That's just funny--one anteater vs. a kajillion ants! Such an unfair battle!

In short, a bad rehash of already stale arguments.

Mar 14, 11:15am Top

>51 faceinbook: I heard somewhere that the nonprofits (incl Blue Cross Blue Shield) were the ones left in exchanges abandoned by the for-profit health insurance companies, which made me think ACA competition was beginning to work?

Edited: Mar 14, 11:41am Top

>53 margd:
I still have no faith in the insurance aspect of this problem. Insurance is high and lowering the cost would be great but that is such a small part of the entire system. They are chattering on about a "market based system tailored to you and your doctor" That is what we had. If it had worked we would not have voted in the ACA. 40 million people could not participate in the market based system. We had tailored plans and risk pools. I paid high risk insurance premiums since the 1990s. We also had a plan that paid for only major medical.
The problem is that the 40 million people who either could not or would not pay into the system were not necessarily people who did not use the system. These individuals have the freedom to use a system and to also refuse to pay into that system.

Unless we decide that one gets medical care only if they carry an insurance card....those who pay are going to pay for those who don't. I suppose that they added an uninsured motorists charge to one's auto insurance, they could do the same with health insurance ?

Paul Ryan was on just a few minutes ago.....he said he wasn't upset about the rising number of uninsured on his healthcare plan....it just meant that people had the freedom to not buy something they did not want to buy.
How dare they decide not to pay ? Seriously.....I want my freedom as well....the freedom to know it is possible for me to take care of myself and my medical costs. I will lose that if I am paying for someone else's gamble. The gamble that they won't need care or that they will be able to afford their care.

"I heard somewhere that the nonprofits (incl Blue Cross Blue Shield) were the ones left in exchanges abandoned by the for-profit health insurance companies, which made me think ACA competition was beginning to work?"

Perhaps....however, how long can non-profits sustain the raising costs of hospitalizations, doctor visits, drugs, medical equipment, therapy and everything else that goes into good patient care. They will have to raise deductibles, cover less and raise premiums.

Who is looking at WHY insurance is so expensive. Hint....it has nothing to do with state lines. The boneheads !

Mar 14, 1:53pm Top

Again....just heard the head of the CDO say that American's should have the individual freedom to opt out of buying health care insurance. Health care is NOT like buying a car. The dealership is not obligated to see that you leave the dealership with an automobile even if you can not afford one. Health care is a human obligation. Totally different than any other thing on the free market.....if we continue to view it as such an obligation and don't start turning people away, who can not afford it, we then need to recognize, what many GOPer's do not want to see, and that is, we ALL have a responsibility as a human being to care for a system that is obligated to care for us.

It is so easy to sit with a comfy plan and say that everyone should have a choice. Or easy to say at the age of 25 that you are healthy and don't need a thing from the system but that is not the point. The point is that the dictates of American society, has taken on a responsibility for you.
If you don't like it go somewhere else. OH......I forget, everyone else has pretty much figured this out. We are still holding on to the false premise that every man is entitled to be a island, at the cost of everyone around them.

Mar 14, 2:03pm Top

Trumpcare is a death panel for Deplorables.

Mar 14, 4:23pm Top

>55 faceinbook: Again....just heard the head of the CDO say that American's should have the individual freedom to opt out of buying health care insurance

I can't speak for absolutely everyone outside the US, but a substantial number of us who hear "ACA is stealing my freedom" or some-such gobbledygook think it's pure batshit lunacy. The powers that be sure did a number on people tying in "freedom" and "healthcare." But then what do I know, I'm obviously a slave to my communist overlords.

Mar 14, 4:43pm Top

Statistics I heard today: 40% of American children are on Medicaid, and 50% of births are paid for by Medicaid (source: NPR, that last stat may apply only to certain states). So the prolife party's proposal to severely cut Medicaid hurts children and babies disproportionately. Other groups that are affected: low-income seniors, especially in long-term care, and the disabled.

Mar 14, 6:29pm Top

>46 Nickelini: Third try to answer—longer responses have been cut off somehow (clumsy fingers, I suppose). I believe especially young people ran out of steam when the bodies quit arriving to the US (back when the press was free to film the coffins). And I believe repression works: Patty Hearst is well-remembered while Fred Hampton is seemingly less so. Black radicals were just plain crushed. Then there’s plain economics: not many communes survived the pressures of US capitalism (or so it seems). But the ideals did not necessarily die—it just became hard for them to coalesce into something durable. The US is very good at cooptation, for one thing. And I know many ‘old radicals’ whose ideals did not change but who had no outlet for their radicalism, or rather no outlet involving much of a group, much momentum. I know a lot of ‘old radicals’ who survive now in relative isolation. We (I’m an aging radical at 57) marched against Reagan…what a lonely delight that was. The US became better at what diffusing dissent, defusing dissent, and worst of all, shrugging off dissent. Crimes like the Watergate break-in are no longer capable of shocking people. After the country lost the Vietnam War and the swine Nixon resigned, we had to watch Reagan wreak havoc on Central America (especially), watch Kissinger walk free…So those with ideals simply lost. I am idealistic to this day, but I am not optimistic.

Edited: Mar 15, 8:49am Top

>58 sturlington:

I am not surprised by the numbers. Many young people do not get married right away as it is cheaper to start families when a woman is single and has a low income. My advice for a long time is to go ahead and work the system. It is simply cruel to continue to allow our healthcare system to dictate how we live, to the point of being considered ahead of home, food and family. If everyone quit buying in, it would have to change. The problem is that people my age still have the means to pay and pay and continue paying.....making it harder for our younger generation to keep up.
The guys who are making the decisions right now....do not have a clue what it means to look at a healthcare premium that is as much as an automobile payment or a week of groceries and then make a decision what to do because it is either/or.
I am not quite sure of the mindset that refuses to accept that perhaps things are different for others but it not only is prevalent amongst many of our elected officials, it reversely affects those who elect them, to the point where they envision themselves in Trump Tower, skipping right through any type of logic or common sense.

Mar 15, 8:57am Top

Concurrent with the dismantling of the ACA, this hit my newsfeed this week:


The average annual premium for employer-sponsored family health coverage in 2016 was $18,142, according to the Kaiser Family Foundation. Under the plan proposed in the bill, a wellness program could charge employees an extra $5,443 in annual premiums if they choose not to share their genetic and health information.

Edited: Mar 15, 3:35pm Top

>61 southernbooklady: I saw the same news story and was dumbfounded. How could there be a more egregious invasion of privacy? Before the HIPPA act it was common for company employees to gossip about health information of employees and even people who were just applying for a job {release of health info on a lot of job application forms}. I am sure it still happens albeit in a more guarded manner in this information on people used as currency society.

edited in " job application forms"

Mar 15, 3:25pm Top

If we end up with universal health care under a Trump presidency I will start checking for portals to the alternate reality I inadvertently stepped into.

Mar 15, 4:13pm Top

>64 southernbooklady: Agree, although I don't see it happening. Many Tea Partiers are rejecting the Ryan plan because it doesn't go far enough in repealing Obamacare.

Mar 15, 6:56pm Top

>65 sturlington: I agree. Even if Trump decided to back single payer he can't introduce legislation on his own. He'd need to get the Republicans leadership to go along, which will never happen.

Mar 19, 4:50pm Top

CBO's estimate of lost health coverage had me wondering if I misread article years back on how Catholic Paul Ryan took to heart the new Pope's message of mercy, etc. Wonder how/if Mr. Ryan reconciles proposed healthcare bill with mission to help the poor??

Paul Ryan Finds God
How a backstage prayer in Cleveland and a new leader in the Vatican set the budget-slashing congressman on a mission to help the poor. “My bet is that he’s on Pope Francis’ team.”


(Remember predecessor Boehner quit as speaker after meeting the pope?)

Edited: Mar 20, 3:09pm Top

Interesting map of changes Trumpcare will bring to people by Kaiser Family Foundation. Looks like I hit the sweet spot for greatest increase >$14,000 . Wow, finally won something . ;-(


Mar 23, 6:30am Top

Study: ACA enrollees’ costs would spike under Republican plans
Feb 24, 2017

...Table 3. Additional cost increases for selected services under the Republican approach
(e.g., Maternity Care: $8,501!!)

...Clearly, using premiums as a proxy for consumer health care costs is a mistake. In judging whether Republican health care plans will be an effective, or even acceptable, replacement, their effects on cost sharing must be taken into account.

Doing so dramatically changes the picture. The Republican plans do reduce premiums — predictably, given how much less coverage consumers would receive. But our analysis shows that the current Republican proposals would substantially increase total costs on average — not to mention the risks of a financially devastating health care expense.

In short, any discussion that focuses on premiums in isolation hides the true impact of Republican plans to repeal and replace the Affordable Care Act. Consumers’ wallets would take a big hit.

David Cutler is the Otto Eckstein professor of applied economics at Harvard University. John Bertko is the chief actuary for Covered California, the state’s health insurance exchange. Topher Spiro is the vice president for health policy at the Center for American Progress.


Edited: Mar 23, 7:39am Top

Saw on Twitter last night that republicans were trying to get more votes by eliminating the requirements that health insurance cover essential benefits such as hospitalization, lab tests, prescriptions, and pediatric care.

ETA Just read, and emergency services.

Apparently, we're going back to the days when the insurance company's role was to jack up premiums every year and then deny all your claims.

Mar 23, 8:16am Top

These are Trump's people--and with repeal of ACA, he and House Republicans are fixing to deal them yet another blow...

The Forces Driving Middle-Aged White People's 'Deaths Of Despair'

In 2015, when researchers Ann Case and Angus Deaton discovered that death rates had been rising dramatically since 1999 among middle-aged white Americans, they weren't sure why people were dying younger, reversing decades of longer life expectancy.

Now the husband-and-wife economists say they have a better understanding of what's causing these "deaths of despair" by suicide, drugs and alcohol.

...In a follow-up to their groundbreaking 2015 work, they say that a lack of steady, well-paying jobs for whites without college degrees has caused pain, distress and social dysfunction to build up over time. The mortality rate for that group, ages 45 to 54, increased by a half-percent each year from 1999 to 2013...



Anne Case and Sir Angus Deaton. 2017. Mortality and morbidity in the 21st century. Brookings Papers on Economic Activity
Thursday, March 23, 2017. 60 p. https://www.brookings.edu/wp-content/uploads/2017/03/6_casedeaton.pdf at https://www.brookings.edu/bpea-articles/mortality-and-morbidity-in-the-21st-century/

Mar 23, 8:28am Top

From Matt Taibbi's Rolling Stone article: http://www.rollingstone.com/politics/features/taibbi-on-trump-the-destroyer-w473....

'... Trump continually presses forward.
We always assumed there was a goal behind it all: cattle cars, race war, autocracy. But those were last century's versions of tyranny. It would make perfect sense if modern America's contribution to the genre were far dumber. Trump in the White House may just be a monkey clutching history's biggest hand grenade. Yes, he's always one step ahead of us, and more dangerous than any smart person, and we can never for a minute take our eyes off him.
But while we keep looking for his hidden agenda, it's our growing addiction to the spectacle of his car-wreck presidency that is the real threat. He is already making idiots and accomplices of us all, bringing out the worst in each of us, making us dumber just by watching. Even if Trump never learns to govern, after four years of this we will forget what civilization ever looked like – and it will be programming, not policy, that will have changed the world.'

Edited: Mar 23, 8:42am Top

We must protect our sensitivity and sense of outrage,
so that after four years of this we will NOT have forgotten what civilization looks like.

I'm feeling whiplash myself after two months of this following eight years of no-drama Obama and his largely scandal-free administration...

Mar 23, 8:45am Top

Found a news story about the repeal of essential health benefits. The consequences of this are so ridiculous it's almost hard to believe even republicans would go for it.


Mar 23, 8:51am Top

74: Not only will Republicans go for it, these repeal provisions are meant to appease the so-called Freedom Caucus and entice them to vote for the bill.

Mar 23, 9:25am Top

>73 margd: In your case the problem may be stopping your momentum.

b) 'Our' sensitivity and sense of outrage, in my view, crushed by the last three decades, and made this possible. I can't help but think about the difference between the domestic response to aerial war crimes committed in Southeast Asia in the 60s and 70s to those from Pakistan to north Africa in the past decade and a half.

Mar 23, 10:07am Top

House Republicans May Have Saved Trumpcare by Making It Even Crueler

The proposal is to eliminate ten essential benefits that, according to the Affordable Care Act, must be offered as part of any insurance plan. Those benefits are:

• Outpatient care without a hospital admission, known as ambulatory patient services

• Emergency services

• Hospitalization

• Pregnancy, maternity, and newborn care

• Mental health and substance use disorder services, including counseling and psychotherapy

• Prescription drugs

• Rehabilitative and habilitative services and devices, which help people with injuries and disabilities to recover

• Laboratory services

• Preventive care, wellness services, and chronic disease management

• Pediatric services, including oral and vision care for children

Good thing these people TELL us they are "pro-life". It would be really hard to think so otherwise.

Or, come to think of it, maybe they mean pro-sick-life. Live and suffer, you fucking sinners.

Mar 23, 10:22am Top

Okay wizards: Will the Democrats save the people? This is a real question: can they/will they stop this from happening?

Mar 23, 10:51am Top

Or will Republicans completely destroy the health insurance industry, along with their credibility, so that universal health care becomes a given?

Edited: Mar 23, 10:55am Top

>79 sturlington: Now that's optimism!

Mar 23, 10:55am Top

>80 RickHarsch: I'm trying. Of course, to get to that point, millions will likely suffer, die, or undergo bankruptcy, so...

Edited: Mar 23, 11:46am Top

My congressman is a Republican so he does not do town hall meetings. He'll do a telephone version in which he'll lecture "attendees" and allow pre-vetted questions, but no follow-ups. He doesn't answer questions, but just uses them as a jumping off point for whatever he wants to talk about.

In any case, the call yesterday was about the Republican plan. He says that the ACA burdened insurance companies because they have to cover things and we could all have dirt-cheap insurance if insurance companies could just omit a few things from coverage. It'll be great! After all, being covered for pregnancy, cancer and diabetes is a waste of money. You might not ever get them. A guy called and talked about the need for universal catastrophic health care insurance. It was a good question, from a doctor who was in the trenches with people who couldn't afford to treat life-threatening conditions. So Gowdy used that call to talk about how great the Freedom Caucus is and I had to hang up for mental wellness reasons.

I'm hoping that the Republican plan dies today. They won't have the momentum to try again. And people are now realizing that the ACA, while imperfect, is much better than no plan at all.

Mar 23, 12:16pm Top

>82 RidgewayGirl: It seems like moderate Republicans are turning against it now.

Mar 23, 12:18pm Top

>83 sturlington: That would not include my rep, Mr Trey "BENGHAZI!!!" Gowdy, who looks like Draco Malfoy grew up and lost all vestiges of empathy.

Mar 23, 12:22pm Top

>81 sturlington: 'millions will likely suffer, die, or undergo bankruptcy, so...'

There you go, an optimistic Republican

Mar 23, 12:50pm Top

>83 sturlington: You have my condolences. The leader of the so-called Freedom Caucus, although not my rep, is from my state, and I was pretty sure he was going to torpedo the bill because it wasn't evil enough.

>85 RickHarsch: LOL

Mar 23, 5:26pm Top

So while the House Republicans were canceling the vote on the Republican health plan because they couldn't pull together enough votes, Trump was sitting in a big rig in the White House driveway, pretending to drive and honking the horn.

You couldn't make this stuff up.

Mar 23, 5:38pm Top

Just saw a news alert that CBO rates revised healthcare bill as worse on both deficit reduction and coverage.


Mar 24, 9:12am Top

And, Office of Management and Budget Director Mick Mulvaney has said if you don't like what your state "mandates" for health care, (if Trumpcare passes,) move to a state with mandates you like better, or work to change your states rules.


Mar 24, 10:31am Top

>89 rastaphrog: Except that he also advocates allowing insurance to be sold across state lines, which means all insurance will move to those states with the least restrictive state rules.

Mar 25, 1:16am Top


Art of the Schlemiel. lol.

Mar 25, 5:00am Top

I followed it on twiter and the NYT last night (in Holland it was night). It was beautiful ! Congratulations Americans !

Mar 25, 8:27am Top

>91 sturlington: “Hey, we could have done this,” he said. “But we couldn’t get one Democrat vote, not one

The headline of that article could have been: "Trump discovers governing the country is hard" or "Trump finds out governing is harder than tweeting"

I find myself wondering if these first sixty, sixty-one days are predictive of the next four years. If so, Trump's presidency is shaping up to be one of the most ineffective in history -- a series of hasty and ill-considered actions that are promptly declared illegal or are rejected. The man does not have the word "compromise" in his dictionary, and has surrounded himself with more of the same. It's hard to see how anything substantial can get done in those circumstances.

Mar 25, 8:41am Top

>94 southernbooklady: That's a good thing, right?

If he wanted Democrat votes, he should have worked with Democrats to give them something they could vote for. This bill had 17% approval. I think they lost even more moderate republicans with their final version.

It sounds like the effort to repeal Obamacare after all those tries is over. This debacle doesn't just make clear how ineffective a president Trump will be but also how absolutely awful the gop is at governing. They got everything they ever wanted and still managed to screw it up.

Is there a German word for how I'm feeling? It's way beyond schadenfreude.

Mar 25, 9:12am Top

The most important thing is for their horrorshow plan not to be implemented because it would cause unbelievable amount of suffering.

They will, however, continue to blame the Democrats and Obama for everything, and given the level of incompetence shown thus far, they won't be able, even if they were motivated, to resolve difficulties.

>94 southernbooklady:

Trump's presidency is shaping up to be one of the most ineffective in history

"Ineffective" as in "incapable of performing functions of a good government", yes, but not "without effect". I'm afraid Trump's win and whatever he does and doesn't do in office will have tons of negative effects for years to come. There have been piecemeal changes all over the place whose impact may not be immediately visible.

Mar 25, 9:18am Top

>96 LolaWalser: They will, however, continue to blame the Democrats and Obama for everything.

This seems to be the game plan, but it's not going to wash now that they control the government.

"Ineffective" as in "incapable of performing functions of a good government", yes, but not "without effect". I'm afraid Trump's win and whatever he does and doesn't do in office will have tons of negative effects for years to come. There have been piecemeal changes all over the place whose impact may not be immediately visible.

This is a good point, but it seems now that everything they try will be vigorously challenged, and if energy keeps up, we have a chance to retake the Senate and some governors' offices in 2018. The ongoing investigations will also hamper what they can they do, and they will be sued at every turn. So obviously, it is not a great scenario, but it is better than the full-on lock-step authoritarianism that was predicted.

Mar 25, 9:36am Top

>96 LolaWalser: "Ineffective" as in "incapable of performing functions of a good government", yes, but not "without effect".

He's very bull-in-a-china-shop. It still surprises me that anyone would think he'd be anything but. It's not like his character or his methods were some big secret.

Edited: Mar 25, 1:14pm Top

Left out of AHCA fight, Democrats let their grass roots lead — and win

...Democrats watched as a roiling, well-organized “resistance” bombarded Republicans with calls and filled their town hall meetings with skeptics. The Indivisible coalition, founded after the 2016 election by former congressional aides who knew how to lobby their old bosses, was the newest and flashiest. But it was joined by MoveOn, which reported 40,000 calls to congressional offices from its members; by Planned Parenthood, directly under the AHCA’s gun; by the Democratic National Committee, fresh off a divisive leadership race; and by the AARP, which branded the bill as an “age tax” before Democrats had come up with a counterattack.

Congressional Democrats did prime the pump. After their surprise 2016 defeat, they made Sen. Bernie Sanders (I-Vt.) the outreach director of the Senate caucus. Sanders’s first project was “Our First Stand,” a series of rallies around the country, organized by local Democrats and following a simple format. Elected officials would speak; they would then pass the microphone to constituents who had positive stories to tell about the ACA.

“What we’re starting to do, for the first time in the modern history of the Democratic Party, is active grass-roots organizing,” Sanders said in a January interview. “We’re working with unions, we’re working with senior groups, and we’re working with health-care groups. We’re trying to rally the American people so we can do what they want. And that is not the repeal of the Affordable Care Act.”...



ETA: Per House members, phone calls on the GOP health bill run 50-to-1 against



ETA: @GlennThrush (New York Times White House correspondent, ex-POLITICO, ex-Newsday, ex-City Limits)

Trump, Bannon and Marc Short wanted to force a public vote to create a GOP enemies list of 'no' voters. Ryan said no.



Trump Becomes Ensnared in Fiery G.O.P. Civil War

Paul Ryan Emerges From Health Care Defeat Badly Damaged

Edited: Mar 25, 10:02am Top

>98 southernbooklady:

He's very bull-in-a-china-shop. It still surprises me that anyone would think he'd be anything but. It's not like his character or his methods were some big secret.

Whoever voted for him and supports him does so BECAUSE of his character and methods, not despite them. It's not by chance that he got the dinosaur, the misogynist, the racist, the xenophobic, the "after me the flood"-corporatist and business vote.

You must have seen and heard people like this a million times over by now, to me it's still shocking:

Why Are Trump Supporters Campaigning Already? - The Daily Show | Comedy Central

But there it is. That's his base. Won't be any china shops left after their reign.


>97 sturlington:

we have a chance to retake the Senate and some governors' offices in 2018

Here's hoping!

Mar 25, 2:03pm Top

One thing these past two months have taught people is to call their representatives. And that it has an effect, even if to make their Republican reps wary. I don't think that kind of energy will just disappear.

Mar 25, 4:04pm Top

How Republicans quietly sabotaged Obamacare long before Trump came into office
Billions that should go to Obamacare are missing, thanks to senators like Marco Rubio

...When the ACA was rolled out, telling insurance companies that they had to insure anybody who signed up, regardless of previous conditions or sickness, everybody realized that the insurance companies would probably lose money in the first decade or so, until previously-uninsured-but-sick people got into the system, got better, and things evened out.

To get the insurance companies to go along with this danger of losing money, the ACA promised to make them whole for any losses in any of the first decade’s years. At the end of each fiscal year, the insurance companies merely had to document their losses, and the government would reimburse them out of ACA funds provided for by the law.

The possibility of their losing money was referred to as the “risk corridor,” and the ACA explicitly filled those risk corridors with a guarantee of making the insurance companies, at the very least, whole.

And then something happened. As The New York Times noted on December 9, 2015, “A little-noticed health care provision slipped into a giant spending law last year has tangled up the Obama administration, sent tremors through health insurance markets and rattled confidence in the durability of President Obama’s signature health law.”

Rubio and a number of other Republicans had succeeded in gutting the risk corridors. The result was that, just in 2015, end-of-fiscal-year risk corridor payments to insurance companies that were supposed to total around $2.9 billion were only reimbursed, according to Rubio himself quoted in the Times, to the tune of around $400 million. Rubio bragged that he’d “saved taxpayers $2.5 billion.”

...The Times not(ed), “Because of Mr. Rubio’s efforts, the administration says it will pay only 13 percent of what insurance companies were expecting to receive this year. The payments were supposed to help insurers cope with the risks they assumed when they decided to participate in the law’s new insurance marketplaces.”

Meanwhile, federal judge Thomas Wheeler of the US Court of Federal Claims, ruled recently (as reported last month by Forbes) that the feds actually have to pay back – to the tune of about $8 billion – the moneys lost by health insurance companies operating in good faith.

But it’s way too late; dozens of nonprofits started to provide health insurance through the exchanges have already gone bankrupt, and the health insurance giants are both subsuming their smaller competitors and merging like there’s no tomorrow. Additionally, Wheeler’s ruling is certain to be appealed – meaning it’s in limbo for the moment.

So, yes, Donald Trump is right that Obamacare had been sabotaged, in a way that would virtually guarantee at least some level of crisis by 2017. Where he’s sadly, paranoiacly wrong is in attributing that sabotage to President Obama.

Democrats should have been screaming bloody murder for the past 2 years. Maybe they can start now, every time a reporter or Republican says, “Obamacare is failing…”


Apr 3, 8:23am Top

How Trump / Republican policies jeopardize care of people with autism and other disabilities, a March 9 op-ed in New England Journal of Medicine:

David S. Mandell, Sc.D., and Colleen L. Barry, Ph.D. 2017. Perspective: Care for Autism and Other Disabilities — A Future in Jeopardy. N Engl J Med 2017; 376:e15March 9, 2017DOI: 10.1056/NEJMp1700697 . Via http://www.nejm.org/doi/10.1056/NEJMp1700697#.WMpgY5KRewA.twitter

Edited: Apr 5, 9:21am Top

Oh, dear...

Pence presents new healthcare offer to Freedom Caucus
By Peter Sullivan - 04/03/17

...Vice President Mike Pence and other White House officials presented an idea to the Freedom Caucus meeting to allow states to choose to apply for waivers to repeal two ObamaCare regulations that conservatives argue are driving up premiums.

Those two regulations detail ObamaCare's essential health benefits, which mandate which health services insurers must cover, and "community rating," which prevents insurers from charging sick people higher premiums.

Conservatives had previously called for the bill to repeal those regulations outright, but the deal now being discussed would give states a choice by allowing them to apply for a waiver from the federal government...



ETA: @jonfavs 10h10 hours ago
If I was working on a bill that allows insurance companies to bankrupt cancer patients, I'd be scared of facing my constituents too.

Meadows says some GOPers are "concerned" that going home for recess "sends the wrong msg" if they are "making real progress" on health care

Apr 10, 10:28am Top

Since my rep holds meaningless phone-in town halls and sends me rote replies signalling his intent to repeal ACA, I hope this petition will get his attention--though he is financially more able to care for his family's health than are many of his constituents...

Huge Movement Launched to Strip Congress of Their Healthcare, Over 800,000 Join
cpowell | April 5, 2017

...The Petition in part states: A lot of Members of Congress promote choice as an American value, which is all the more reason for them to have to continue to choose their own health coverage from the free marketplace. If private health care is good for the American citizen, it should also be good for the people that defend it.

...If the petition receives 500,000 signatures, it will be delivered to House Speaker Paul Ryan, Sen. Bernie Sanders and President Donald Trump.

As of this article’s writing, Jimenez’s petition has over 800,000 signatures and is rising quickly.



Apr 10, 11:21am Top

>105 margd: My rep is a Freedom Caucus weasel who also will hold only those phone-in meetings. It's such a cowardly move, especially given that he was against the ACHA because it didn't take enough health care away from low income people.

But if you ask him to, he'll be happy to waste more taxpayer dollars holding more meaningless hearings about Benghazi.

Edited: Apr 16, 4:06am Top

Can Trump Take Health Care Hostage?
Paul Krugman APRIL 14, 2017

...Mr. Trump...has decided to blame Democrats for not cooperating in the destruction of their proudest achievement in decades. And on Wednesday, in an interview with The Wall Street Journal, he openly threatened to sabotage health care for millions if the opposition party doesn’t give him what he wants.

In that interview, the president of the United States sounded just like a mobster trying to extort protection payments from a shopkeeper.

“Obamacare is dead next month if it doesn’t get that money,” he declared, referring to cost-sharing subsidies that reduce out-of-pocket expenses for low-income families, and are crucial even to higher-income families, because they help keep insurance companies in the system. “I don’t want people to get hurt.” (Nice shop you’ve got here, shame if something were to happen to it.) “What I think should happen and will happen is the Democrats will start calling me and negotiating.” (I’m making them an offer they can’t refuse.)

It’s a nasty political tactic. It’s also remarkably stupid.

The nastiness should be obvious, but let’s spell it out. Mr. Trump is trying to bully Democrats by threatening to hurt millions of innocent bystanders — ordinary American families who have gained coverage thanks to health reform. True, Democrats care about these families — but Republicans at least pretend to care about them, too...

...(Remarkably stupid, exhibit A.) There’s a reason an open letter (http://talkingpointsmemo.com/news/csr-letter-trump-industry-groups) to Mr. Trump urging that the cost-sharing subsidies be maintained was signed by a wide array of lobbying organizations, including very conservative groups like the U.S. Chamber of Commerce. What they understand is that sabotaging Obamacare would be a disaster for their interests...

But here’s the thing: Even if Mr. Trump wimps out, as he is doing on so many other issues, he may already have done much of the threatened damage. Insurers are deciding right now whether to participate in the 2018 Obamacare exchanges. Mr. Trump’s tough talk is creating a lot of uncertainty, which in itself may undermine coverage for many Americans....



Trump Makes His First Big Changes To Obamacare
Jeffrey Young | 04/13/2017

... new policies are intended to make the exchanges more attractive to insurance companies next year, after more insurers pulled out of the program this year. Consumers may be forced to endure more hassles in order to keep insurers in the fold because without the insurers, there’s no coverage to buy.

...(However) the changes the administration is making could actually reduce overall enrollment and discourage healthier, and thus less costly, consumers from signing up.

These are the key elements of the new regulation:

The open enrollment period will be half as long as originally proposed. Sign-ups for 2018 health coverage will run from Nov. 1 to Dec. 15, 2017, instead of going until Jan. 31, 2018. This could make it more difficult to spread the word about enrollment and provide assistance in signing up. The administration argues it will prevent people from waiting until they get sick to buy policies, something they have more time to do during a longer enrollment period.

Insurance companies will be allowed to refuse to sell policies to consumers who fail to make all their premium payments this year. The Obama administration gave consumers a 90-day grace period before they could be kicked out for nonpayment. It didn’t allow insurers to demand that money be paid back before enrolling people in coverage for the following year. The Trump rules permit, but don’t require, insurers to collect unpaid premiums.

People who need to obtain coverage after the open enrollment period will have to prove it. Certain life changes ― such as getting married, having a child or moving ― give consumers the opportunity to buy plans at any point during the year. Under Obama, these people merely had to attest to their new circumstances; Trump will require documentation. Insurers complained that people used these “special enrollment periods” to get coverage only when they needed medical care.

Insurers will be allowed to sell skimpier plans. The Affordable Care Act defines four “metal” levels of coverage ― bronze, silver, gold and platinum ― that offer increasingly more generous coverage that, in general, comes with increasingly higher premiums. Each metal level must cover a certain percentage of a typical person’s medical expenses. For instance, a silver plan has to cover at least 70 percent. Obama allowed plans to vary within their metal level by 2 percentage points in either direction. Trump will give them more leeway. A silver plan could cover between 66 percent and 72 percent of medical costs. This has a side effect of potentially lowering the value of the tax credit subsidies for premiums, because they’re based in part on the cost of the second-cheapest silver plan in each geographic area. If that benchmark silver plan covers only 66 percent of medical expenses, it will have a lower price, and that lower price will lead to smaller subsidies for all policies in that locale.

Insurers will be allowed to include fewer “essential community providers” in their networks. Narrow network plans are a key way for insurers to keep costs down by excluding the most expensive providers. Obama required them to include at least 30 percent of area health providers that care for “medically underserved” and poor patients. Trump will reduce that threshold to 20 percent and leave it to states or private accrediting entities to determine whether an insurance policy has enough providers in its network.



ETA: Opinion: Trump’s threat over subsidies risks damaging Obamacare beyond repair
J.B. Silvers (former health CEO, professor of health finance at Case Western Reserve University) | Apr 14, 2017 4:02 p.m. ET

...There are two critical considerations facing insurers right now. First, the ones that still remain in the individual exchanges have to decide whether to submit their 2018 plan designs and premiums by May 23. Second, the law continues to force them to set premiums for the key Silver plans based on the cost-sharing reductions in the law. But without the promised subsidies to help the working poor with their out-of-pocket expenses, insurers will have to eat the difference.

Even the possibility of such an event will force them to either raise their Obamacare premiums for next year by 20%, according to the Kaiser Family Foundation, or just drop out.

..The insurance industry won’t play Charlie Brown to President Trump’s Lucy and have the football yanked away time after time. In the last two years, Congress reneged on the ACA promise of normal risk-reduction backup in the startup period, paying only 12% of what was promised. The proposed AHCA replacement threatens major reduction in premium subsides. This third threat will be too much. Insurers will just drop the mike and exit stage right.

While others in the administration are trying to avoid this by extending deadlines and reassuring continuing current support to stabilize the market, Trump’s misreading of the market may damage the exchanges beyond repair and, with it, the continued role of private insurers in future government options.



Aah, this might be what's prompting threat over subsidies--Congress v Obama/Trump lawsuit?

The bizarre lawsuit that could still blow up the ACA insurance markets
Nicholas Bagley Mar 29, 2017

...A pending court case, House v. Price (née House v. Burwell — and so much turns on the name change), has given the administration a bomb it could use to blow up insurance markets across the country. At stake is the legality of the payments the federal government makes to insurance companies to help cover the medical expenses of low-income people.

Destroying those markets, however, carries huge political risks. Trump’s full-throated support for a reckless replacement bill has convinced millions of Americans that he’s intent on taking away their insurance. If their insurance does go away, they’ll probably blame him. It’s his presidency, and his problem.

By moving to defuse House v. Price, the Trump administration could signal that it means to make the best of Obamacare. At the same time, however, the case may represent the last best chance to rip the statute up from the roots. Skittish insurers are watching closely to see what the administration will do. Time is short: Insurers will have to decide very soon whether they want to participate on Obamacare’s exchanges in 2018.

The administration thus faces a stark choice, and its approach to the litigation could shape the future of health reform...


Apr 21, 9:10am Top

Donald Trump is holding Obamacare hostage (AND risking govt shutdown) to get his border wall
The White House says it's willing to open funding to pay for insurance subsidies if Dems will back a border wall
Matthew Rozsa | Friday, Apr 21, 2017

...According to White House budget director Mick Mulvaney, President Donald Trump is now open to funding insurance subsidies under the Affordable Care Act, but would require Democrats to fund parts of Trump’s agenda like the border wall in exchange, The Washington Post reported. Because the negotiations between Democrats and Republicans to prevent a government shutdown have deliberately avoided bringing up a border wall, Mulvaney’s announcement could undermine one of the key premises that have allowed both parties to move forward in developing a stopgap spending bill...


Apr 21, 9:42am Top

I won't shoot your baby in the head (I'll let it starve to death instead) if you give me your money. Sounds like a great deal.

Apr 21, 11:09am Top

Might be a little off topic but this article title grabbed my attention: Growing life span inequality has given the rich an extra $130,000 in government benefits

May 2, 3:49pm Top

Influential Republican Attacks Party’s New Health Care Bill

...At the heart of the debate is an amendment to the repeal bill proposed by Representative Tom MacArthur, Republican of New Jersey, with the blessing of House Republican leaders.

The amendment won over the hard-line House Freedom Caucus last week, in part by giving state governments the ability to apply for waivers from the existing law’s required “essential health benefits,” such as maternity, mental health and emergency care, and from rules that generally mandate the same rates for people of the same age, regardless of their medical conditions.

The MacArthur amendment has given pause to numerous moderate Republicans (e.g. Michigan's Fred Upton), in large part because of concerns over whether it would allow states to gut those consumer protections.

As Mr. Ryan was defending the plan, the Association of American Medical Colleges came out against it, joining the American Medical Association and a host of disease advocacy groups. Dr. Darrell G. Kirch, the president and chief executive of the medical colleges group, said the newest version of the repeal bill “dilutes protections for many Americans and would leave individuals with pre-existing conditions facing higher premiums and reduced access to vital care.”...


Edited: May 4, 11:32am Top

In the 2010 Pledge to America, the GOP committed that Congress will post all bills online three days before a vote.

A vote on GOP's Obamacare replacement will come before Congressional Budget Office projects its impact
Dan Mangan | 5/4/2017

...Republicans aim to pull off a vote on their controversial Obamacare replacement bill in the House on Thursday, before the revised legislation is fully analyzed by the Congressional Budget Office.

...That dash to get the bill out of the House and over to the Senate likely reflects an expectation that the CBO would, for the second time in as many months, offer a grim outlook on the effects of the bill.

In March, when it analyzed an earlier version of the bill, the nonpartisan CBO found that it would result in 24 million more people becoming uninsured by 2026 than would be the case if Obamacare remained intact as is.

The CBO also estimated that premiums for individual health plans next year and in 2019 would on average be 15 to 20 percent higher than what they would be under Obamacare.

However, since then, a series of revisions were made, and the CBO has not analyzed the bill with those changes....



What to Watch For: Nail-Biter on Repealing Health Law
THOMAS KAPLAN | 5/4/2017

Expect to hear complaints from Democrats on two fronts: The substance of the bill and the process by which Republicans are passing it.

For one thing, the vote will occur without a new analysis from the Congressional Budget Office, the official scorekeeper on Capitol Hill.

Representative Jim McGovern, Democrat of Massachusetts, complained on Wednesday night about what he described as “fixes upon fixes to fix the fixes to fix the fixes.”

...Even if the House passes the bill on Thursday, the Affordable Care Act will remain in place — at least for now.

The repeal bill would then head over to the Senate, where it is not likely to be met with great celebration.

...Already, Republicans in the Senate have aired a variety of concerns about the House plan, including how it would affect states that expanded Medicaid under the health law and whether it would raise premiums to unaffordable levels for older Americans...



In Senate, pessimism over ObamaCare repeal
Alexander Bolton - 05/04/17

Republican senators say they don’t see a way to get healthcare reform over the finish line, even if the House passes a bill this week.

A senior GOP senator said the chances of getting 51 votes for legislation based on the House healthcare bill are less than 1 in 5.

The senator also put the chances that the House bill will meet Senate budgetary rules preventing a filibuster at less than 1 in 5, meaning portions of the legislation would have to be removed.

Lawmakers are keeping quiet about their concerns because they want to help Speaker Paul Ryan (R-Wis.), whose job they fear may be in jeopardy if the House fails again to approve an ObamaCare repeal bill.

...But the GOP senators are also preparing: Senate Majority Leader Mitch McConnell (R-Ky.) has convened a group of conservatives and moderates to figure out what healthcare legislation could get 51 votes on the Senate floor.

...In March, before the House bill collapsed the first time, the Senate plan was to bring the legislation directly to the Senate floor, bypassing committee action. It’s not clear whether those plans are now in flux.

...Republican senators say the House bill will have to undergo substantial revision if it ever passes the lower chamber, and they have serious doubts about whether the House will accept those changes.

...Republicans are using special rules known as budget reconciliation to avoid a Democratic filibuster on an ObamaCare replacement. This would allow them to pass the legislation with 51 votes.

...Some senators argue the push in the House could set up the Senate for blame....



ETA: Never mind that this is a life-and-death matter for some Americans... :-(

@GeorgeTakei 11h11 hours ago
Let us be clear: They are stripping away healthcare for over 24 million so that the super wealthy get a tax cut. That's what this is about.


Little-Noted Provision of GOP Health Bill Could Alter Employer Plans
Stephanie Armour and Michelle Hackman | May 4, 2017

...Many people who obtain health insurance through their employers—about half of the country—could be at risk of losing protections that limit out-of-pocket costs for catastrophic illnesses, due to a little-noticed provision of the House Republican health-care bill to be considered Thursday, health-policy experts say.

The provision, part of a last-minute amendment, lets states obtain waivers from certain Affordable Care Act insurance regulations. Insurers in states that obtain the waivers could be freed from a regulation mandating that they cover 10 particular types of health services, among them maternity care, prescription drugs, mental health treatment and hospitalization.

...Under the House bill, large employers could choose the benefit requirements from any state—including those that are allowed to lower their benchmarks under a waiver, health analysts said. By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation.

The measure would give employers added flexibility to take steps that could lower costs by limiting more-expensive coverage areas. And it would lessen the federal regulation of insurers, a goal of GOP lawmakers who believe the ACA is an example of government overreach.

The impact on employer plans expands the scope of the health bill to affect, potentially, everyone not insured by Medicare or small-business plans, since the bill also includes cuts to Medicaid and changes to the individual market. Employer health plans are the single largest source of health insurance in the country, with about 159 million Americans receiving coverage through their jobs....



A Little-Noticed Target in the House Health Bill: Special Education
ERICA L. GREEN | MAY 3, 2017

...School districts rely on Medicaid, the federal health care program for the poor, to provide costly services to millions of students with disabilities across the country. For nearly 30 years, Medicaid has helped school systems cover costs for special education services and equipment, from physical therapists to feeding tubes. The money is also used to provide preventive care, such as vision and hearing screenings, for other Medicaid-eligible children.

...The new law would cut Medicaid by $880 billion, or 25 percent, over 10 years and impose a “per-capita cap” on funding for certain groups of people, such as children and the elderly — a dramatic change that would convert Medicaid from an entitlement designed to cover any costs incurred to a more limited program.

AASA, an advocacy association for school superintendents, estimates that school districts receive about $4 billion in Medicaid reimbursements annually. In a January survey of nearly 1,000 district officials in 42 states, nearly 70 percent of districts reported that they used the money to pay the salaries of health care professionals who serve special education students....



Congressional exemption from GOP healthcare plan to be addressed separately
Olivia Beavers | 05/03/17

As Republicans rush to vote on their latest ObamaCare repeal-and-replace plan, it appears to still include a waiver exempting members of Congress and their staffs from losing the healthcare bill's popular provisions.

...All members of Congress and their staff are required, like every other ObamaCare enrollee, to buy coverage through the ObamaCare marketplace. ...



The GOP Health-Care Bill Is an Abdication of Responsibility and a Moral Disgrace
Jonathan Chait | May 3. 2017

...They are rushing through a chamber of Congress a bill reorganizing one-fifth of the economy, without even cursory attempts to gauge its impact. Its budgetary impact is as yet unknown. The same is true of its social impact, though the broad strokes are clear enough: Millions of Americans will lose access to medical care, and tens of thousands of them will die, and Congress is eager to hasten these results without knowing them more precisely. Their haste and secrecy are a way of distancing the House Republicans from the immorality of their actions.



The Daily 202: 10 storylines to follow as the House votes on health care
AP | Thursday May 4, 2017

1. Fred Upton's compromise will get credit for salvaging the bill.

2. From a public policy perspective, the concession to Upton may not actually help people with preexisting conditions very much.

3. The lack of buy-in from industry groups and other key stakeholders is making it harder to get certain wavering Republicans on board.

4. The House is voting before the nonpartisan Congressional Budget Office gets a chance to estimate just how many people will lose coverage under this bill and how much it grows the deficit.

5. More broadly, Ryan's prestige is on the line.

6. The White House also has a lot riding on this.

7. The next two weeks could be rough for Republicans, no matter how they vote. After Thursday, lawmakers return home for a two-week recess.

8. The GOP civil war will continue: Some moderates are very mad at their leader for negotiating with the Freedom Caucus.

9. No matter what happens, all this uncertainty about the future of the law is already taking a serious toll on the health system.

10. Assuming the bill passes, it will immediately become the Senate's problem.



May 4, 12:00pm Top

Certain pre-existing conditions might no longer be covered under the proposed GOP healthcare plan. These include pregnancy, a history of fertility treatment or Caesarean section, domestic abuse or rape. Insurance companies could charge higher premiums or decline coverage just for being female.



May 4, 12:40pm Top

>113 Taphophile13: And not only just on the ACA. This ability to reject people for pre-existing conditions would also be given to employer-provided health insurance.

Many of the pre-existing conditions boil down to "existing as a woman" so that's fun.

Please call your Congressperson today. You may have to be persistent as they are being flooded with calls, but please add your voice. If your rep is voting against this bill, your call will strengthen their resolve. If you've got a Freedom Caucus minion like I do, your call will remind him that he is supposed to represent the people of his district and that a Yes vote may well have repercussions down the road, say in 2018.

May 4, 2:35pm Top

>114 RidgewayGirl: Also, from what I've read it looks like employers would be able to shop around for the state with the least protections, so you're not even safe if you're from a blue state.

Edited: May 4, 2:51pm Top

217:213 to repeal and replace ACA...exempting themselves and their staff...
followed by a kegger at the White House...

Hope it's the last carefree moments the Yeas enjoy.

May 4, 3:17pm Top

“Members have been asked to vote for a bill that is particularly treacherous, that is going no where in the Senate,” said Representative Charlie Dent, the Pennsylvania Republican who has led the opposition among moderates. “This legislation will be gutted and we will have voted for a bill that will never become law. Will it cause headaches for people? Absolutely."


May 4, 7:12pm Top

Is this the most shameful moment of Trump's reign so far? He's just one despicable moron. What are those 217 Republicans who passed this? I bet you one thing--good Christians one and all, regularly parking bums in pews on Sundays.

Piss on them all.

Edited: May 5, 8:28am Top

Planned Parenthood would be defunded for one year under GOP health bill
Paige Winfield Cunningham, Washington Post | May 4, 2017

...The women's health provider stands to lose roughly 30 percent of its revenue under a provision in the GOP health-care bill to block it from getting Medicaid reimbursements for one year unless its hundreds of clinics stop offering abortions...



Trump praises Australia's universal health care: 'You have much better health care than we do'
Abby Phillip, Washington Post | May 4, 2017

...Seconds after praising his party's efforts to pass a new health-care bill that estimates said would leave millions uninsured, President Donald Trump praised Australia's government-funded universal heath-care system.

"We have a failing health care -- I shouldn't say this to our great gentleman and my friend from Australia, because you have better health care than we do," a tuxedo-clad Trump said at a meeting with Australian Prime Minister Malcolm Turnbull in Manhattan on Thursday.

Australia has a government-funded health-care system, called Medicare, that exists alongside private insurance. The system is funded in part by taxes, including on the wealthy.

The comments came hours after Republicans in the House narrowly approved legislation that would repeal and replace the Affordable Care Act....


May 5, 9:07am Top

Up next, praise for universal health care in other countries, continued fighting against it for the US because "things are different here" or some variation thereof

Edited: May 5, 11:48am Top

A week ago, I accompanied my son as he donated stem cells to a leukemia patient (unknown to him for now). I am so proud of my son and thrilled that he could give hope of a cure to this other fellow. Thrilled also to learn of all the other diseases that may be succumbing to new stem cell therapies--sickle cell anemia, macular degeneration, multiple sclerosis, etc. These state-of-the-art remedies are very expensive, however--without affordable, solid health insurance, we 99% can only gift the very rich with our (freely given) tissues. What a downer yesterday's House vote was compared to last week's donation experience....

(Matches are also made across the world increasing chance that any one patient will find a compatible donor in a participating country: https://www.wmda.info/ Here is youtube video of 13YO African-American girl meeting a German woman whose bone marrow donation cured her of sickle cell anemia: https://www.youtube.com/watch?v=qyMnAAeNWCI. MDs ask that donors publicize their experience so that others may consider registering availability. The chance a donor will ever be called is only 1 in 500, according to one website.)

May 5, 4:00pm Top

How far will you let the bastards go?

May 6, 6:56am Top

@NevSchulman 13h13 hours ago

So just to be clear: people with pre-existing mental health conditions have access to firearms, but not healthcare? #TrumpCare

Edited: May 6, 8:13am Top

The thing with repealing the ACA and replacing it with the ACHA is that it still has to go through the Senate where it's almost certain to be amended and then back to the House again...and whether they can get enough Senators to approve is one thing and if they do whether the house can hang with it in it's Senate amended form with it's slim margin of victory is another thing as the Senate version coming back might change it a lot. The Republicans have made such an issue over repealing this though that it's never going to go away. Right now I'd say the odds of the ACHA becoming law before Trump's term is over is not very good--not in the form that's been sent to the Senate anyway.

Here's the other thing---because if passed this is going to make life more difficult for millions of people---the democrats can hang this on every single republican lawmaker that votes for it. Whether it's because people lose their coverage, or their insurance rates go much higher or their coverage is compromised in any way. This is the Republican plan with a capital R and if it works like shit (and it will) they own it.

I will again though reassert that the ACA is not really a good bill. We should have had single payer nationalized health care system--that covers everybody no matter who or what their problems are. We should have wiped out the health insurance industry and brought the pharmaceuticals under control. The fact that the ACA didn't do these things has led us to this even worse republican version of it. I kind of think that people of all political persuasions would be a lot more upset if their nationalized health care (should they have ever gotten that) were being taken away for which they were paying no insurance premiums and they were back to paying insurance premiums out of their own pockets to a reinstitutionalized private insurance paid system like we've had forever. The bold and the right move that the Obama administration should have made would have been the government sponsored single payer system.

May 7, 9:07am Top

Health-related, another broken promise?

Trump proposes steep cuts to White House ‘drug czar’ office amid opioid crisis
Lena H. Sun and Scott Higham | May 5

The Trump administration is proposing to gut the budget of the White House “drug czar” by 95 percent, effectively eliminating the decades-old Office of National Drug Control Policy, the lead federal agency responsible for managing and coordinating drug policy, according to a memo that its acting director sent Friday to agency employees...

...effectively eliminating the decades-old Office of National Drug Control Policy, the lead federal agency responsible for managing and coordinating drug policy, according to a memo that its acting director sent Friday to agency employees.

The draft budget plan comes as the nation is struggling with an escalating opioid epidemic. Ending opioid addiction was a centerpiece of Donald Trump’s 2016 presidential campaign, and he drew support from many of the rural areas and small ­working-class towns hit hardest by the drug crisis. In March, President Trump commissioned a new addiction task force to help combat the opioid crisis, tapping his friend and former rival New Jersey Gov. Chris Christie (R) to lead the fight....


May 8, 1:06pm Top

Reminds me when Mitch McConnell took a swipe a few years ago at wait-times for Ontario hospital where I was born. Much hilarity ensued in local newspapers, which unfavorably compared life expectancy in Ontario c.f. McConnell's home state of Kentucky. (Which isn't to say Ontario doesn't have its challenges in northern communities.) Anyway, the future of ACA could be said to rest in McConnell's hands right now...hope we don't end up like eastern Kentucky.

Life expectancy differs by 20 years between some US counties
Susan Scutti |Mon May 8, 2017

...(JL) Murray (MD, U of Washington) and his colleagues calculated a gap of 20.1 years between US counties with the lowest and highest life expectancies.

The counties with lowest life expectancy are located in South and North Dakota, while counties along the lower half of Mississippi, in eastern Kentucky, and southwestern West Virginia also showed lower life expectancies compared to the rest of the nation. The North and South Dakota counties include Native American reservations.

At the other extreme, residents of counties in central Colorado can expect to live longest, Murray and his colleagues said...

Ellen Meara, a professor or health economist at the Dartmouth Institute for Health Policy and Clinical Practice..."To have a gap of 20 years in a country as wealthy as ours is absurd."

Murray agrees. "The inequality in health in the United States -- a country that spends more on health care than any other -- is unacceptable," he said. "Every American, regardless of where they live or their background, deserves to live a long and healthy life."


May 9, 7:12am Top

127 contd. (life expectancy by county)

Kentucky Is Home to the Greatest Declines in Life Expectancy
Olga Khazan | May 8, 2017

...eight of the 10 counties with the largest decreases in life expectancy since 1980 were all in lower-income areas of Kentucky. According to the study, the counties with the largest decreases in life expectancy between 1980 to 2014 were:

Owsley County, Kentucky (-3 percent)
Lee County, Kentucky (-2 percent)
Leslie County, Kentucky (-1.9 percent)
Breathitt County, Kentucky (-1.4 percent)
Clay County, Kentucky (-1.3 percent)
Powell County, Kentucky (-1.1 percent)
Estill County, Kentucky (-1 percent)
Perry County, Kentucky (-0.8 percent)

Rounding out the bottom 10 were Kiowa County in southwestern Oklahoma, with a 0.7 percent decline in life expectancy, and Perry County, Alabama, with a 0.6 percent decline.


May 9, 9:17pm Top

NY democratic congressman Sean Maloney having town hall meetings in the district of republican John Faso critiquing Faso on voting for the Trump bill. That's an interesting tactic if you ask me and more democrats should invade their rivals territories and explain to voters in those districts how much worse and fucked up Trump's plan is. That being said--single payer is the way to go.

May 19, 4:56pm Top

House May Need to Vote Again on GOP Obamacare Repeal Bill
Billy House | May 18, 2017

...According to several aides and other procedural experts, if Republicans send the bill to the Senate now and the CBO later concludes it doesn’t save at least $2 billion, it would doom the bill and Republicans would have to start their repeal effort all over with a new budget resolution. Congressional rules would likely prevent Republicans from fixing the bill after it’s in the Senate, the aides said.

In the Senate, the bill must hit separate $1 billion deficit reduction targets in the jurisdiction of the Finance Committee and the chamber’s health committee. Republican aides said failing to meet those numbers would force the House to fix the bill even if the legislation meets the overall cost-savings target.

If Republican leaders hold onto the bill until the CBO report is released, then Ryan and his team could still redo it if necessary. That would require at least one more House vote of some sort...


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