In New York, a battle is brewing over a bill called Coverage for All that would use a surplus of federal funds to pay people who are undocumented to enroll in the state’s Essential Plan under the federal Affordable Care Act, potentially granting 250,000 people access to healthcare. Immigrant advocates are rallying for the bill’s inclusion in a two-day special legislative session despite Democratic…
This post was originally published on Latest – Truthout.
Most health insurance plans must for now continue to cover preventive services, including the HIV prevention pill, with no out-of-pocket costs for consumers, under a deal reached between the Department of Justice and a group of employers in Texas. The agreement is in effect while this case, which challenges the Affordable Care Act’s requirement that insurance plans cover certain preventive medical…
This post was originally published on Latest – Truthout.
When a federal judge in Texas declared unconstitutional a popular part of the Affordable Care Act that ensures no-cost preventive care for certain services, such as screening exams for conditions such as diabetes, hepatitis, and certain cancers, it left a lot of people with a lot of questions. On the face of it, the March 30 decision could affect ACA and job-based insurance plans nationwide and a…
This post was originally published on Latest – Truthout.
Beginning on Saturday, states across the U.S. will start the process of stripping Medicaid coverage from millions of people as pandemic-related protections lapse, part of a broader unraveling of the safety net that was built to help families withstand the public health crisis and resulting economic turmoil.
Medicaid’s continuous coverage requirements were enacted early in the Covid-19 pandemic to help vulnerable people maintain insurance amid the health emergency, resulting in record-high Medicaid enrollment.
But at the end of last year, congressional negotiators agreed on a bipartisan basis to set April 1 as the beginning of the “unwinding” process for the continuous coverage mandates, which prevented states from conducting regular eligibility screenings for Medicaid recipients.
The bipartisan deal gave states 12 months to determine who is still eligible for Medicaid, but some states—including Arkansas and South Dakota—are jumping at the opportunity to quickly remove people from the program. (State timelines for kicking off the unwinding process can be seen here.)
“Tonight at midnight some people in AZ, AR, ID, NH, and SD will lose their Medicaid coverage,” Joan Alker, executive director of the Georgetown Center for Children and Families, tweeted Friday. “South Dakota is especially vexing as expansion kicks in July 1st. The state could structure their renewals to ensure that parents move seamlessly into expansion. But they are erroneously claiming federal rules mean they can’t. Not true.”
Residents of the 10 states that have refused lifesaving Medicaid expansion under the Affordable Care Act (ACA) are likely to be hit hardest by the end of continuous coverage requirements, which the Biden administration estimates could result in 15 million people losing health insurance nationwide—including millions of children.
“Because those states tend to make only the extremely poor eligible for Medicaid, they will have many people who make too much to qualify for the government health insurance but not enough to reach the income needed to get federal subsidies to afford health plans sold on ACA marketplaces—the coverage the administration is counting on as the main fallback,” The Washington Post‘s Amy Goldstein reported earlier this week.
“The toll will be large, too, in 13 states that have not chosen to extend Medicaid benefits to women for a full year after they give birth,” Goldstein added. “Texas falls on both lists.”
Because of the administrative barriers associated with income verification and other eligibility tests, many people are likely to lose Medicaid coverage even though they’re still eligible for the program.
The Health and Human Services (HHS) Department has estimated that nearly 7 million people could be removed from Medicaid despite still being eligible due to “administrative churning.”
The consequences of what one commentator has dubbed “The Great Medicaid Purge” could be disastrous, given the health impacts associated with insurance loss.
As HHS summarized in a recent report:
People who experience churning or coverage disruptions are more likely to delay care, receive less preventive care, refill prescriptions less often, and have more emergency department visits. One study found that unstable Medicaid coverage increased emergency department use, office visits, and hospitalizations between 10% and 36% and decreased use of prescription medications by 19%, compared to individuals with consistent Medicaid coverage. Children with interruptions in coverage also are more likely to have delayed care, unmet medical needs, and unfilled prescriptions.
“I feel sick,” said Adam Gaffney, an ICU doctor at the Cambridge Health Alliance. “Some 15 million people will be purged from Medicaid, including 7 million who actually remain eligible for the program but fail to jump through the bureaucratic hoops! Medicaid is not enough: we need seamless, lifelong universal care now.”
The Medicaid continuous coverage requirements are the latest pandemic-era protections to fall in recent months.
Starting on March 1, enhanced Supplemental Nutrition Assistance Program (SNAP) benefits were cut off in dozens of states, slashing food aid for tens of millions.
Additionally, the boosted Child Tax Credit (CTC) expired in late 2021 due to opposition from Sen. Joe Manchin (D-W.Va.) and congressional Republicans, resulting in a rapid surge in child poverty. Shortly before the expanded CTC lapsed, boosted unemployment benefits that helped millions weather economic chaos ended.
As the pandemic-era safety net crumbles, congressional Republicans are looking to roll back Medicaid, SNAP, and other key programs even further with spending cuts and punitive work requirements.
“Republican calls to cut government funding put everything from child care to opioid treatment and mental health services to nutrition assistance at risk for millions,” Rep. Rosa DeLauro (D-Conn.), the top Democrat on the House Appropriations Committee, warned earlier this week.
This post was originally published on Common Dreams.
A ruling handed down by a U.S. district judge on Thursday will threaten a range of lifesaving preventative healthcare services for more than 150 million people, legal experts and advocates said, as the decision challenged the legality of a federal task force that enforces coverage for the services.
Judge Reed O’Connor, a Bush appointee who sits on the U.S. District Court for the Northern District of Texas, ruled that insurance companies do not have to comply with preventative care recommendations made by the U.S. Preventive Services Task Force (USPSTF), which was established by a key provision in the Affordable Care Act (ACA), also known as Obamacare.
O’Connor ruled that the appointments of members of the task force violate the Appointments Clause in the U.S. Constitution and said that violation “invalidates its power to enforce anything against anyone nationwide,” according to Slate journalist Mark Joseph Stern.
The USPSTF has issued recommendations for a wide range of preventative care services, including screenings for breast cancer, colorectal cancer, cervical cancer, and diabetes; interventions and tests for pregnant patients; anxiety screenings for children and adolescents; and pediatric vision tests.
Under the ACA, insurance companies are required to cover those services, but following O’Connor’s ruling coverage will no longer be mandated.
The decision is “nothing short of catastrophic to the U.S. healthcare system,” said Stern.
\u201cI anticipated this decision in September when O’Connor first telegraphed it. It is nothing short of catastrophic to the U.S. health care system. Millions of Americans, including many pregnant women, will have to forgo basic care if it is upheld.\nhttps://t.co/eVpemaBN5c\u201d— Mark Joseph Stern (@Mark Joseph Stern) 1680184452
The ruling stemmed from a lawsuit filed in 2020 by Christian employers who objected to paying for services such as contraceptives and preexposure prophylaxis (PrEP), to prevent HIV transmission.
In September, O’Connor ruled that coverage for PrEP violated the companies’ religious freedom in a decision that one doctor who specializes in HIV treatment condemned as “disgusting and inhumane” and likely “driven solely by homophobia and transphobia.”
\u201cA Bush-appointed judge blocks the ACA’s coverage of preventative care, including cancer screenings and the HIV-prevention drug PrEP, as the Stephen Miller-backed plaintiffs claim it “encourage[s] homosexual behavior, prostitution [and] sexual promiscuity.”https://t.co/IVTbOmOzCg\u201d— Emma Vigeland (@Emma Vigeland) 1680191769
The companies are being represented by Texas attorney Jonathan Mitchell, who helped develop the state’s abortion ban that allows private citizens to sue anyone who “aids or abets” a person who obtains abortion care.
More than 150 million Americans who have private health insurance have coverage for preventative care under the ACA, as well as approximately 20 million Medicaid and 61 million Medicare recipients.
Last July, as O’Connor was considering the case, titled Braidwood Management Inc., vs. Xavier Becerra, national health organizations including the American Medical Association, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists warned that a ruling in the plaintiffs’ favor would “reverse important progress and make it harder for physicians to diagnose and treat diseases and medical conditions that, if caught early, are significantly more manageable.”
“With an adverse ruling, patients would lose access to vital preventive healthcare services, such as screening for breast cancer, colorectal cancer, cervical cancer, heart disease, diabetes, preeclampsia, and hearing, as well as access to immunizations critical to maintaining a healthy population,” the organizations wrote. “Our patients cannot afford to lose this critical access to preventive healthcare services.”
The Biden administration is expected to appeal O’Connor’s ruling, and since insurance coverage contracts typically run through the end of the year, coverage will likely not change for many before 2024.
If upheld, the ruling will deal “a devastating blow to American public health,” said University of California law professor Jennifer Oliva.
\u201cA federal judge deals a devastating blow to American public health by enjoining the ACA preventative mandate nationally. Included among plaintiffs\u2019 claims was that it was against their religion for insurance plans to cover counseling for substance use disorder.\u201d— Jennifer Oliva (@Jennifer Oliva) 1680188419
Last year, a Morning Consult poll found that at least 2 in 5 Americans were not willing to pay out-of-pocket for preventative services currently covered by the ACA.
O’Connor previously ruled in 2018 that the ACA should be struck down in its entirety, but that ruling was overturned by the U.S. Supreme Court.
The judge’s latest ruling offers “another reason why we need Medicare for All,” said the Debt Collective. “The milquetoast ACA is being dismantled before our eyes. There is no reason not to fight for real solutions when the non-solutions stand no better chance.”
This post was originally published on Common Dreams.
A federal judge in Texas has struck down a major preventive care rule set by the Affordable Care Act (ACA) that has allowed millions of Americans to access critical health care like cancer screenings, immunizations, and HIV treatment cost-free, in a decision that experts are saying will have devastating impacts across the country if upheld. Judge Reed O’Connor, a George W. Bush nominee…
This post was originally published on Latest – Truthout.
Here’s one of many indicators about how broken the United States healthcare system is: Guns seem to be easier and cheaper to access than treatment for the wounds they cause. A survivor of the recent mass shooting in Half Moon Bay, California, reportedly said to Gov. Gavin Newsom that he needed to keep his hospital stay as short as possible in order to avoid a massive medical bill. Meanwhile, the suspected perpetrator seemed to have had few obstacles in his quest to legally obtain a semi-automatic weapon to commit deadly violence.
Americans are at the whim of a bewildering patchwork of employer-based private insurance plans, individual health plans via a government-run online marketplace, or government-run healthcare (for those lucky enough to be eligible). The coverage and costs of plans vary dramatically so that even if one has health insurance there is rarely a guarantee that there will be no out-of-pocket costs associated with accessing care.
It’s hardly surprising then that the latest Gallup poll about healthcare affirms what earlier polls have said: A majority of Americans want their government to ensure health coverage for all. In fact, nearly three-quarters of all Democrats want a government-run healthcare system.
Gallup also found that a record high number of people put off addressing health concerns because of the cost of care. Thirty-eight percent of Americans said they delayed getting treatment in 2022—that’s 12 percentage points higher than the year before. Unsurprisingly, lower-income Americans were disproportionately affected.
Women are especially impacted, with more women than men delaying treatment as per the same Gallup poll. The findings were consistent with results published by researchers at New York University’s School of Global Public Health, which found that women’s healthcare was increasingly unaffordable, compared to men’s—in a study that solely focused on people with employer-based health coverage. Imagine how out-of-reach healthcare is for uninsured women.
Added to that, Republican-led abortion bans have made it even harder for American women to obtain reproductive healthcare. On the 50th anniversary of the recently overturned Supreme Court decision Roe v. Wade, abortion providers in Massachusetts, for example, reported a steady stream of people driving to their state—one where abortion remains legal—to access care.
President Joe Biden and the Democratic Party appear to think that this grim status quo is perfectly acceptable. Democrats’ reliance on the Obama-era Affordable Care Act (ACA) as a bulwark against Republican opposition to any government intervention in healthcare seems to be resoundingly successful—at least on paper. In December 2022, Biden touted the fact that 11.5 million Americans, a record high number, had signed up for ACA plans during the last enrollment period. He said, “Gains like these helped us drive down the uninsured rate to eight percent earlier this year, its lowest level in history.”
His administration, rather than working to fulfill what a majority of his party’s constituents want—a government-run healthcare system—has continued instead to tweak the ACA by extending a period of discounted monthly premiums for private insurance plans. Such tweaks are not permanent. Neither are they a panacea for accessing adequate care. If anything, they are a façade protecting profit-based private insurance companies.
A survey by the Commonwealth Fund found that although the number of insured Americans is now at an all-time high, more than 40% of those who bought ACA plans and nearly 30% of those with employer-based plans were underinsured—that is, the plans were inadequate to cover their healthcare needs.
By focusing solely on the number of people who had health plans as a measure of success, the White House is participating in a great coverup of the ongoing American healthcare tragedy.
Meanwhile, just over the horizon from Biden’s celebration of record numbers of ACA signups is the fact that millions of people currently enrolled in the Medicaid government health plan could lose access because of the end of an emergency provision that allowed for “continuous enrollment.” That provision expires at the end of March 2023. If all Americans were automatically enrolled in government-provided healthcare regardless of eligibility, this would not be a concern.
Right-wing sources, so terrified that too many Americans want a government-run health system, are busy shaping public opinion against it. The Pacific Research Institute’s Sally Pipes recently published an op-ed about how Canada’s national health system was a good reason why the United States should not have a similar program. Using the deadly logic of a free marketeer, she wrote, “In Canada, healthcare is ‘free’ at the point of service. As a result, demand for care is sky-high.”
The implication is that charging people for service would reduce the demand, just as it would for, say, an electric vehicle. In Pipes’ world, people are accessing healthcare just for fun, and if they were charged money for it, their ailments might resolve themselves without treatment.
The Heritage Foundation also published an attack on Britain’s National Health Service (NHS), gleefully claiming that it is “cratering,” and warning that it is a lesson for American liberals who might support a similar “single-payer” system in the United States.
The Wall Street Journal‘s editorial board published a similar warning, claiming that the NHS was “failing patients, with deadly consequences.”
It’s puzzling why the Pacific Research Institute, Heritage Foundation and Wall Street Journal appear unconcerned about the 330,000 Americans who lost their lives during the Covid-19 pandemic simply because they don’t live in a nation with a universal healthcare program.
The United States spends nearly twice as much per capita on healthcare than other comparable high-income nations. According to Health Affairs, excessive administrative costs are the main reason for this discrepancy—these are non-medical costs associated with delivering healthcare in a patchwork system of employer-based private health and publicly subsidized plans. In fact, “administrative spending accounts for 15 – 30 percent of health care spending.”
Again, right-wing media outlets and think tanks appear unconcerned by this disturbing fact. They only want to convince Americans that a government-run health plan is a bad idea. And, sadly, the Democratic Party leaders like Biden seem to agree.
The National Union of Healthcare Workers, together with Healthy California Now, created an online calculator for individuals to determine how much money they would save if the United States had a single-payer system.
I have an employer-based healthcare plan that is considered very good. Using the calculator, I determined that I would save more than $16,000 if California, the state where I live, had a single-payer system. That’s money I could be saving for my children’s higher education or for my retirement.
The victims of mass shootings, like the Half Moon Bay survivor, are saddled with high costs of care on top of the trauma of having been shot. Every year, there are more than 80,000 survivors of injuries from firearms in the United States. Having a single-payer healthcare system would not fix our epidemic of gun violence. But it would certainly make it easier to bear.
Canada and Britain’s state-run systems of health care may be imperfect, but they are a vast improvement on the survival-of-the-fittest approach that the United States takes.
This post was originally published on Common Dreams.
Republican Party insiders have indicated that, for the time being, the party will not seek to repeal the Affordable Care Act (ACA), an Obama-era piece of legislation that expanded access to health care for millions of Americans. The GOP has made dozens of attempts to overturn the law since it was first passed in 2010. In the House of Representatives alone, Republicans have introduced at least 100…
In what advocates call a “grotesque display of corporate profiteering,” the health insurance giant formerly known as Anthem reported making $2.3 billion in net profit off its policyholders over the past three months as analysts predict a dramatic spike in the cost of health insurance premiums in 2023.
Elevance Health, the largest for-profit company within the Blue Cross Blue Shield Association, surpassed Wall Street expectations on Wednesday and reported nearly $40 billion in revenue during the third quarter of 2022. Returns to shareholders increased by 7 percent, generating $1.6 billion in profits for investors. Elevance provides health coverage for 118 million people across multiple states.
Elevance claims its profits are the result of offering more service to more customers. However, health care activists who help patients fight for coverage from their insurance providers say a chunk of this profit undoubtably comes from denying insurance claims from sick people who cannot afford proper care otherwise. Denying claims, they say, is a “regular business practice” for squeezing out extra profits. Insurers know the vast majority of patients do not exercise their right to appeal when claims are denied and are often unsure how to do so.
“Part of this money is made denying claims,” said Aija Nemer-Aanerud, Health Care For All campaign director at People’s Action, in an interview. “How many surgeries, medications and doctor visits would $2.3 billion amount to if we didn’t live under a for-profit system set up to advance the interests of greedy corporations instead of actually care for people?”
A spokesperson for Elevance did not respond to an email requesting internal data that would show whether the company is turning profits by denying health insurance claims, but organizers have gathered horror stories from patients across the country. The six largest private health care insurers enjoyed a combined $41 billion in profits in 2021, and in 2020, private insurers denied more than 42 million in-network claims from patients covered by Affordable Care Act (ACA) marketplace plans, according to People’s Action and the Kaiser Family Foundation.
Thanks to federal transparency requirements tied to ACA subsidies, we know that means nearly one in five claims under ACA marketplace plans were denied by private insurers in 2020. This figure only includes federally subsidized ACA plans, not the private plans provided by employers that many people have. Eleana Molise, a neighborhood organizer with ONE Northside in Chicago, said one in seven of all medical claims are estimated to be denied nationally.
“This especially affects Black and Brown people who are sold the worst insurance, and people in rural America, where you get fewer or no health care providers, or they are ‘out-of-network,’ meaning you get stuck with the bill,” Molise said in a livestream Tuesday with health care advocates, impacted patients and Sen. Bernie Sanders (I-Vermont).
“A rational health care system is a system that guarantees health care for all as a human right, and it is s system that is cost effective, a system that is comprehensive … it is not a system designed to make private health insurance companies huge profits,” Sanders said, repeating his call for universal public health insurance known as Medicare for All.
Private health insurers will often refuse to pay for medical care under the rules baked into insurance plans — deductibles must be met, doctors must be within the insurer’s network, and any drugs prescribed must be on the insurer’s approved list of medications.
However, advocates report that people are often stuck with massive bills for medical care that is rightfully covered under their plans, forcing them to pay out-of-pocket or challenge the insurer under complicated and frustrating appeals processes handled by the company itself.
“The wolf is guarding the henhouse,” said Ken Whittaker, executive director of the social justice group Michigan United. “They know most people don’t know you can appeal your claim, and less than 1 percent appeal claims when they are denied … and that’s more money for CEOs and Wall Street investors.”
While it’s unclear just how much profit is raised by denying insurance claims, advocates say the industry’s behavior leaves little doubt that private insurers are gouging patients and public health care programs. For example, an Elevance CEO took home $17 million in salary and bonuses in 2020, the same year Elevance and other Blue Cross Blue Shield companies agreed to pay a $2.67 billion settlement in a major antitrust case filed on behalf of policyholders.
A recent New York Times investigation found that private insurance companies exploited Medicare Advantage, which provides private health coverage for people 65 and older but is paid for by the federal government, to rake in billions of dollars from taxpayers. The majority of large insurers sent the government inflated bills, and Elevance and other companies face federal lawsuits for elaborate schemes to inflate profits. As The Times notes:
Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.
Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.
Medical bills that the insurance company refuses to pay after an emergency room visit or a major illness are the most common form of claim denial, Nemer-Aanerud said, but millions of uninsured and underinsured people are unable to afford basic preventative care that would help them stay healthy long-term — and keep costs down for everyone else. Coverage of lifesaving treatments and prescriptions are also denied by insurers, often the result of secret kick-back agreements made with pharmaceutical companies that drive up drug prices and determine which medications are covered for patients.
Callie Gibson, whose husband Mark Hall was denied access to proper medication for a chronic digestive disease, said the issue is affecting her family right now, but health coverage denial can happen to any of us. Hall was on medication that worked for years, but after switching from Medicaid to a private employer’s plan through Cigna Health, he was forced to switch to a biosimilar despite an appeal from his doctor. Even after taking higher doses, the new drug does not adequately control digestive bleeding and other painful symptoms, preventing Hall from living his daily life.
“Because ultimately, the insurance companies don’t care about you as an individual,” Gibson said during the livestream with Sanders, reflecting on the couple’s experience with Cigna. “They care about their shareholders, the people who are making money off this company, and they are not going to take action as long as they are continue to make money, and until we hold them accountable for what they are doing.”
The Health Care For All campaign is helping people fight for their claims through the appeals process, and anyone who has been denied health coverage is encouraged to contact the campaign.
This post was originally published on Latest – Truthout.
Having tanked his party’s effort to expand Medicare and close the Medicaid coverage gap, Sen. Joe Manchin is now dangling his support for an extension of Affordable Care Act subsidies as massive premium hikes loom for millions of people who buy insurance on the exchanges.
Insider reported Wednesday that Manchin has “signaled he’s open to extending enhanced subsidies under the Affordable Care Act, a move that would help Democrats avert a huge political threat in the November midterms.”
The American Rescue Plan — a Covid-19 relief package that President Joe Biden signed into law last year — included provisions that boosted ACA subsidies for low-income people and ended the income cap on subsidies. The changes were aimed at ensuring no one is forced to pay more than 8.5% of their total income to purchase health coverage in the ACA marketplace, which can be prohibitively expensive without federal subsidies.
But the provisions are set to expire at the end of the year in the absence of congressional action, sticking the roughly 14 million people who buy insurance on the ACA exchanges with dramatically higher premiums. Notifications of premium increases would begin going out in October, just ahead of the crucial midterm elections.
Even though eligibility for ACA subsidies — which progressives often characterize as gifts to the insurance industry — is already restricted on the basis of income, Manchin told Insider that he wants even more means testing, which he called “the main thing.”
“We should be helping the people who really need it the most and are really having the hardest time,” said Manchin, who supported the ACA subsidy boost in the American Rescue Plan. “With healthcare, people need help. They really do.”
That’s certainly true of people in his home state of West Virginia. After visiting a free medical clinic located just miles from Manchin’s riverfront home in Charleston, The Lever’s Andrew Perez reported earlier this week that one resident, Charles Combs, “has resorted to extracting his own teeth because dental care is too expensive.”
Traditional Medicare currently doesn’t cover dental services. Late last year, Manchin blocked an effort — spearheaded by Sen. Bernie Sanders (I-Vt.) — to expand the program to cover dental, vision, and hearing.
“The Charleston clinic made clear just how badly people need such care — and not just seniors, and not just West Virginians. Combs, for instance, is still in his 50s, while the clinic saw patients of all ages driving hours from Ohio, Kentucky, and Virginia,” Perez noted. “The [Remote Area Medical] clinic hinted at the kind of universal healthcare system America could have, if not for senators like Manchin and their healthcare industry donors.”
“The organization doesn’t ask patients about what its team calls the ‘three I’s’: identification, income, or insurance,” Perez continued. “Patients are treated with kindness, compassion, and professionalism — and fairly quickly. All services are free.”
There are uninsured people in @Sen_JoeManchin’s state extracting their own teeth with a hammer. https://t.co/MRIMwP3Qny https://t.co/jlLZwAVFZD
— Marisa Kabas (@MarisaKabas) June 22, 2022
In an interview with Punchbowl News this week, Manchin voiced concerns about the price tag of extending the ACA subsidies — scrutiny he has not applied to the trillions of dollars in Pentagon spending he’s voted for over the past decade.
“The bottom line is there’s only so many dollars to go around,” Manchin said.
According to a recent analysis by Families USA, the roughly 23,000 West Virginians who buy health insurance coverage on the ACA exchanges will see their annual premiums rise by an average of $1,536 — 63% — if Congress lets the subsidy provisions expire.
“With little debate or media focus, Democrats are on the verge of dooming millions of Americans to huge new healthcare bills, which will in turn serve to ruin any hope Democrats have of winning the midterms,” journalist Jon Walker warned in The American Prospect earlier this year. “Beyond broadly hurting 14 million people, the end of these subsidies will create thousands of uniquely horrific stories of financial devastation.”
This post was originally published on Latest – Truthout.
Senator Ron Johnson (R-Wisconsin) suggested in an interview on Monday that if Republicans win control of Congress and the White House in 2024, they will work to repeal the Affordable Care Act (ACA) — a move they’ve attempted dozens of times without success.
The law is popular throughout the U.S. and is viewed favorably by a majority of Johnson’s constituents in Wisconsin. But Johnson’s comments on Monday seemed to imply that Republicans would continue trying to undermine or repeal the law should they regain power in Washington.
During a podcast interview with Breitbart, Johnson said that if Republicans won in 2024, it would allow them to “actually make good on what we established as our priorities.”
“If we were going to repeal and replace Obamacare — I still think we need to fix our health-care system — we need to have the plan ahead of time so that once we get in office, we can implement it immediately, not knock around like we did last time and fail,” Johnson said, referencing the last time Republicans took control of both houses of Congress.
For now, Johnson added, the GOP’s goal will be blocking President Joe Biden’s agenda if they win the 2022 midterms later this year.
Johnson, who is seen as one of the most vulnerable incumbent senators running for re-election in this year’s midterm races, was immediately criticized for his statement.
“Voters are learning exactly what Republicans will do with a Senate majority, in their own words: raise taxes on seniors and working families, end Medicare and Social Security — and once again try to spike the cost of health care while ripping away coverage protections from Americans with pre-existing conditions,” a statement from the Democratic Senatorial Campaign Committee read.
Later on Monday, Johnson attempted to walk back his statements on repealing the ACA, saying that he was only using the GOP’s 2017 attempt to repeal the law as an “example” of how Republicans failed in the past, and how they should change their strategies in the future.
“I was not suggesting repealing and replacing Obamacare should be one of [the] priorities” for Republicans, he said. “Even when we tried and failed, I consistently said our effort should focus on repairing the damage done by Obamacare and transitioning to a health system that works.”
Although Johnson claimed that criticisms of his original comments were “false attacks” against him, he did not say if he supported keeping the law in place.
However, Johnson has been an ardent opponent of the ACA, and has voted consistently to repeal it at almost every possible opportunity. Even after Republicans moved on from attempts to repeal the ACA in 2017, the Wisconsin senator still insisted that the party should continue efforts to scrap the law.
In addition to speaking out against the law more generally, Johnson has also voiced opposition to popular aspects of the law. He has proposed eliminating restrictions that prevent companies from using pre-existing conditions as a pretext to deny patients care, for example.
Even though many election experts believe this year will result in huge wins for Republicans, Johnson faces difficult chances at reelection. A recent Marquette University Law School poll shows that only 33 percent of Wisconsin residents approve of the Republican senator, while 45 percent disapprove.
It’s likely that much of this disapproval is the result of Johnson’s comments throughout the coronavirus pandemic, as the lawmaker falsely claimed that vaccines were harming athletes and peddled unproven treatments for COVID while deriding prevention methods against the virus that actually worked. Johnson has also reneged on a promise to adhere to self-imposed term limits. After promising voters that he would only serve two terms in office, Johnson announced earlier this year that he would be running for a third term.
This post was originally published on Latest – Truthout.
The largest survey of its kind since the start of the Covid-19 crisis found that 38% of respondents — representing around 100 million Americans — characterized the for-profit U.S. healthcare system as either “expensive” or “broken,” an indication that the pandemic has markedly shifted public opinion.
Gallup and West Health, the two organizations behind the new survey out Tuesday, began the polling process by asking respondents to concisely describe the U.S. healthcare system in their own words. Nearly 40% used the word “expensive” and 13% said the system is “broken” — the two most common descriptors offered by respondents.
“The results stand in stark contrast to findings from just two years ago,” the groups note in their detailed summary of the findings. “In 2019, West Health and Gallup conducted a major survey on U.S. healthcare costs and found that close to half of Americans (48%) believed the quality of care found in the U.S. was either ‘the best in the world’ (13%) or ‘among the very best’ (36%). This was two-and-a-half times the 18% who reported that the quality of care was either ‘the worst in the world’ (3%) or ‘among the worst’ (16%).”
According to the survey, nearly half of Americans say the coronavirus pandemic soured their view of the U.S. healthcare system, which is dominated by large insurance companies and pharmaceutical corporations and imposes some of the highest costs in the world — while achieving some of the worst outcomes.
West Health chief strategy officer Tim Lash stressed that “negative public sentiment” surrounding the healthcare system “did not form overnight or begin with Covid-19.”
“It’s been decades in the making after failed promises by elected officials to do something to help Americans suffering at the hand of high prices for healthcare and prescription drugs,” Lash said. “However, public opinion plays an important role in the policy process, and if policymakers are listening, they have no choice but to act.”
While far from the sole catalyst behind Americans’ changing views, the coronavirus pandemic — which has killed nearly 800,000 people in the U.S., including one in 100 older Americans — has thrown into sharp relief the massive inefficiencies and cruelties of a healthcare system whose primary objective is maximizing profit, not delivering high-quality care to all.
“I think that Covid really illustrated just how dysfunctional the system actually is,” said one survey respondent.
Because a majority of Americans receive health insurance through their employers, the pandemic and resulting economic calamity produced what one study characterized as the “greatest health insurance losses in American history,” with millions being dropped from their plans and forced to seek refuge in badly underfunded public programs or the hard-to-navigate Affordable Care Act exchanges.
Additionally, hospitals have hit Covid-19 patients with massive charges throughout the pandemic, potentially discouraging many from seeking lifesaving treatments.
Gallup and West Health’s new poll, a nationally representative survey of more than 6,600 U.S. adults, found that the percentage of Americans who reported forgoing care due to cost concerns — 30% — tripled in the three months prior to September and October, when the survey was conducted.
Nearly a third of U.S. adults report that they could not afford quality healthcare if they needed it today, up from 18% in February. One in 20 respondents — representing around 12.7 million people — told Gallup and West Health that a friend or family member died over the past year after not receiving treatment because they couldn’t afford it.
Overall, 94% of Americans believe the cost of healthcare in the U.S. is “higher than it should be,” the survey showed.
“Americans have reached their breaking point,” said Shelley Lyford, president and CEO of West Health. “Between March and October, the percentage of people reporting trouble paying for healthcare, skipping treatments, and not filling their prescriptions spiked to their highest levels since the pandemic began, exacerbating another public health threat borne out of cost rather than illness.”
Dan Witters, a senior researcher for Gallup, said in a statement Tuesday that “the sharp worsening in public opinion regarding the affordability of care and medicine is startling, and likely a result of myriad factors related directly and indirectly to the Covid-19 pandemic.”
“From rapidly rising inflation, to deferred care pushed into 2021, to more people having to pay for Covid-19 care itself,” Witters added, “the U.S. healthcare cost crisis is now coming to a head.”
The new survey was published as congressional Democrats continued working to finalize their $1.75 trillion reconciliation package, which includes a patchwork of healthcare provisions including expanded ACA subsidies and a prescription drug plan that was badly weakened by industry-friendly lawmakers. Other popular proposals, including a plan to add dental and vision benefits to Medicare, were dropped during negotiations.
“At a time when one out of four Americans cannot afford their prescription drugs, maybe, just maybe, it’s time we take on the greed of the pharmaceutical industry,” said Sen. Bernie Sanders (I-Vt.), who is pushing for a more ambitious plan to slash skyrocketing medicine costs.
This post was originally published on Latest – Truthout.
In the face of massive support for Medicare for All and the failure of the U.S.’s for-profit health care system, the inevitable fall of the medical-industrial complex can be predicted, if not with precision, with certainty. Everyone is aware of the impending demise, none more so than those in charge of the for-profit health care system and their supporters in Congress, as evidenced by the frenetic activity at the Centers for Medicare and Medicaid Services (CMS) to transfer the traditional Medicare program to the insurance industry as fast as humanly possible. Given this urgency, physicians representing Physicians for a National Health Program delivered a petition signed by 13,000 individuals, including 1,500 physicians, to Health and Human Services Secretary Xavier Becerra this week demanding the end to the privatization of Medicare.
Privatization, the transfer of a public good to private, for-profit entities, is already true for over 40 percent of Medicare in the form of Medicare Advantage, private insurance plans that have been persistently and pervasively overpaid by Medicare for decades. As Kip Sullivan recently described in “Single Payer Health Care Financing,” this fraud has been going on for decades.
In 1995, the U.S. General Accounting Office (GAO) warned Congress that Medicare was overpaying Health Maintenance Organizations (HMOs), the precursors to Medicare Advantage plans, by 6 to 28 percent compared to what it would have paid had all those HMO enrollees remained in traditional Medicare because most HMOs benefited from “favorable selection,” meaning, healthier patients enrolled in HMOs. In 1999, the GAO again warned Congress that Medicare spent more on beneficiaries enrolled in HMOs than it would have had those beneficiaries been enrolled in traditional Medicare. The following year, the GAO told Congress that it was largely excess Medicare payments to HMOs, not their efficiencies, that allowed plans to attract large numbers of beneficiaries, again exceeding costs expected under the traditional program, adding billions to Medicare spending.
Twenty-six years later, in its 2021 report to Congress, the Medicare Payment Advisory Commission wrote, “The Commission estimates that Medicare currently spends 4 percent more for beneficiaries enrolled in MA [Medicare Advantage] than it spends for similar enrollees in traditional fee-for-service (FFS) Medicare.” This low number is difficult to square with the profit that insurance companies are making and the extra benefits that they offer. What has been clear to Congress for decades, is that Medicare Advantage, which inserts a middleman to “manage” care between CMS and doctors and hospitals, costs more than traditional Medicare, which does not require a middleman between the senior and the provider. From 1972 to 2004, overpayment by Medicare to HMOs was the rule and due mostly to favorable selection. After 2004, overpayment persisted for Medicare Advantage plans (formerly known as Medicare + Choice) for two reasons: favorable selection (“cherry picking,” or selecting healthy patients, as well as “lemon dropping,” or getting rid of sick patients, perfected by HMOs) and upcoding.
What is upcoding? When a doctor bills the insurance company or Medicare for a patient, the doctor uses a diagnosis code. For example, a patient who is seen for pneumonia will be billed with the diagnosis code for pneumonia. But what if instead of just billing for pneumonia, the physician also coded for shortness of breath, hypoxia (low oxygen level), productive cough and exposure to tuberculosis, some of which might or might not be accurate, but could certainly be present in someone with pneumonia? This would be upcoding and would be considered fraud, but in the Medicare Advantage world, upcoding is known as risk-score gaming, and it is perfectly legal.
Risk-score gaming is how Medicare Advantage has been drawing serious overpayments since its full implementation in 2006. Medicare Advantage does this by submitting diagnosis codes that create more CMS Hierarchical Condition Categories (HCCs) for each patient. For example, a 76-year-old female with obesity, type 2 diabetes, major depression and congestive heart failure has an HCC risk score of 1.03. For this patient, CMS pays a Medicare Advantage plan that does not upcode $9,000.
If however, the Medicare Advantage plan upcodes — same patient, same medical conditions but more codes: morbid obesity instead of obesity, diabetes with retinopathy instead of diabetes; a mild, single episode of major depression instead of unspecified major depression; chronic obstructive lung disease instead of asthma and a stage 3 ulcer instead of ulcer — her risk score jumps to 3.63, and CMS pays the Medicare Advantage plan for the same patient $32,000. The plan reaps obscene profits, some of which goes to marketing, some of which goes to improve benefits driving up the number of new members, but most of which go back into profits, all the while draining the Medicare trust fund, driving up Part B premiums (monthly payments made by beneficiaries to Medicare) and diverting taxpayer funds from other social services.
For each 0.1 increase in risk score at current enrollment levels, there are $15 billion in overpayments ($13 billion from CMS, and $2 billion from Part B beneficiaries) and the Medicare Advantage plan takes $3.5 billion in profits. Risk-score gaming is the business model for Medicare Advantage and creates a major transfer of wealth to Medicare Advantage from taxpayers and traditional Medicare recipients.
In addition to greater costs to the federal government, Medicare Advantage plans deny care for enrollees, create cost-related problems for enrollees, limit specialized care due to narrow networks (especially at the end-of-life), have worse health outcomes (including higher mortality), and unenroll high-cost beneficiaries (“lemon drop”) who are in poor health.
All evidence points against using the multibillion-dollar health insurance industry to improve outcomes and save money. But evidence is no match for profit. In 2019, the Medicare budget approached $800 billion, and by 2026, it is projected to be $1.35 trillion. This amount of taxpayer money keeps capitalists up at night, especially the medical-industrial complex types, scheming up ways to grab some for themselves. Lucky for these capitalists, CMS is continuing its march towards privatization, or what is known in the parlance of health economists, “de-risking” all of Medicare, meaning eliminating the risk of providing health insurance to seniors by having someone else bear the risk. But the truth is the exact opposite: These overpayments are allowing the insurance industry to pretend they bear risk when in fact it’s the taxpayer who is bearing risk.
There is much profit to be gained by “bearing the risk” for Medicare through favorable selection and upcoding, as evidenced by the outsized profits for insurers in Medicare Advantage compared to margins in the group or individual market. There should be little surprise, then, that the industry is chomping at the bit to “bear the risk,” that is, be overpaid to insure the remaining 60 percent of seniors who have deliberately chosen not to enroll in Medicare Advantage, those that are safely (or so they thought) enrolled in traditional Medicare.
But safe they are not, and every enrollee in traditional Medicare should take note: A program known as the Global and Professional Direct Contracting model in a little-known government agency known as the Center for Medicare and Medicaid Innovation (“The Innovation Center”) is already moving them, without their knowledge or consent, to “risk-bearing,” for-profit middlemen known as Direct Contracting Entities (DCEs). The goal: to end what’s left of traditional Medicare.
The Innovation Center was created under the Affordable Care Act (ACA) in 2010 with a mandate to test “innovative” payment and service delivery models for Medicare that would decrease costs, and if not improve, at least not worsen care. The ACA gave full authority to the Innovation Center to scale up any model it deemed fit, to all of Medicare without congressional approval. In the past 10 years, 54 models have been developed, 50 of which failed and all of which continue to use market-driven models of care. Not one model has been developed to test out single-payer, which actually would decrease costs and save lives. The latest demonstration project, created in the waning days of the Trump administration and greenlighted by the Biden administration, is the DCE model, which is being rolled out to traditional, fee-for-service Medicare beneficiaries without congressional approval or anyone’s vote.
What is a Direct Contracting Entity? Simply put, it is a “risk-bearing,” for-profit middleman to manage health care for traditional Medicare beneficiaries, just like Medicare Advantage plans are for seniors who have signed up for Medicare Advantage plans. The difference is that while 26 million seniors have voluntarily signed up for a middleman when they chose Medicare Advantage, the 38 million seniors in traditional Medicare have not.
How do you get seniors who have specifically chosen traditional Medicare to switch to a non-traditional Medicare-Advantage-like plan with a mysterious name like “Direct Contracting Entity”? You don’t tell them! You lure their primary care providers to participate in a DCE by promising the doctors much better Medicare reimbursement rates and more time with their patients, and once the doctors sign up with a DCE, all their patients are automatically “aligned” by CMS with the DCE the doctor has chosen. The DCE sends patients a letter they are likely not going to read or understand, and presto! Millions of seniors previously on traditional Medicare now belong to a DCE. That’s how DCEs leverage and monetize the doctor-patient relationship for the profit of corporations.
DCE middlemen accept capitated payments for seniors in traditional Medicare just like Medicare Advantage plans, “cherry pick and lemon drop,” deny care, upcode, spend as little as 60 percent on health care for beneficiaries (compared to Medicare Advantage’s 85 percent), and keep the rest as profit. The playbook is an old one, and it works.
There are 53 DCEs in 38 states and Washington, D.C., mostly owned by for-profit, private equity firms, investor-owned primary care practices, Accountable Care Organizations (a network of doctors and hospitals that is jointly accountable for the health of a group of Medicare patients and that receives financial incentives from Medicare to save money on patient care while meeting certain quality metrics) and Medicare Advantage plans. Many DCEs are owned by publicly traded corporations straight out of Wall Street. These are the corporations that will potentially manage the care of up to 30 million seniors who thought they were free of insurance companies. Instead, their health will be weighed against profit. And in a market-driven, for-profit health care system, the bottom line always wins.
But the most important question still remains: Why the urgency to “de-risk” (privatize) Medicare, no matter the cost? Enter Liz Fowler, architect behind the ACA, an industry darling who ensured health insurance companies would reap billions every year under the ACA, the new director of the Innovation Center brought in by the Biden administration to oversee the full privatization of Medicare. Industry giants and Washington insiders can read the writing on the wall as well as anyone else. They are acutely aware that a majority of Americans say it is the government’s responsibility to provide health care for all. They know that a pandemic has shined a light on the inefficiencies, inequities and indifference of our health care system. They know that Americans died in greater numbers and at increased rates compared to countries with universal health care systems in place. In the face of this inevitability, what would the medical-industrial complex and Congress do? Sell off Medicare, and fast, before Americans actually get Medicare for All.
Health and Human Services Secretary Becerra, a supporter of Medicare for All, and CMS Administrator Chiquita Brooks-Lasure have the authority to terminate the Direct Contracting model program. Congress has the power to hold hearings on the Innovation Center and pass legislation to provide congressional oversight to the Center’s pilot programs. The Innovation Center has put a hold on new DCE applications, to the consternation of industry, but all signs point to the continuation of using DCEs to privatize traditional Medicare. The Innovation Center will put a pretty bow around DCEs and talk about “equitable outcomes” and “person-centered care” but we should not be fooled: The end of Medicare is near. It is up to us to demand DCEs, not Medicare, be ended.
This post was originally published on Latest – Truthout.
This post was originally published on Real Progressives.
Over the course of the COVID-19 pandemic, Southern states have been among those that have done the least to protect their residents from contracting the deadly virus.
They were some of the last to impose mask mandates and among the first to reopen after temporary shutdowns. And many sectors in the region, like poultry processing, never shut down at all. That makes it particularly striking that essential workers in Southern states disproportionately fall in the Medicaid coverage gap. Not provided health insurance through their jobs and unable to afford it in the private market, these workers risk their lives to keep the economy running — and disproportionately die in the process. Eight of the 12 states that have refused to accept federal funds to expand Medicaid under the Affordable Care Act are located in the South: Alabama, Florida, Georgia, North Carolina, Mississippi, Tennessee, Texas, and South Carolina. All have Republican-controlled legislatures.
A recent report by the Center on Budget and Policy Priorities (CBPP) looked at data from 2019, the year before the pandemic hit, and calculated that over 550,000 people working in essential or frontline industries fall in the Medicaid coverage gap. The states with the greatest number of essential workers in the coverage gap are Texas (209,000) and Florida (98,000) — GOP-led states that have had notoriously ineffective public health responses to the COVID-19 pandemic. In total, over 2 million people living in Southern states fall into the gap.
“A large body of research demonstrates that Medicaid expansion increases health insurance coverage, improves access to care, provides financial security, and improves health outcomes,” the report states.
CBPP also documented glaring racial disparities, finding that people of color make up 60% of those in the Medicaid coverage gap even though they account for only 41% of the non-elderly adult population in non-expansion states. In Texas, 74% of those in the coverage gap are people of color, while Black people account for a majority of people in the coverage gap in Mississippi and 40% in Georgia and South Carolina. At the same time, people of color face a higher risk of COVID-19 infection, hospitalization, and death.
The report notes that about three in 10 adults in the coverage gap have children at home. And a third are women of childbearing age, meaning that if they get pregnant they can apply for existing Medicaid coverage. However, the coverage would not begin until they are determined to be eligible, meaning they could miss out on critical prenatal care during the first months of pregnancy. CBPP points to an Oregon study that found Medicaid expansion was associated with an increase in early and adequate prenatal care.
In addition, CBPP calculates that about 15% of people in the Medicaid coverage gap have disabilities. That includes 7% with serious cognitive difficulties, and more than 6% who have difficulty with basic physical activities such as walking, climbing stairs, carrying, or reaching.
In the years leading up to the pandemic, states that expanded Medicaid cut their uninsured rates by half. That made them better prepared for both the ensuing public health crisis and consequent economic downturn, which resulted in an estimated 2 million to 3 million people nationwide losing employer-based coverage between March and September.
Efforts are now underway in the Democratic-controlled Congress to find a way to bring Medicaid to more essential workers — and Americans in general — despite Republican resistance at the state level.
U.S. Rep. Lloyd Doggett, a Texas Democrat, recently proposed the “Cover Outstanding Vulnerable Expansion-Eligible Residents (COVER) Now Act.” The bill, which already has over 40 cosponsors, would authorize the federal Centers for Medicare and Medicaid Services (CMS) to work directly with counties, cities, and other local governments to expand Medicaid coverage in states that have refused to do so. It’s based on previous successful demonstration projects in several counties in California, Illinois, and Ohio, and it’s won the endorsement of groups including the American Diabetes Association, National Alliance on Mental Illness, and the Texas Academy of Family Physicians.
“The COVER Now Act empowers local leaders to assure that the obstructionists at the top can no longer harm the most at-risk living at the bottom,” Doggett said in a statement.
And over in the Senate, Raphael Warnock of Georgia this week announced that he is drafting a proposal that would bypass his state’s Republican leadership while calling on the White House to include a “federal fix” in the next jobs package. Warnock told reporters that he’s hoping to introduce legislation soon. The Georgia Recorder has reported that Gov. Brian Kemp (R) is pushing a plan to expand Medicaid to about 50,000 additional Georgians, but the Biden administration has put the brakes on it over concerns that it requires participants to rack up 80 hours of work, school, or other qualifying activity every month to gain and keep their coverage.
In a letter sent last month to Senate Majority Leader Chuck Schumer of New York and Minority Leader Mitch McConnell of Kentucky, Warnock and U.S. Sen. Jon Ossoff of Georgia suggested that one possible solution could be a federal Medicaid look-alike program run through the CMS.
“We have a duty to our constituents and a duty to those suffering from a lack of access to health care to provide for them when they are in need,” Warnock and Ossoff said in the letter. “We can no longer wait for states to find a sense of morality and must step in to close the coverage gap and finally ensure that all low- and middle-income Americans have access to quality, affordable health care.”
This post was originally published on Latest – Truthout.
Last week, Senate Minority Leader Mitch McConnell issued what surely must rank among the most hypocritical statements ever uttered by a senior senator. Were he to become majority leader again after the 2022 midterms he would, the Kentuckian stated, be “highly unlikely” to preside over a confirmation of a Biden-nominated Supreme Court justice.
McConnell is no stranger to hypocrisy. Remember, he was the Senate leader who conjured a precedent out of his nether regions in 2016 in refusing to hold confirmation hearings for President Obama’s nominee Merrick Garland, and in claiming it was too close to an election and that the voters should have a say. And he was also the Senate leader who, a presidential election cycle later, then did a spectacular U-turn and rammed through Amy Coney Barrett’s hearings and confirmation vote just days before last year’s Election Day, when more than half the country had already cast early votes.
McConnell was also the leader who twice marshaled his caucus to oppose voting to convict Donald Trump, after the House had impeached him. The second time around, he did so despite publicly averring that Trump did, indeed, bear moral responsibility for instigating the January 6 insurrection. And he’s the same leader who, after acknowledging that the ex-president bore blame for the most dangerous insurrection in modern U.S. history, then promptly turned around and appeased his base by saying that he would “absolutely” support Trump in 2024 if he were the party’s presidential nominee, and that he would oppose a bipartisan commission to investigate the insurrection.
In other words, McConnell is no stranger to the art of shameless double-talk. He has spent years consolidating his power at the expense of the integrity of basic civic institutions, and he has thought nothing of undermining the country’s democratic culture to appease his increasingly extreme base. Where Trump was bluster and bombast, McConnell is a political beast of a different species, a wily, deeply cynical operator who uses the levers of power in as ruthless a manner as any Senate leader in modern history.
So, why is his statement on a potential Biden Supreme Court nominee any different from his past statements and actions? On one level, it’s not; it’s simply more of the same amoral politicking. But on another level, it’s exponentially worse than what has come before. If McConnell in 2016 was a caterpillar feeling his way toward a new, anti-democratic, ruling philosophy, McConnell in 2021 has completed his metamorphosis into a malignant moth. In that, he is marching lockstep with the ever more anti-democratic trajectory that the GOP — the party of mob attackers, conspiracists, QAnon adherents, white supremacists and voter suppression advocates — as a whole has now embarked upon.
What the Senate minority leader — whose 50 senators represent 43.5 percent of Americans, and whose Senate caucus hasn’t represented a majority of the country’s population in a quarter century — is basically saying is that a minoritarian political party has an absolute right to stymie the political majority. He is averring that the GOP has a God-given free pass to impose on the entire country ever more extreme legal interpretations of everything from abortion access to environmental regulations to voting rights, no matter where the voting public stands on these issues.
McConnell seems to have long viewed his legacy as being about securing a conservative hold on the judiciary for decades to come. Now that he has a 6-3 Supreme Court majority and has planted conservative flags up and down the federal judiciary, he is getting more audacious still, looking to use the wave of GOP-passed voter suppression laws to secure a congressional majority again and then to basically neutralize the ability of Democrats to have any say in who presides over the country’s powerful court system. After all, a 6-3 conservative majority on the Supreme Court still occasionally pushes back against GOP excesses; witness the recent refusal to overturn the Affordable Care Act and its unwillingness to entertain Trump’s challenges to state election results in 2020. But if the Republicans could move toward a 100 percent conservative court, well, at that point nearly anything would be possible for GOP operatives. The courts would, at that point, simply be both a rubber-stamp for Republican social and economic priorities, and a reliable blocking mechanism for any and all progressive policies pushed at a city, state and federal level by Democrats, centrists and left-of-center groupings.
In the sort of fractured, frequently stalemated and increasingly antagonistic political environment that has come to be the default in the U.S., the courts occupy a central role in the political process. They shape cultural norms, economic relationships, access to the ballot, and more. They determine what rights vulnerable, marginalized groups have or don’t have. And they set limits on what government can and can’t do on big-picture issues, such as immigration, health care provision, gun control and efforts to tackle climate change.
McConnell’s shot across the bows on future Supreme Court nominees is the action of a man increasingly comfortable with the idea that howsoever a party rigs the game is legitimized simply in pursuit of power. If you can’t win free and fair at the ballot box, modern GOP thinking goes, then limit access to voting. And if even that fails and the GOP doesn’t win power despite a constricted voting environment, then Republicans seem intent on doing an end-run around the electorate and its priorities by stacking the courts with uber-conservatives.
As the ultimate player of this toxic game, Mitch McConnell is now, in his own anti-charismatic way, the U.S.’s most dangerous practitioner of might-is-right politics. His legacy may well be the conservative judges whom he has helped elevate to positions of power around the country and all the way up to the Supreme Court. But, if he succeeds in regaining Senate control in 2022, he may also leave a legacy of the thorough destruction of democratic norms in a country that, rightly or wrongly, likes to consider itself the world’s most durable democracy.
This post was originally published on Latest – Truthout.
In a long-awaited decision, the Supreme Court rejected a right-wing challenge to the Affordable Care Act (ACA) in California v. Texas, preserving health insurance for 21 million people who are predominantly low-income and people of color.
The 7-2 opinion, written by Stephen Breyer, held that the plaintiffs did not have standing to contest the constitutionality of the ACA. Thus, since they could not demonstrate that they had been harmed by the “individual mandate,” the plaintiffs had no right to sue in the first place. Samuel Alito and Neil Gorsuch dissented. They would have thrown out the entire ACA.
Republican attorneys general from 18 states, led by Texas, and two individuals claimed the ACA’s mandate that individuals purchase health insurance was unconstitutional, even though there is no longer any penalty for failure to buy such insurance. The plaintiffs’ argument didn’t pass the straight face test, even for four of the Court’s conservatives. John Roberts, Brett Kavanaugh, Clarence Thomas and Amy Coney Barrett all agreed with the three liberals on the Court that the plaintiffs had no standing to bring the lawsuit in the first place.
The Court never reached the issue of whether the individual mandate was constitutional or whether, even if it was unconstitutional, the whole ACA should be overturned. Article III, section 2 of the Constitution sets forth the prerequisite of standing. It requires that a lawsuit raise a genuine “case” or “controversy” before a federal judge can review it. Breyer reaffirmed that the Court does not issue “advisory opinions.”
Since the ACA was enacted in 2010, right-wingers — including the Trump administration — have been trying to wipe it off the books. In 2012, the Court held in National Federation of Independent Business v. Sebelius that the monetary penalty for failure to purchase health insurance constituted a permissible tax and the individual mandate was therefore constitutional.
In 2017, Congress nullified the penalty by reducing it to $0, leaving no consequence for individuals who do not buy insurance. Plaintiffs in the current case then sued, arguing that the individual mandate was unconstitutional because Congress had zeroed out the penalty so it could no longer be justified as a tax.
A U.S. District Court judge in Texas held that the plaintiffs had standing to sue, the individual mandate was unconstitutional, and the individual mandate was not severable from the rest of ACA so the entire Act must fall.
The Fifth U.S. Circuit Court of Appeals agreed with the District Court that plaintiffs had standing and the mandate was unconstitutional. But the appellate court determined that the District Court’s analysis was “incomplete” and sent the case back to the lower court to consider evidence of whether the individual mandate was severable from the rest of the Act.
Attorneys general in California and 15 other states, together with the District of Columbia, intervened to defend the ACA. The House of Representatives joined the defenders of the ACA at the appellate stage. After the Court of Appeals remanded the case to the lower court, the defenders asked the Supreme Court to review the case and it agreed to do so.
Breyer wrote, “With the penalty zeroed out, the IRS can no longer seek a penalty from those who fail to comply” with the requirement to buy insurance. Thus, “there is no possible Government action that is causally connected to the plaintiffs’ injury — the costs of purchasing health insurance.”
As a result of the Court’s decision to uphold the ACA, insurers cannot reject 133 million people living with pre-existing conditions — including those who have tested positive for COVID-19 — or charge them substantially higher premiums. Young adults who have been allowed to remain on their parents’ health insurance policies until age 26 will not lose their coverage. If the Court had struck down the ACA, the biggest losers would have been low-income adults who became eligible for Medicaid after it was expanded in 38 states and Washington D.C. and extended coverage to more than 15 million people.
Seventy-eight percent of enrollees in the ACA now have a choice of three or more insurance providers, whereas only 57% had such a choice in 2017.
For years, Republicans promised they would abolish the ACA and replace it with something better, but they never made any concrete proposals. Even many congressional Republicans who opposed the ACA distanced themselves from the plaintiffs’ lawsuit. Robbing people of their health insurance in the midst of a deadly pandemic was not good politics.
Some Republicans are resigned to the survival of the ACA. Indeed, Sen. Roy Blunt (R-Missouri) said, “It’s been my public view for some time that the Affordable Care Act is largely baked into the health care system in a way that’s unlikely to change or be eliminated.” Sen. Josh Hawley (R-Missouri), who represented one of the plaintiffs in the lawsuit against the ACA as attorney general of Missouri, said the Supreme Court had made clear “they’re not going to entertain a constitutional challenge to the ACA.”
But additional challenges to the ACA may reach the high court in the future. One such lawsuit is Kelley v. Becerra, which contests insurance plans that cover preventive care including birth control. Five members of the Supreme Court have indicated agreement with that position.
Nevertheless, the Court’s decision in California v. Texas is a significant affirmation that the 21 million people who now receive health care through the ACA should not lose their insurance. This result is an indication that the high court — even with its overwhelming majority of right-wingers — has little appetite to overturn the ACA.
This post was originally published on Latest – Truthout.
At a meeting in the name of bipartisanship between President Joe Biden and Sen. Shelley Moore Capito (R-West Virginia) on Wednesday, the president asked that the Senate Republicans bump up their infrastructure offer to $1 trillion in new spending. And, though Republicans have been touting a $1 trillion package, they are reportedly extremely displeased with the president’s request.
Republicans have marketed their plan as being close to $1 trillion in spending. The majority of their $928 billion proposal, however, constitutes baseline spending with just $257 billion in new spending. The senators claim that the president told them in a previous meeting that it was okay that their offer was mostly baseline spending, but it’s unclear what exactly was said.
Regardless, Biden is now asking that the plan include $1 trillion in new spending, a hefty increase from the Republicans’ previous paltry offer. They are expected to make another offer as soon as Friday, when Biden and Capito will be holding another meeting.
At Wednesday’s meeting, the Republicans were still insistent that the bill cannot be paid for with a raise in the tax rate for corporations and the wealthy as Biden has proposed, despite the popularity of the proposal. The GOP has instead offered mostly unrealistic plans to pay for the proposal.
A person familiar with Wednesday’s meeting told Politico that it’s unlikely that the Republicans will come up with a plan that satisfies Biden’s request. “I don’t think Senate Republicans are interested in $1 trillion in new spending, or changing the tax cuts … or raising other taxes — and that’s been clear from day 1,” they said.
It’s unclear where the Republicans will go from here. Biden has already cut his plan by about $600 billion to $1.7 trillion in new spending to appease them and now is offering an even lower threshold, but they evidently can’t even agree to that.
It took the GOP weeks, after all, to come up with a plan that covers only about a quarter of the new spending that the president is asking for. And, despite many weeks of negotiations, the gap between the two proposals is still around $1.4 trillion.
Meanwhile, Democrats and progressives have grown increasingly frustrated with the negotiations that have already gone on longer than expected. Rep. Pramila Jayapal (D-Washington), chair of the Congressional Progressive Caucus, on Tuesday joined the chorus of lawmakers calling for Democrats to move forward with the bill without Republicans.
“It’s time to go big, bold, and fast on an infrastructure plan that repairs bridges and roads — but also guarantees paid leave and child care,” tweeted Jayapal. “The GOP isn’t going to meet us halfway. It’s time to go alone — and get this done.”
Sen. Bernie Sanders (I-Vermont) has been reiterating this point for weeks that “the bottom line is the American people want results.” He pointed out that most Americans don’t think about bipartisanship when they benefit from things like the hugely popular stimulus checks that no Republicans voted for — and warns that further dragging out talks could hurt Democrats’ chances in 2022 and beyond.
Meanwhile, Democratic operatives are fearful that the infrastructure talks could end up looking like the fight over the Affordable Care Act in 2009, reports MSNBC. Republicans, led by Sen. Mitch McConnell (R-Kentucky) dragged on talks over and propagandized about the health care proposal for so long that, by the time it came to a vote, it was heavily politicized and conservatives had successfully turned a majority of the public against it. (Public opinion on the program has since flipped.)
Democrats and progressives warn that Republicans aren’t going to vote for the bill regardless of how many concessions the president makes — after all, Democrats made concessions for the January 6 commission and still failed to get enough Republican votes to overcome the filibuster in the Senate.
This post was originally published on Latest – Truthout.
Republican lawmakers in Missouri are refusing to fund an expansion of the state Medicaid program that constituents approved in a vote last year, a move that will likely spur legal challenges in the months ahead.
In August, voters in Missouri were asked whether they supported expanding Medicaid eligibility as laid out in the Affordable Care Act (ACA). Though the vote was somewhat close, more than 53 percent of voters said they supported the expansion, with less than 47 percent saying they opposed it.
The expansion would cover an additional 230,000 residents of the state, Politico reported at the time.
Thirty-nine states and D.C. have adopted measures to expand Medicaid since the ACA became law in 2010, with 12 states refusing to do so. Of those 39, however, two states — Oklahoma and Missouri — adopted expansion through a referendum vote but have not implemented it yet.
In spite of the outcome of the ballot initiative, Republican lawmakers last week stripped provisions from the state budget that would fund the expansion, essentially defying the will of voters.
During debate on the provision last week, some Republicans said that it was up to Missourians themselves to get insured through their places of work, implying that increasing Medicaid expansion would encourage laziness in the workforce.
“I’m sorry, if you’re a healthy adult, you need to get a job,” State Senator Andrew Koenig, who leads the Ways and Means Committee in Missouri, said.
Democratic lawmakers blasted Koenig’s assertions as out of touch with reality, noting that many who would qualify under the expansion of coverage are employed.
“We have a working class that cannot afford for-profit health insurance, and I’m one of those people, that could be one illness or one injury away from bankruptcy,” Democratic State Senator Brian Williams retorted. “And those are people who go to work every single day.”
Koenig also ignored the fact that not everyone with a job gets insurance, as only 52 percent of the workforce in Missouri currently receives employer-based health insurance. Meanwhile, more than 1-in-10 residents (10.1 percent) are uninsured, higher than the national rate (9.2 percent), a gap that could be closed by increasing eligibility requirements for Medicaid.
Others in the GOP have attempted to frame the issue as a fiscal problem. In an interview that was published over the weekend, Senate President Pro Tempore Dave Schatz, a Republican, complained that the expansion of Medicaid was too expensive to push forward on.
“The social services, senior services, that portion of the budget is about 46 percent of our state’s budget,” Schatz said. “That’s a very, very large program, and continues to grow.”
Increasing the number eligible to the program would only cost a small fraction of the state’s budget — about $1.9 billion in total (Medicaid spending in Missouri is about $10.1 billion). Of that amount, more than 9-in-10 dollars would be provided by federal funds, with the state only paying for $130 million in additional costs.
The expansion of eligibility for all residents with household incomes at or below 138 percent of the federal poverty level would be a drastic change for the state. Currently, Missouri doesn’t allow any childless adults to qualify for its Medicaid program, and families with children can only qualify if they make less than 21 percent of the federal poverty level. For a family with two parents and a single child, for example, eligibility is cut off after the household income exceeds $5,400 per year.
Gov. Mike Parson, a Republican, has the final say on whether the eligibility requirements will be expanded starting on July 1. In a tweet discussing the issue, Parson indicated his office was still undecided.
“We will assess our options and legal requirements on how to move forward with Medicaid expansion, once the budget is finalized,” Parson wrote.
If Parson doesn’t expand eligibility requirements, it will likely lead to lawsuits from those who expected to be eligible as a result of the referendum last year, said Jim Layton, a former official within the state’s attorney general’s office.
“The [state] constitution says people up to this level of income qualify in Missouri for Medicaid and that’s just what we have to live with,” Layton said in an interview with Fox 4 in Kansas City this past week. “The question will be when someone gets online or goes in an office on July 1 and says, ‘I wasn’t eligible on June 30 but today I’m eligible.’”
This post was originally published on Latest – Truthout.
Last year, on the campaign trail, President Joe Biden released a $750 billion, 10-year plan designed to massively expand the reach of the Affordable Care Act (ACA). It would create a public option, allow undocumented immigrants to buy into that public option, lower the age at which Americans become eligible for Medicare, take Medicaid expansion into the 12 Republican heartland states that chose not to expand it themselves, and permit Americans to buy prescription drugs from overseas at a cheaper cost.
Since assuming office, such sweeping health care ambitions have taken a back-burner to getting COVID relief passed, to developing a large-scale infrastructure plan, and to initiating a reset on environmental policy. But that doesn’t mean there is less urgency to lock into place big-picture health insurance changes. After all, the Biden administration inherited a barn-on-fire situation from the previous president, and we are still in the middle of a pandemic.
There are, in 2021, more than 2 million low-income American adults who live in states that didn’t expand Medicaid, and who can’t access private insurance on the exchanges because their income is deemed too low to qualify for tax credits. Of these 2 million, more than a third live in Texas. All told, by the middle of 2020, at the height of the pandemic, about 30 million non-elderly Americans remained without insurance. That’s down from 48 million in 2010, but it’s up from 28 million at the end of Barack Obama’s presidency. The increased numbers of uninsured in the years from 2017 to now are the clear result of former President Donald Trump’s effort to eviscerate his predecessor’s central legislative accomplishment and make it ever-harder for Americans to enroll in the subsidized insurance plans.
From 2017 through to January 20, 2021, health care advocates had to play defense pretty much all the time. From day one of his administration, Trump, with the full backing of most of the GOP, had the ACA, known more popularly as Obamacare, in his sights. In his first months in office, the Senate came within one vote of rolling back the legislation that had created the ACA. It was that one vote, cast by an ailing Sen. John McCain against dismantling the ACA, that fueled Trump’s loathing for, and mockery of, the dying Arizonan.
After Republicans failed in Congress to repeal the ACA, Trump sought to kill it by a thousand cuts: to make it harder for patients to enroll on health care exchanges, to limit Medicaid expansion, to cut funding for outreach campaigns to educate people on how to enroll. Finally, having failed to destroy the program this way, Trump’s administration decided to side with Texas and other GOP states in their Hail-Mary lawsuit attempting to have the entire thing declared unconstitutional.
That case was heard by the Supreme Court last year, and a decision on it should come down in the next few months. Given the extraordinarily conservative composition of today’s Supreme Court, it’s at least possible — though perhaps not likely, given previous rulings on the issue — that they’ll end up taking a judicial axe to the entire project.
Which is why it’s all the more vital that, in the interim, state and federal officials work to expand the ACA as rapidly as possible. After all, the more people are covered, and the more the ACA is seen to be an indispensable, life-saving pillar of the country’s health care delivery edifice, the harder it will be to pull the rug out from under it. Given that neither party seems likely to push for a more rational, more equitable universal health care system anytime soon, ironing out the kinks in the ACA and expanding its reach seem to represent the best short-term path toward near-universal coverage.
An ACA expansion would inevitably still fall short of a truly universal, single-payer system, and it would do little to address systemic problems such as over-billing and the profiteering of middle-men institutions, which go hand in hand with for-profit insurance systems as a primary delivery system for medical services. But it would, nevertheless, bring additional millions of uninsured Americans under health care umbrellas.
Earlier this year, the Biden administration extended the special enrollment period for the ACA insurance exchange through August 15 of this year, arguing that, because of the extraordinary circumstances of the pandemic, it was imperative to make it as easy as possible for Americans to find affordable health insurance coverage. California and other states with their own exchanges also followed suit in keeping enrollment open.
The result of this has been encouraging: In the first weeks of the special enrollment period, well over 200,000 people signed up for coverage, eclipsing, by orders of magnitude, the numbers from the first weeks of earlier special enrollments. Hundreds of thousands more have begun the application process to get insurance via these exchanges; and additional tens of thousands have been declared eligible for Medicaid and the Children’s Health Insurance Program.
Moreover, the latest COVID relief package in Congress freed up billions of dollars to increase subsidies to lower-income people buying coverage on the state exchanges. In many cases, premiums for people around the country will be cut in half. And in some states, funds will be used to essentially eliminate premiums for poorer residents. In California’s case, for example, this means an additional $3 billion for subsidies. As a result, come May, some low-income Californians will be paying only $1 per month for their health insurance. Hoping to get more Californians to take up insurance through the exchange, the state will spend $20 million on an outreach and advertising campaign promoting the new lower rates.
For a state that has already managed to cut its uninsured population from about 17 percent down to roughly 7 percent, all of this is a huge deal. Combine it with the ongoing efforts to expand Medi-Cal to cover all low-income undocumented adults, and one sees a road-map being drawn in California that would, over the coming years, get the state as close to having universal coverage as possible given the nature of the current U.S. health insurance system.
Where California goes on health care coverage, the nation might one day follow – especially with California’s former Attorney General Xavier Becerra now in charge of the Department of Health and Human Services, and pushing an emphasis on health equity and public health readiness. Already, California has self-funded Medicaid expansion to include young undocumented adults up to the age of 26. Quite possibly, later this year the state may expand the expansion to include a much larger proportion of the undocumented population. This jibes well with the proposals then-candidate Biden put out on the campaign trail. Hopefully, once California paves the way, Biden and the Democratically controlled Congress will follow through on their health care commitments at a federal level too.
This post was originally published on Latest – Truthout.
Deference to state governments has severely undermined public health efforts during the pandemic and deepened geographic inequality in the United States.
This post was originally published on Dissent MagazineDissent Magazine.