Surprise! Over the Weekend, Graham-Cassidy Went from Bad to Worse!!

It’s hard to believe this Zombie bill could get any worse. But it did.

Last night Politico received a leaked copy of a revised Graham-Cassidy bill.  I presume the “leak” was by someone who recognizes this effort as so ill-conceived and harmful that the country should know about it ASAP.  In good time, at the eleventh hour, before this terrible legislation is put to a vote.

http://www.politico.com/story/2017/09/24/obamacare-graham-cassidy-repeal-243079

Thank you, dear leaker, whoever you are.  You have exposed this last-ditch Republican effort to undo Obamacare.  Instead of getting better, Graham-Cassidy has gone from bad to absurd, which might be laughable if it were not so cravenly cruel.

This latest effort amounts “bribery” of the “swing senators” from Arizona, Alaska and Kentucky, with more block grant monies promised to each of their states.  However, as the Politico article points out, this masks the overall slash-and-burn assault on Medicaid.

So, promising more money to the “swing states,” is less like a bribe and more like a mugger telling you to be grateful to be mugged because you can keep your watch.

Another retrograde revision tries to win over Senators Cruz and Lee by effectively removing federal regulation of health insurers in favor of the states.

Among other things, this would lift existing caps on out of pocket costs and lead to the unwinding of protections for individuals (like my hard-working diabetic daughter) who have “pre-existing conditions.”

On this point, Politico quotes Larry Levitt of the Kaiser Family Foundation:

“This revised bill is tantamount to federal deregulation of the insurance market.  If there were any doubt that people with pre-existing [conditions] are at risk of being priced out of individual insurance, this bill removes them.”

It’s high time to put aside political differences and mend the problems of the Affordable Care Act.  While Congress continues to battle over health care, with perennial waste of time and money, people are dying.

Americans should demand congressional collaboration and cooperation and an end to this hyper-partisan nonsense.

[Check out my March 15, 2017 blog post:  https://jerrysturgill.blog/2017/03/15/fix-obamacare-stop-wasting-time-and-money-tearing-it-down]

Meanwhile, you have probably seen news of our own Idaho Senators’ willingness to vote for Graham-Cassidy.  (Which makes me wonder why they didn’t try to be hold out votes too, to attract more hush-up, block-grant money to Idaho and make the proposed Medicaid mugging less bad.  Oh well.)

Whether or not Graham-Cassidy passes, Messrs. Risch and Crapo should be held accountable–now and at future ballot boxes–for their cowardly toeing of the far-right party line and their abject failure to help make health care available and affordable for more Idahoans.

 

Graham-Cassidy-oppose

 

Another Zombie Health Care Bill

We hoped it was dead!  But it still isn’t.  Repeal and replace has risen again.  A Senate vote is expected next week.

Senators Graham (R-SC) and Cassidy (R-LA) have proposed a last ditch budget amendment.  Apparently, they think the news cycle is so saturated with natural disasters we will not be paying attention to a man-made one.

cemetery hand

However, we MUST pay attention, especially here in Idaho.  We should pummel our Idaho U.S. Senators with demands to vote against this terrible, zombie bill, before next week’s vote.

There is so much wrong with this process, even before you get to the relative badness of the bill.  Like prior attempts at repeal and replace, Senators Graham and Cassidy, with alarming Senate and White House support, are trying to avoid the deliberative process of the Senate (remember, that failure of “regular order,” about which Senator McCain so passionately spoke in the last round).

The political subterfuge of this “rush job” is obvious and represents hyper-partisanship at its absolute worst.

The proposed process for Graham-Cassidy is even more compressed than before, and is intended to avoid exposure to political and public scrutiny.

It will squash the budding potential for bipartisan collaboration and cooperation and is a violation of democratic process.  As a result, we will careen from one half-supported half-baked result to another.

Because of the short deadline, no scoring will be done by the Congressional Budget Office before a vote.  Even so, the Republicans appear ready to hurry ahead, no doubt because the CBO fueled criticism of their last repeal and replace efforts.

This is like prescribing medicine before the test results are back and a proper diagnosis can be made.

As for the badness of the bill, the Graham-Cassidy amendment is clearly worse than previous repeal and replace efforts.  Suffice it to say that, if passed, it would have a massive negative impact on Idaho and the rest of the country.

The insurance markets, now relatively stable, would be turned upside down.  Even more people (32 million) would lose health insurance.  Federal protection for people with pre-existing conditions would disappear.  Planned Parenthood would be defunded.  Medicaid would be crippled and ultimately disappear.

The whole idea is to kick-the-can-down-the-road to the states with block grants, shifting the burden of fixing health care to disparate state legislative and executive bodies.

The result will be an uneven system of health care “haves” and “have-nots,” with hugely damaging economic and social consequences, especially for thinly-populated, heavily-rural states like ours.

Given the poor performance of the Idaho state legislature on health care generally, Idahoans especially should be screaming “foul.”

Call our Senators, today, and every day, until next week’s vote.  Senator Crapo’s number in D.C. is (202) 224-6142, and Senator Risch’s is (202) 224-2752.  Call Senators McCain (202) 224-2235, Murkowski (202) 224-6665 and Collins (202) 224-2523) too, if you have time.

 

People of Good Will Unite!

We must overwhelm the attitudes of white supremacy, nationalism and insularity that take us backward and harm us all.

David Duke, KKK Imperial Wizard was correct in his weekend Tweet to @realDonald Trump:  White Americans put Donald Trump in office.

david duke
KKK’s David Duke in Charlottesville, Virginia -August 12, 2017

By “White Americans,” though, he surely refers to members of a distinct minority for whom whiteness and white privilege is essential to identity.  They cling to it desperately as they watch their whiteness diluted and dismissed as cultural and historic artifact.

Charlottesville is evidence of this virulent white minority and the sad fact that the fight for civil rights in America is not over.  As hard as it is to imagine in this modern era, there are young, khaki-clad white Americans, wearing MAGA hats, who cling to a past of confederate white supremacy, anti-Semitism, slavery and segregation.

Don’t they see their mindset holds them and the rest of our society back?  Overcoming such attitudes and practices has been essential to cultural and economic progress.  Watch the movie Hidden Figures and wonder if we could have been first in space and sooner to the moon if American society had not committed the crimes of slavery and post-slavery segregation.

Even the Neanderthals intermingled with Homo sapiens and gave up their “big brow” identities.

Charlottesville was an odious clash between progress and those willing to do violence for their identities of color, race, religion and nationality.  For what purpose?

Return to slavery?  Segregation?  Closed borders?  Travel bans?  Trade wars?  All these hobble progress and diminish economic activity.  The only modern hypothetical I can think of is a Walmart closing its doors to customers and allowing only its employees to do business within its walls.  Its “economy” would shrink and failure would loom quickly.

Historic examples include the many failed “utopian” experiments where groups of people walled themselves away from the of rest society, “drank the Kool-Aid” and otherwise spiraled into dysfunction and self-destruction.

Diversity, acceptance, inclusiveness, respect, open doors:  These are not just long-accepted American values, they are essential to American economic progress and prosperity.

Add smart investments in education, job growth and upward mobility, and the economy can soar—for the benefit of everyone.

 

Coming Soon:  Dragging the Anchors of Economic Inequality

Senator Crapo Responds . . . to My Letter

Our federal delegation seems to be failing us on one of the most important issues of our time: health care. For what matters most, they are doing least.

In response to my recent personal letter to Senator Crapo about health care, I received a “form letter,” email response.  (What was I expecting?)

The response completely ignores the issues I raised and reads like an apology for the heartless legislation now before the Senate.  [Senator Crapo’s email is copied verbatim below.]

  • No mention of the CBO scoring that shows tens of millions will lose health coverage under any version of the Senate legislation.
  • No mention of the disproportionate impact on Idaho, because of our already shameful “coverage gap” and the likely losses to already-stretched medical services in our far-flung rural communities.
  • No mention of the disproportionate benefit of tax cuts for the wealthy at the cost of the poor.
  • No acknowledgement that the problems of the current law can be traced to conservative, compromise provisions inserted in the Act; the virulent Republican opposition since; and, the new administration’s squeezing off of legally-mandated support in an effort to force failure–which is like a “caregiver” pressing a pillow over the head of a struggling hospital patient.

Senator Crapo’s email response makes clear the opposition to the current law (the “PPACA”) is based on the right-wing imperatives of unfettered markets and lower taxes. Facts, logic and a concern for the health of society (and our state) do not seem to matter.

For Idaho and Idahoans, this may be the most impactful decision our Senators ever make. Unfortunately, like lemmings (and our Congressmen before them), they appear to be following the partisan crowd in their “rush to the sea.”

In a show of courage, Senators Crapo and Risch should pull back their support and advocate for collaboration with the rest of the Senate (the whole Senate) to find ways to improve the PPACA.

I hope they will muster the courage.  Sadly, Senator Crapo’s apologia does not give me much hope.

 

Senator Crapo’s response to my letter:

July 21, 2017

Jerry Sturgill
Boise, ID

Dear Jerry:

Thank you for contacting me about health care reform. I value the constructive thoughts, opinions, and ideas shared by all Idahoans and welcome this opportunity to respond.

Prior to the implementation of the Patient Protection and Affordable Care Act (PPACA), America’s health care system was in need of reform; however, PPACA favors a one-size-fits-all, top-down approach that has led to increased premiums, smaller provider networks and stifled competition between insurers. It is necessary to work toward implementing consumer-driven, state-based health reforms that ensure the American people have access to the health care coverage that is right for them. On May 4, 2017, the U.S. House of Representatives took the first step toward comprehensive health reform by passing H.R. 1628, the American Health Care Act.

The Senate is currently considering various proposals to repeal and replace PPACA. Any successful reform initiative must include provisions that stabilize the insurance market, repeal the individual and employer mandates and job-stifling PPACA taxes. With premiums rising and coverage options disappearing, the status quo of PPACA is no longer an option.

Congress remains actively engaged with governors, stakeholders and consumers to develop an effective system that works for all Americans. America deserves a better process and a better product, and I look forward to doing my part to make this happen.

In the meantime, please feel free to continue to contact me about health care reform or on other matters of interest to you. For more information about the issues before the U.S. Senate as well as news releases, photos, and other items of interest, please visit my Senate website, http://crapo.senate.gov.

Sincerely,
Mike Crapo
United States Senator

 

 

My July 4th Letter to Senator Crapo. About Health Care, Of Course.

There is good reason for skepticism about our federal delegation. Even so, today I have mailed and emailed this urgent letter to Senator
Crapo.

Dear Senator Crapo,

On election night, when I called to congratulate you on your victory, you were gracious, told me of your working with and listening to both sides of the aisle and accepted my offer to be in touch for moments and matters of importance to Idahoans

This is one of those moments.  The matter is health care.

H.R. 1628 “The Better Care Reconciliation Act” currently before the Senate will have a devastating impact on many Idahoans.  I respectfully implore you to oppose it.

The predicted problems with this legislation are compounded for Idaho in the fact that 78,000 Idahoans already have suffered for years without health care coverage, in large part because the Idaho State Government refused Medicaid expansion under the Affordable Care Act (ACA).

Idaho’s Coverage Gap will grow and access to health care will become even more unattainable with the Medicaid contraction and rising premiums predicted by the CBO.

I recently received this note from someone already in the Idaho Coverage Gap:

“Jerry, it’s a sad state of affairs. I am one of the 78,000 here in Idaho. I don’t want something for nothing, but just can’t do the premiums. And it is obviously going to get worse.”

You and I have both served as Bishops in our church.  My ward is unusual in that it takes in the downtown area of Boise and the largest concentration of emergency housing for the homeless in Idaho.  Our ward also has a large swath of Section 8 housing.

Because of my experiences at Church and after the election, I joined the board of the Interfaith Sanctuary, one of the three large homeless shelters in Boise and the only one that accepts families.

ifs

In these roles, I have worked with (and conducted funerals for) the most vulnerable in our community and learned of the mental and physical problems that led to their homelessness and, like an iron boot, kept them there.

Access to health care through Medicaid is often the only thing that gives hope and the possibility of returning to productivity.

The coverage contractions and increasing premiums caused by the BCRA will only result in more homelessness, loss of hope and a growing social burden and responsibility.

In this divisive and individualistic political and cultural environment, I hope you will apply our shared values to encourage care for our poorer brothers and sisters.

The ACA was meant to do that, by spreading the risks and costs of health care to as many as possible. (We all share the costs and risks of driving with car insurance!  Why not health care?)

After strenuous and constant opposition, the ACA mandate is reportedly “hated,” but the fact is that without it (or increased taxes) more people will suffer the effects of poverty and the crushing unavailability of health care—at a cost to all of us.

Consider, for example, the statistics that show where Medicaid was expanded, the costs of emergency care went down.  Otherwise, the costs of emergency care must be spread with increased taxes and higher health care prices.

For these and other reasons, the AHCA and BCRA have been characterized as “Rich Care” for some Americans rather than “Better Care” for all Americans.  No surprise that recent polls show most Americans are against it.

This is not an area where deficit reduction or reducing taxes on the rich should be a consideration.  A healthier society will be a happier, more productive society.  Deficits and rich people will take of themselves.

Please vote against the BCRA and collaborate with both sides of the aisle to fix the ACA or otherwise spread risks and costs to make health care fair and affordable for all Idahoans and all Americans.

Thank you for your kind consideration and your continued service.

Sincerely,

JERRYSIG200

Jerry Sturgill

P.S.  Please feel free to share this message with Senator Risch.  I look forward to being in touch again on future topics, like tax reform, immigration, climate change and public lands.

About Health Care: I Am Not a Communist, I Just Care About People

There is solid logical and factual basis for opposition to the “repeal and replace” legislation passed by the House and now before the Senate.

Logic first.

Barring accident, taking preventative measures leads to better health and reduces the risk of future catastrophic illness.  Such measures include annual checkups, better diet, exercise and seeing the doctor when symptoms first appear.

Putting off prevention can lead to escalating problems and higher costs, like putting off repairing a few shingles in your leaky roof until the whole roof collapses. The logical result is wider damage and higher costs.

Most people, including me, tend to wait because of cost.

In my case, I could have avoided years of discomfort and permanent damage if I had not had a high deductible plan and put off seeing the doctor.  Rather than spend the money, I lived with the symptoms, with the self-deception that they might go away.

Logically, these tendencies are especially acute among poor working families, who tend to serve more immediate needs — like food and shelter — instead of spending time and money seeking medical advice.

If you cannot identify with this, you must be really lucky.  You should consider volunteering at a homeless shelter.

Now the math.

The data referred to in my last post simply confirms the above logic and puts numbers to the effects of health insurance contraction under the American Health Care Act (AHCA or “Trumpcare”).

If you want to dig into the numbers, look at the data from Idaho that describe the 78,000 uninsured who do not qualify for coverage — because they make too much to fit the narrow qualifications in Idaho for Medicaid and not enough to qualify to participate on the “Your Health Idaho” individual insurance exchange.  This is the estimated number of Idahoans in the “Idaho Coverage Gap”.

Then plow through the reports from the Congressional Budget Office (CBO), which “scored” both versions of the the American Health Care Act (AHCA), H.R. 1628 passed by the House of Representatives and  the Senate version of the bill ironically named the Better Care Reconciliation Act of 2017 (BHRA).

CBO has quantified what is obvious in the legislation: the Senate bill would eliminate coverage for 15 million Americans next year and for 22 million by 2026; cut Medicaid by $772 billion over the same period; next year increase individual market premiums by 20 percent; and, make comprehensive coverage “extremely expensive” in individual markets.

To try to understand the potential impact of the AHCA on poor Idaho working families spend time with analysis published by the Kaiser Family Foundation and at least one of several studies of the impact of coverage expansion (including Medicaid expansion) on general health and mortality rates.

map

50states

According to the KFF analysis, an estimated 4.5 million uninsured adults live in the states that did not accept the expansion of Medicaid under the Affordable Care Act (ACA or “Obamacare”).   Of that number, an estimated 52,000 live in Idaho.  These are Idahoans who would have been covered under the ACA, but missed the opportunity because of the Idaho government decisions to not accept Medicaid expansion dollars and to sponsor its own individual exchange.  (Whatever the exact number, it includes some or all of the 78,000 in the Idaho Coverage Gap.)

What are the health impacts?  The study sponsored by the Harvard School of Public Health concludes that the availability of coverage in Massachusetts (the model for the ACA), has had the effect of improving public health reducing mortality rates.  While demographics and health care resources in Massachusetts may differ from those of Idaho, it is significant that a well-constructed, scientific study has concluded that 830 human adults obtaining previously unavailable health insurance coverage could prevent at least one death per year.

The next step is my own analysis of this data and required mathematical extrapolation. It is indicative only (meaning that it is simply an illustration) of the logic at the beginning of this post and my last post.

My analysis assumes that if the AHCA is passed by the Senate after the July 4th recess, its impacts would apply equally across the Idaho population, which represents around one-half of one percent of the total U.S. population.  It assumes that Idaho on its own does not find a way to close the Idaho Coverage Gap. (Efforts so far have failed.)  And, it assumes the Harvard Study results could apply to Idaho across the board to all who lose coverage. With those assumptions:

  • Between 125,000 and 150,000 people will lose coverage in Idaho within the next decade.
  • Between 150 and 180 people are more likely to die as a result.

This analysis has been dismissed as “hysterical.”  Our own Congressman, Mr. Labrador, attracted national and international news coverage when he said that lack of access to health insurance does not result in death.

Paul Ryan has also tried to spin the CBO data by saying that the “loss” of coverage under the AHCA is simply people opting away from buying health insurance in the absence of the “freedom robbing” mandate.

His argument ignores the fact that the largest negative impact on coverage under the AHCA is Medicaid contraction.  His argument is also like someone in the Medicaid gap saying he or she would choose to buy a BMW but exercises the freedom not to do so.

While I am aware that we live in a world of “alternative facts,” please understand that I have done my best to discern and share sound logic and credible facts.

Please encourage others, including our Senators, to do likewise.

 

Call on Idaho Senators to Protect Idaho from Trumpcare

Our Senators must have courage, beginning this week, to resist partisanship and stand up against the devastating effects the Senate version of the American Health Care Act (“Trumpcare”) will have on Idahoans.

Why such a partisan divide on health care?  Why did the House pass a bill that will put health insurance beyond the reach of 23 million people?  Why have Republican Senators scurried off to work in secret on the Senate version of the bill?

Putting aside partisanship and callousness, one significant part of the answer is highlighted in yesterday’s New York Times article about GOP Senator Dean Heller and his opposition to the Senate bill.  About a week ago he said he could not support a measure that would deprive millions of health care and do nothing to lower insurance premiums.

According to the Times, “Now Mr. Heller is facing an intense backlash in Nevada, his home state, where there is talk of a primary race challenge against him next year and a pair of the state’s wealthiest Republican donors are fuming.”

The leading edge of the “backlash” is from President Trump and his rich supporters, in this case, billionaire Nevada casino magnates, Sheldon G. Adelson and Steve Wynn.

Meaning, the health care fight is largely over the taxes imposed on the wealthy to make health insurance affordable for the poor.

Money versus health.  Greed versus individual and societal well-being.

Notwithstanding attempts by Republicans, including Raul Labrador and Paul Ryan, to explain otherwise, if the Senate version of Trumpcare passes, 22 million Americans will become uninsured and people will die.

A Harvard medical study published in the New England Journal of Medicine showed that for the states that adopted the Obamacare Medicaid expansion, mortality rates have declined. Many previous studies support the same, obvious conclusion that with access to health care, mortality rates decline — including for young people.

The Republican-controlled Idaho Legislature has already exposed tens of thousands of Idahoans to higher risk of mortality by refusing to adopt the Medicaid expansion.  The further contraction of Medicaid with Trumpcare will make life even more difficult for tens of thousands of Idahoans.

Idahostats

Voting for Trumpcare is like voting to strip most of the Boise metro area of health insurance and allowing one whole neighborhood to die as a result.

Because of their disregard for the lives of their constituents, Raul Labrador and Mike Simpson should be ashamed for their votes in favor of the House version of the bill. Senators Crapo and Risch should be ashamed if they support the Senate version.

If you agree, please call or send emails to Senators Crapo and Risch.  The Senate will come back to this terrible bill after their July 4th recess, so email as soon as you can.  Encourage our Senators to follow Nevada Senator Heller’s example.

Mike Crapo, Phone: (202) 224-6142 Email:       https://www.crapo.senate.gov/contact/email-me

James E. Risch, Phone: (202) 224-2752 Email: https://www.risch.senate.gov/public/index.cfm/email