Trump Attacks HealthCare He Promised to Protect

During the 2016 election Trump repeatedly claimed he would help people with pre-existing conditions yet his direction to Attorney General Barr to attack the constitutionality of the Affordable Care Act says differently. It is the Affordable Care Act, aka Obamacare, that protects people with pre-existing conditions from being charged outrageous and often unaffordable premiums.

Trump also campaigned promising, “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.” His proposed 2020 budget cuts all three.

This isn’t just about breaking campaign promises it’s about people’s lives, their physical well-being and their financial health. If Trump succeeds in overturning the Affordable Care Act in court and his proposed budget is passed there are a host of the negative consequences to the lives of most Americans.

Without the Affordable Care Act, most young adults 18-26 will lose the option to be covered under their parent’s insurance plan. Many young adults work part time while going to trade schools or college and aren’t eligible for employer sponsored health insurance and individual plans are notoriously expensive so overturning the Affordable Care Act via the courts will cause tens of thousands of young Americans like my daughter to lose their health insurance.

Do you know anyone with cancer or other expensive life threatening conditions? Should the courts overturn the Affordable Care Act insurance companies would once again be able to set annual and lifetime limits on the amount they’ll cover. Between two episodes of blood clots, one of which involved open heart surgery, a staph infection the nearly killed her and various other surgeries my wife would long ago have busted through the caps that many insurers were once allowed. In other words people like my wife would either die from lack of care or their family would go bankrupt or both.

The Affordable Care Act requires insurers to maintain at least an 80% medical loss ratio; that means at least 80% of premiums have to be spent on actual medical care. If an insurance company ends the year with less than that they have to refund you the difference. The first two years after the ACA first went into effect I got substantial refund checks. My insurer finally got the hang of not overcharging. Without the ACA you can bet medical loss ratios will fall and meaning premiums will go up just to so the insurance company can have higher profits.

Trump’s 2020 budget cutting Medicare and Medicaid would also impact many of us either directly or through our loved ones and friends. Medicare is already the most efficient provider of health insurance spending upwards of 95% of premiums on health care as opposed to the 80% allowed to private insurers. Cutting Medicare will mean cutting coverage or cutting physician reimbursement or both. Considering that Medicare already pays most physicians less than other insurers you can see it won’t end well.

Do you know someone in a nursing home? If so, chances are that Medicaid covers some or all of the cost since it covers 2 out of 3 nursing home residents. Trump’s 2020 budget cuts Medicaid, are you ready to care for you parent or grand-parent when they are kicked out of the nursing home?

Trump’s actions are just cruel and heartless. Let’s hope his enablers in the Senate at least see the electoral downside of this and stop him before it’s too late. If they don’t the 2020 election will be a blood bath at the polls.

Published in the Seguin Gazette April 5, 2019

ACA Not Good Enough for All Americans

Too many Americans still can’t afford health insurance even after passage of the Affordable Care Act and four million have lost their subsidies on the through Exchanges over the last four years. A recently released study by the Kaiser Family Foundation shows that particularly older and rural folks find it hard to afford individual insurance whether on the Affordable Care Act Exchange markets or not.

Part of the problem is that Exchange subsidies cut off federal assistance for premiums at incomes at 400 percent of the poverty line, or nearly $49,000 for an individual and just over $100,000 for a family of four. Rather than phasing out by reducing the subsidy gradually the subsidy just disappears, lending the phenomenon the name "subsidy cliff." The Kaiser study uses this example: "On average across the U.S., a 40-year-old making $45,000 would pay $227 a month (6% of their income) for a subsidized bronze exchange plan, whereas the same person making $50,000 would pay $340 a month (8% of their income) for the same plan without a subsidy."

And if you’re older it goes from bad to worse: "a 27-year-old making $50,000 would pay 7% of their income in premiums for the average lowest-cost plan nationally, whereas a 60-year-old making the same income would pay 17% of their income in premiums. Even at an income of $70,000 (577% of the poverty level), a 60-year-old would have to pay 12% of income for a low-cost plan on average."

Rural areas get hit even harder since health insurance there is even more expensive. The Kaiser study provides this example of a 60-year-old in almost any county in Nebraska, earning $50,000 and paying between 30 percent and 50 percent of their income in premiums. And that's for the least expensive, ACA-compliant plans.

There are several ways to deal with the problem. One way is to eliminate the subsidy cliff by adjusting the subsidy so that the premium paid by the insured is never more that 6% of their income. That’s an expensive solution. A better way would be to expand Medicare to cover people 50 and older. Even better is the Medicare For All Act of 2019 introduced last week by Representatives Debbie Dingell, Pramila Jayapal, and co-sponsored by over 100 other members of Congress.

Our current healthcare system in the United States is ineffective, inefficient and outrageously expensive. Around 70 million Americans are uninsured or cannot afford the costs of their co-pays and deductibles. The quality of our healthcare is worse than other industrialized countries with lower life expectancy in the U.S. than other nations, and a much higher infant mortality. The U.S. spends more money per capita on healthcare than any other industrialized nation in part because we waste hundreds of billions of dollars every year on unnecessary administrative costs like insurance CEO salaries in the millions of dollars, while healthcare industry executives measure success in profits, instead of patient care.

When the Franklin Roosevelt administration created Social Security conservatives fought it but the lives of millions of older Americans were improved immediately and seniors have continued to benefit from it 80 years later. When Medicare was passed under the leadership of Lyndon Johnson conservatives fought it, Ronald Reagan even made speeches calling it socialism, but again millions of older Americans lives were improved and seniors today recognize their lives would be much worse without it. Conservatives are fighting Medicare for All but it will improve the lives of tens of millions of Americans and save us and our country billions of dollars at the same time.

Published in the Seguin Gazette - March 8, 2019

Protecting A Million Texans Requires Your Vote

As if you needed another reason to make time to vote in November think about this, Texas is one of 20 states suing the federal government to take away healthcare from millions of Americans especially middle and lower income Texans. Our Republican Attorney General, Ken Paxton, joined the suit earlier this year in an effort to use the courts to do what Congress chose not to. Paxton is empowered by the fact that Republicans control both houses of the legislature and every statewide office.

The cynical ploy used by the Attorneys General is the claim that since the individual mandate was central to the Affordable Care Act, the fact that Congress repealed it invalidates the entire law. Since 1.2 million Texans are covered through plans purchased via the Exchange created by the Affordable Care Act (ACA) having the court decide in favor of killing it will endanger the lives and health of all of them. Of course it won’t have any effect on the 4.5 million Texans denied coverage by Gov. Greg Abbott’s decision not to accept the 90% federally funded Medicaid expansion.

Whether or not Democrats can beat Paxton directly by electing Justin Nelson to replace him or indirectly through electing a majority in one or both houses of the legislature and cutting his budget, it can be done. Readers have three or four ways to protect the healthcare of over a million Texans. They can vote to replace the current Attorney General with Justin Nelson who if elected will certainly withdraw from the suit. They can vote to replace the Governor with Lupe Valdez who can make it known to the legislature that she will veto any budget that continues to fund attacks on the Affordable Care Act. They can vote to replace the incumbent in the House with John Rodgers who would fight to force Paxton to drop the suit by cutting his budget. Rodgers would also demand that the state take the federal money to expand Medicaid which would not only be a boon to those 4.5 million Texans not currently insured, it would also stimulate the economy of the entire state leading to many more jobs and higher paying jobs as well. If you live in the part of Guadalupe County which is in Senate District 25 you can replace the incumbent who is widely recognized one of the worst legislators in Texas with Steve Kling.

On the federal side we have an opportunity to put a stop to Republican efforts to repeal the ACA in whole or in part by taking back one or both houses of Congress. We need to hold onto a House seat by voting for Vicente González so that in other districts where Republican incumbents are in jeopardy of losing their seats we can gain enough to achieve a majority there. This is really important as Republicans in the House are still working to undermine the ACA by any means available. They are also plotting to cut Medicare, Social Security, and Medicaid benefits claiming that they are causing a deficit; when in fact that deficit is caused mostly by the tax breaks they just gave big banks and billionaires. A Democratic House majority insures that Medicare, Medicaid, Social Security and the ACA all continue to be adequately funded.

There is also the very real possibility of replacing one of the Senate’s most unpopular members if we all get out and vote for Beto O’Rourke. If Texas voters flip that seat it will go a long way toward making it possible to win a majority in the Senate.

Vote! Vote! Vote!

Trump Incompetence Might Strengthen the ACA

For all that Republicans complain about the Affordable Care Act it has been tremendously successful in increasing the percentage of Americans covered by health insurance of one sort or another. In those states, unlike Texas, that took the Medicaid expansion funds offered very few are left without access to quality healthcare. Every year more people have learned about the availability of insurance coverage at affordable rates and signup rates continue to climb.

This year we have a Republican president who is determined to undermine the law of the land and has taken measures intended to reduce the number of Americans with health insurance. Trump has reduced the time period of open enrollment in half, to just 6 weeks, ending December 15. Possibly worse, he’s cut funding for advertising of open enrollment by 90% leaving groups that assist people in selecting and signing up for affordable, subsidized plans scrambling for ways to overcome the barriers.

A couple of weeks ago, in an attempt to overcome the lack of promotion, a small group of Democrats knocked on nearly 400 doors in Seguin handing out flyers and explaining that help is available through CentroMed and other providers both in and near Seguin. We want everyone to know that they can call one central phone number, 210-977-7997, or visit the coalition website www.enrollsa.com to make an appointment.

One of the great things about the Enroll SA coalition is even if the applicant isn’t eligible for subsidized health insurance through the Affordable Care Act the enrollment staff will check eligibility for other forms of assistance including Medicaid, CHIP (Children’s Health Insurance Program) or low cost care at community clinics.

While some of Trumps efforts to undermine the Affordable Care Act may very well have the intended effect his incompetence and that of his staff may also work against him. His executive order ending payments to insurance companies called cost-sharing reduction (CSR) subsidies. They are paid directly to insurers, and they provide financial assistance for individuals who make between 100 and 250 percent of the poverty line. Cut those subsidies off, and insurers will try to make up the difference by raising premiums. In a report on the likely effects of cutting off the subsidies earlier this year, the Congressional Budget Office estimated that premiums would be about 20 percent higher for typical plans purchased under the law.

But the joke is on Trump, as the premium hikes won't directly affect most low-income people, because Obamacare's subsidies increase with premiums, insulating those individuals from higher costs. Instead, this move is likely to raise premiums for people who earn too much to qualify for subsidies under Obamacare, the people who have already been hit hardest by the law's price hikes.

There are some reports of insurers offering plans with premiums in the range of $0-10 for those who are eligible for subsidies so if a member of your family or your friend isn’t currently insured be sure to let them know that now might be the best time of all to apply for coverage. Give them the phone number 210-977-7997, or help them visit the coalition website www.enrollsa.com to make an appointment. The great folks at CentroMed on County Line Road in New Braunfels as well as some organizations right here in Seguin can help anyone find out how to get covered.

Published in the Seguin Gazette - November 17, 2017

It's Not About Healthcare, It's About Campaign Contributions

Once again the Republican Party is leading the charge to take away access to health care from 30 million or so Americans. The leadership is attempting to rush the bill through with minimum scrutiny in order to meet a September 30 deadline for acting with only Republican votes.

When eight months and countless hours of hearings in multiple committees in both the House and Senate had been held prior to the vote on the Affordable Care Act Republicans screamed that the bill was being voted on before anyone knew what was contained in it. Now that Republicans control congress their efforts to take away health care from tens of millions of Americans, 11 million of whom are so poor they qualify for Medicaid, there will be only one hearing and it will be in the Homeland Security Committee which has never held a hearing on healthcare or much of anything else that isn’t about security from terrorism. There will be no witnesses testifying other than the senators who developed the legislation, so no one will hear from health policy experts or the people who will be affected. Make no mistake about it, this is a backroom deal and the goal is to give tax breaks to millionaires and billionaires who don’t need or deserve those breaks.

Unlike Texas, about half the states accepted federal funds and expanded Medicaid. Some of those states are represented by Republican Senators that have already stated that they will vote to take away that funding. Just eliminating Medicaid expansion means 11 million Americans will lose their healthcare. Sure they can still go to an emergency room when they’re really sick or injured but that treatment only covers stopping them from dying right then it doesn’t cover prescription anti-biotics or blood pressure medicine and it doesn’t cover follow up care to insure that a wound hasn’t become infected.

Even Republican governors like John Kasich of Ohio and Bill Walker of Alaska oppose the repeal because they know that doing so will hurt their constituents. Walker is seen as key to getting the bill passed this time as he’s believed to have influence over Sen. Lisa Murkowski, one of the three Republicans to vote no last time.

You’d think that at least some Republican Senators might shy away from voting for something that will hurt their constituents so severely but what you don’t know is that a network of wealthy donors has made repeal of the Affordable Care Act and the tax breaks that depend on it a condition of them providing $300 million to $400 million for the 2018 election cycle. In other words no tax breaks, no campaign donations. If Congress fails to repeal the network, led by the Koch brothers, will likely spend much of those funds on primary challengers and make an example of those Republicans who stood in the way.

That’s the problem with our campaign finance system; it’s obvious that these wealthy donors expect to get what they want for their money and just as obvious that our elected leaders are willing to give it to them but it isn’t illegal, even though it is antithetical to a healthy democracy.

 Published in the Seguin Gazette September 22, 2017

Are We Terrorists or Christians?

In 2001 the entire country was up in arms after the attack on 9/11 that killed nearly 3,000 Americans. Thousands of people, rich and poor, teenagers and 30 somethings volunteered to join our military and risk their lives in order to take the battle to the terrorists.

This week the Congressional Budget Office reported that the Senate healthcare bill will cause 22 million Americans to lose their health insurance. We know from studies done after the release of the similar House bill which causes 23 million to lose their insurance that between 10,000 and 30,000 of those folks will then die unnecessarily.

Even taking the low number that’s more than three times as many people dying every year than who died in the 9/11 attack. We went to war over that attack. We spent trillions of dollars to fight that war on the basis of preventing another attack. Yet now, 16 years later, our elected leaders are willing to allow 10,000 mostly poor people to die every year in order to give rich people a tax break. Not only that but thousands more will go bankrupt, losing their homes and everything they’ve ever worked for.

How are we any better than the terrorists if we lie down and take it when the Donald Trump and his Republican enablers in Congress deny children healthcare simply because their parents are too poor to pay for it? How are we better than the terrorists if we accept that grandmothers will be turned out of the nursing homes that provide the medical care they need because their families don’t have the resources to pay for it? How are we any better than the terrorists if we continue to allow sick people to suffer and die to save a few dollars on our taxes?

I frequently hear claims that this is a Christian nation most often by some Republican elected official. If you believe that, how to you reconcile that with denying hardworking people and their families life saving healthcare? I can’t make that connection because the nuns who taught me at St. Lawrence the Martyr and the brothers who taught me at Archbishop Rummel made it very clear that “when you did it to one of the least of these my brothers and sisters, you were doing it to me!"

The majority of Americans don’t want what John Cornyn wants to pass of on us. We disagree with Ted Cruz that the bill isn’t tough enough. Most Americans want something better than the Affordable Care Act not something worse. There is a better replacement available that most Americans do support. The replacement is called Medicare for All, or single payer. Medicare could be everyone’s health insurance plan whether a new born or a great-grandmother, sick or healthy, rich or poor. It wouldn’t matter if got cancer after the company you worked for went out of business or moved the factory to China because your health insurance wouldn’t be attached to your employer. You’d never be in the situation where you or your child got sick when you didn’t have insurance.

If America is really a Christian nation shouldn’t we start acting like one?

Guadalupe Rallies to Defend the ACA/Medicaid/Medicare

Last Saturday more than 80 area residents rallied at the Guadalupe Regional Medical Center on E. Court Street in support of maintaining the Affordable Care Act, Medicaid and Medicare. The group acted because of the threats to those programs posed by actions of the Republican controlled Congress. Republicans have begun the process of repealing the Affordable Care Act. They’re also working to turn Medicaid into straight block grants to the states and convert Medicare to a voucher system.

The goal of the event was to send a message to newly elected Congressman Vicente Gonzalez that many of his constituents rely on various parts of our current healthcare insurance system and drastic changes will be unwelcome. Doctor Sarah Typhair held a sign stating “This M.D. proudly supports the A.C.A.” Many in attendance have children or grand-children covered through the provision that allows them to stay on their parents insurance until age 26. Some rely on the fact that A.C.A. forced insurers to drop the lifetime cap that meant people like my wife who have had multiple serious health issues no longer lose coverage after $1 million dollars of healthcare.

Congressional Republicans have been using the phrase “Repeal and Replace” for quite a while now so you’d think they’d have most of the details figured out but you’d be wrong. While Republicans have the repeal part down they can’t agree on the replace part at all. The Congressional Budget Office analyzed one of the more widely accepted proposals and found that if enacted it would increase deficit spending by $171 billion or force a 26% cut in the subsidies available to those who get their insurance through the exchange meaning that many would once again find health insurance unaffordable.

Turning Medicaid into a block grant is sure to fix the number of dollars spent and therefore further limit the number of people who benefit from it. Texas has the highest rate of uninsured in the nation at 17% due to Governor Greg Abbott’s failure to expand Medicaid which the federal government would have paid for 90%. That’s 4.6 million Texans whose only option for healthcare is the emergency room and no follow up care or prescription coverage. Converting to block grants means our rate of uninsured will climb higher still.

The proposal to convert Medicare to a voucher program would mean that seniors would get a fixed amount of money to use in order to purchase health insurance on the private market. There are a host of problems with that not the least of which is insurers don’t want to insure seniors in the first place because of their numerous and expensive health problems. Another problem is that there’s no guarantee that the voucher would cover the entire cost of the insurance premium so those seniors who are already struggling to pay their bills or for their prescriptions will have an even greater costs shifted onto them.

Rally participants urged Congressman Gonzalez to come out strong as a defender of the Affordable Care Act, Medicaid and Medicare. Every there understands that those programs aren’t perfect but the Trump Republican proposals to abolish or dismantle them are moves in the wrong direction. Gonzalez would do well to become a champion for improving those programs.

Published in the Seguin Gazette March 3, 2017