ACA Open Enrollment

It’s that time of year again when people without employer provided health insurance can sign up for a plan on marketplace provided under the Affordable Care Act, also known as Obamacare. Open enrollment started November 1 and runs until December 15. Donald Trump with help from congressional Republicans has made it harder for people to sign up by reducing the open enrollment period and cutting funding for promotion and assistance it’s still possible to find help if you need it.

Healthcare.gov has links to local assistance providers as well as renewing or updating your existing plan. While Trump has been messing with the financing he managed in some ways to accidentally lower the premium in some cases. In Guadalupe County a 40 year-old making $20,000 a year can get a Gold level insurance plan for just $32 a month or a Bronze plan for $0. If that 40 year-old earns $35,000 a Gold plan will cost them $223 a month or $105 a month for a Bronze plan. Gold level plans have lower deductibles than bronze or silver plans.

Previously I’ve spoken to folks who help people sign up for Obamacare plans and they told me that while some folks don’t qualify for the subsidies that get the premiums so low they also find people who qualify for Medicaid or their children qualify for CHIP and don’t know it so they help them sign up for that. If you know someone without health insurance now is the perfect time to help them contact Seguin Community Health Center at 1104 Jefferson Street, Seguin, phone number (830) 379 – 9797 for assistance in applying.

There are roughly 5 million Texans without health insurance or nearly 18% of the state population. Texas has both more people uninsured as well as a higher percentage of uninsured of any state in the country. Approximately 1.25 million Texas children under 18 are among those uninsured.

A study done by the Texas Alliance for Health Care., shows the lack of health insurance would cause hardships for hospitals, physicians, and ordinary Texans.

Among the study’s findings: In 2016, the cost of lower lifetime earnings and worse health for uninsured Texans was $57 billion. Barring any change in policy, that cost will rise to $178.5 billion by 2040. The $3.5 billion price tag for hospitals and physicians who provide unsubsidized and uncompensated care in 2016 will rise to $12.4 billion by 2040 without a change in policy. The value of lost earnings and poor health due to lack of health insurance in Texas is estimated to be $178.5 billion in 2040 (or $74 billion in 2016 dollars).

Speaking of uncompensated care, Texas is seeing a rash of closures of rural county hospitals primarily due to funding shortfalls caused by the state failing to accept Medicaid expansion. You can thank, our state representative John Kuempel and Governor Greg Abbott for that.

All the Democratic candidates for president are talking about how they plan to fix this nation’s health insurance mess. Bernie Sanders and Elizabeth Warren offer sweeping plans that would take Medicaid and CHIP out of the hands of the state and make sure every American has health insurance. Consider that when listening to all the candidates as you decide who to support in the March primary.

Published in the Seguin Gazette - November 13, 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

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

“Hands off Obamacare, Medicaid and Medicare”

On Sunday afternoon more than 20 people from New Braunfels and other parts of Comal County rallied in support of the Affordable Care Act, Medicaid and Medicare outside Congressman Lamar Smith’s office. All the participants are worried that access to healthcare will be lost for themselves or family members or friends if Republicans in Congress pass legislation to dismantle the Affordable Care Act without even having a replacement for it.

It is widely understood that the Republican plan to convert Medicare to a voucher will jeopardize the health and lives of many seniors. The problem is there is no guarantee that they’ll be able to acquire comparable insurance even with higher premiums since many of those on Medicare are much sicker than the average population. Since insurers make their profits by avoiding the sickest people some will find healthcare unattainable.

Don’t forget that a significant fraction of Medicare participants, like my wife, aren’t retirees, they’re people who are totally disabled and frequently unable to acquire health insurance on the individual market at any price. Even the Texas high risk pool didn’t want her and pushed her off to Medicare.

Let’s not forget about Medicaid, Texas Republicans have already cut reimbursement rates for some of the most vulnerable children in Texas. Now those children can’t get the physical therapy and other services they need to be even remotely healthy or self sufficient.

Lamar Smith needs to be told “Hands off Obamacare, Medicaid and Medicare”.