GOP Health Care Proposal Pulled at Last Moment

Published in Woonsocket Call on March 26, 2017

Days ago, unified Democratic lawmakers combined with a deep philosophical wedge between the conservative House Freedom Caucus and moderate Republicans over policy details of the American Health Care Act (AHCA), forced the Trump Administration and House Speaker Paul Ryan to pull the AHCA proposal minutes from a floor vote to steer it away from a humiliating legislative defeat last Friday. Interestingly, the seventh anniversary of President Barack Obama signing the Affordable Care Act (ACA), his signature health care law, took place one day before the House vote.

A day before Friday’s scheduled vote to dismantle and repeal Obama’s ACA, President Donald Trump taking a high-risk negotiation tactic straight out of his bestselling book, “The Art of the Deal,” gave a late-Thursday night ultimatum to the House GOP lawmakers. Trump told to them to vote up or down on AHCA or he would be prepared to move on to other legislative agenda items.

As to Trump’s ultimatum to GOP House lawmakers, CNN Presidency Historian Timothy Naftali noted on CNN Newsroom with Fredricka Whitfield, “He played chicken and he blinked.”

House GOP Making Legislative Sausage

In a report issued on March 13, the Congressional Budget Office (CBO), detailed the drastic impact of the initial AHCA legislative proposal. CBO, a federal agency that provides budget and economic information to Congress, found that AHCA would result in 24 million losing health insurance coverage by 2026, Medicaid would be cut by $880 billion over the next ten years, and premiums and out-of-pocket costs would skyrocket increase, particularly for older adults and individuals with lower incomes.

Earlier this week, on Monday, Ryan and his House GOP Leadership team made eight amendments to AHCA to pull in skeptical GOP moderate and conservative lawmakers, including the controversial speeding up tax cuts while whittling down the Medicaid program. Later, on March 23, CBO confirmed that these amendments would lead to essentially the same level of coverage losses, about 24 million people and cost increases for individuals and would yield $187 billion less in savings than the original GOP health care proposal.

Meanwhile, on Wednesday, Senator Wyden and Congressman Pallone revealed that the Center for Medicare & Medicaid Services’ independent Actuary “estimated that the repeal of the tax on prescription medications, known as the ‘pharma fee,’ beginning January 1, 2017 would increase Medicare Part B premiums by $8.7 billion through fiscal year 2027.” noted the Center for Medicare Advocacy.

On Thursday, three more amendments were offered to sway GOP House critics. One would strip the requirement that insurance companies cover essential health benefits (EHB). This amendment would effectively eliminate annual out-of-pocket caps, reinstate annual and lifetime coverage limits, and gut protections for pre-existing conditions. Another would delay – but not remove – the Medicare payroll tax cut that will undermine Medicare’s financing and its future stability.

After the defeat of AHCA, Trump blamed the Democrats for the House GOP’s failure to pass its health care proposal to scrap Obamacare. “The Democrats were not going to give us a single vote,” he said, warning that “Obamacare will explode” forcing the opposition party back to the negotiation table to craft a better health care law.

House Speaker Ryan also noted that “We are going to be living with Obamacare for the foreseeable future.”

“We just really did not get a consensus today,” say Ryan. “That’s why I thought the wise thing to do was not proceed with a vote but to pull the bill. When asked if he was going to try “to prop it up, Ryan responded by saying “it is so fundamentally flawed, I don’t know that that is possible.”

Sighs of Relief from Aging Groups, Democrats

“The American Health Care Act is not American in spirit or health care in substance. In fact, it’s a tax cut bill for the wealthy, not a health care bill for the people. It will make America sicker. Congress should reject this charade and this disaster of a bill today,” states Judith Stein, Executive Director of the Center for Medicare Advocacy.

“The House Congressional leadership was destined to lose on their disastrous American Health Care Act, which would have effectively repealed Obamacare and hurt seniors, including beneficiaries of Medicare and Medicaid. It doesn’t matter whether they pulled or failed to pass the bill,” says Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare in a statement. “It needed to go down and we thank the millions of National Committee members and supporters – and those of other senior advocacy organizations – whose protests were loud, numerous, and furious.”

“No one knew’ that health care could be so complicated. Hopefully, he has learned a lesson… that health legislation is built on a complex foundation that considers the real human needs – and costs – of changes to the system. A common refrain from Donald Trump during the campaign was, ‘What do you have to lose by electing me?’ Now we know what’s at stake: affordable health care for older Americans, Medicare, and Medicaid,” says Richtman.

“The leadership’s decision to withdraw the bill from consideration proves that the voices of Americans are very powerful. This harmful legislation would have added an Age Tax on older Americans and put vulnerable populations at risk,” says AARP Executive Vice President Nancy LeaMond, in a statement.

LeaMond calls on Congress to focus on the issues important to older Americans and their families, including: protecting and improving Medicare’s benefits and financing; providing access to affordable quality coverage; preventing insurers from engaging in discriminatory practices; lowering prescription drug costs; providing new incentives to expand home and community based services; and strengthening efforts to fight fraud, waste, and abuse.

Adds, Justice in Aging Executive Director, Kevin Prindiville, “Congress tried to rush this disastrous bill through Congress without regard for the health and safety of older Americans and their families, and such a bill cannot and should not be revived. Older adults and their families rely on Medicaid and Medicare and these programs must be protected.”

Compromise might well be the way to make sound changes to the nation’s health care law, says Rep. David N. Cicilline (D-RI), who serves as House Democratic Policy and Communications Committee. “The Affordable Care Act is a good law, and Republicans and Democrats should be working together to make it even better. If Republicans ever decide to come to the table, we should work together to increase competition, expand coverage, and bring down premiums. That’s a decision that Republicans have to make – whether to work with Democrats or continue down the path they’re on,” he says.

Rep. James Langevin (D-RI) also stresses the importance of reaching over the aisle to create a better health care law and getting away from partisan bickering. “It’s time for Republicans to move on from their misguided crusade to dismantle the ACA. The health care law has brought insurance coverage to millions of Americans. Its consumer protections, premium assistance, essential health benefits, and countless other provisions that were at risk of elimination have improved our nation’s health and saved lives. We must work together in a bipartisan manner to strengthen and improve the ACA, not risk the health and wellbeing of everyday Americans for an empty, partisan victory,” he says.

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House GOP Leadership Puts its Health Care Proposal on Fast-Track

Published in Woonsocket Call on March 12, 2017

After years of calling for the dismantling of Obama’s signature health care law, the 2010 Affordable Care Act (ACA), dubbed Obamacare, an emboldened GOP controlling both the White House and two chambers of Congress, began legislative efforts to substantially change the way the federal government subsidizes health coverage for millions of Americans and puts the brakes on Medicaid expansion that extended coverage to millions more.

On March 6, House Speaker Paul Ryan (R-Wis), with the blessing of President Donald Trump, began his legislative efforts to enact the House GOP’s 123 page health care proposal, the new American Health Care Act (AHCA). Democratic lawmakers and aging groups charge that the AHCA lacks a fiscal estimate from the bipartisan Congressional Budget Office as to how many people will lose their health insurance coverage as a result of the bill or how much it will cost.”

According to rating agency S&P Global Ratings, between 6 million and 10 million people could lose health insurance coverage if the GOP’s health care proposal to “repeal and replace” Obamacare passes. Specifically, there would be a decline in enrollment in the individual health insurance plan market of between 2 million and 4 million people. There would also be a decline of between 4 million and 6 million people in the nation’s Medicaid system after 2020 to 2024, says the recently released analysis.

GOP Health Proposal on Fast-Track

Just hours after AHCA was introduced early in the week, the House Energy and Commerce Committee and Ways and Means Committee began holding markups on their specific portions of the GOP’s health care proposal. After deliberating for almost 18 hours the Ways and Means approved its portion by a vote of 23-16, along party lines. After a marathon 27-hour markup session, the AHCA proposal was approved by the second House panel, Energy and Commerce Committee, by voted 31 to 23, by party line, too. Next week, the House Budget and Rules committees is expected to take up the GOP health care proposal, with a full House floor scheduled for the week of March 20. It has been reported that Ryan hopes to have a bill to President Trump for signature before April recess.

“Obamacare is rapidly collapsing. Skyrocketing premiums, soaring deductibles, and dwindling choices are not what the people were promised seven years ago. It’s time to turn a page and rescue our health care system from this disastrous law,” said House Speaker Ryan in a statement released when AHCA was thrown into the legislative hopper.

Ryan asserted that the GOP health care proposal would “drive down costs, encourage competition, and give every American access to quality, affordable health insurance. It protects young adults, patients with pre-existing conditions, and provides a stable transition so that no one has the rug pulled out from under them.”

The GOP health care proposal would keep two of the most popular provisions of Obama’s ACA, specifically providing health care coverage to people with pre-existing conditions (though insurers would be allowed to charge higher premiums to individuals with lapsed health care coverage) and allowing children to stay on their parents’ health plans until the age of 26.

But, the GOP’s efforts to repeal and replace Obama Care has brought aging groups together to put the brakes on House passage.

Aging Groups Come Out Swinging

Seniors’ advocates object to the ACHA’s impact on federal programs that provide both healthcare and long-term care to retirees. The bill rescinds an 0.9% tax on upper income earners’ wages, which had been used to extend the solvency of Medicare until 2028. Removing the tax decreases Medicare’s solvency by four years, which could lead to benefit cuts down the road. Advocates also decry the age-rating provisions in the repeal bill, which would allow insurers to charge older Americans up to five times as much for premiums as younger enrollees pay. The $4,000 tax credits for near seniors (aged 50-64) which replace Obamacare subsidies won’t make a dent in the premiums that this age group will pay under the GOP plan. Older Americans who can’t afford insurance will then arrive at the threshold of Medicare less healthy, putting additional strain on the system.

“This legislation is a triple whammy for seniors. It’s bad for Medicare beneficiaries, bad for near seniors, and bad for the Medicare program,” says Max Richtman, President and CEO of the Washington, D.C.-based National Committee to Preserve Social Security and Medicare.”

Richmond is especially alarmed that the AHCA also makes radical changes to the Medicaid program. The bill cuts $370 billion from Medicaid over 10 years by imposing “per capita caps,” meaning that states will get a fixed federal payment per beneficiary instead of the guaranteed match they now receive. Those fixed payments will not be able to keep pace with rising healthcare costs, leaving the states with significant shortfalls. “Millions of seniors rely on Medicaid for skilled nursing care, both in the home and at community-based facilities. The cut in federal payments will compel states to remove seniors from Medicaid rolls or radically reduce benefits, forcing them and their families into poverty.”

Following the release of the GOP’s AHCA, the Washington, D.C.-based AARP, the nation’s largest advocacy group representing over 37 million members, came out swinging. The GOP legislative proposal would weaken Medicare, leaving the door open to a voucher program that shifts costs and risks to seniors, warned AARP Executive Vice President Nancy LeaMond in a statement.

“Before people even reach retirement age, big insurance companies would be allowed to charge them an age tax that adds up to thousands of dollars more per year. Older Americans need affordable health care services and prescriptions. This plan goes in the opposite direction, increasing insurance premiums for older Americans and not doing anything to lower drug costs, noted LeaMond.

LeaMond charged, “On top of the hefty premium increase for consumers, big drug companies and other special interests get a sweetheart deal. “Finally, Medicaid cuts could impact people of all ages and put at risk the health of 17.4 million children and adults with disabilities and seniors by eliminating much needed services that allow individuals to live independently in their homes and communities.”

“Although no one believes the current health care system is perfect, this harmful legislation would make health care less secure and less affordable,” says LeaMond, noting that her nonprofit aging group will work with either political party to hammer out a health plan that “puts Americans’ health care first, not the special interests.”

Adds Judith Stein, executive director of the Center for Medicare Advocacy in a statement, “the proposed AHCA would also gut key financing mechanisms of the Affordable Care Act that would amount to tax cuts for the wealthy – by some estimates, by hundreds of billions of dollars. Regrettably, these tax cuts include provisions that would jeopardize Medicare’s financial stability. “We fear such cuts will lead to renewed calls to ‘save’ Medicare by privatizing it for future generations,” says Stein.

According to the Center for Medicare Advocacy’s statement, the proposed GOP legislative proposal would dismantle key structural supports of ACA, including eliminating the employer coverage mandate and the individual mandate to obtain health coverage, and instead would impose a 30 percent penalty for lapses in coverage. Instead of the ACA’s subsidies that make health coverage more affordable for millions, the new legislation would offer age-based tax credits ranging from about $2,000 to $4,000 – likely insufficient to pay for meaningful insurance coverage.

The Medicare Advocacy Group also warns that older Americans needing health insurance coverage before becoming Medicare eligible would also be hit hard by the proposed AHCA. The ACA’s protection of older adults that prevents insurance companies from charging no more than three times the premium amount charged of younger individuals (a 3:1 ratio) would be replaced by a higher 5:1 ratio – this dramatically increasing the premium amount insurance companies can charge older adults. Critics call this change an “age tax.”

Finally, the Republican’s AHCA would also phase out ACA’s expansion of Medicaid starting in 2020, structurally reforming virtually the entire Medicaid program (including Medicaid expansion). These changes would have a devastating impact on providing health care by capping federal Medicaid payments to each state to a limited, preset amount per person (often referred to as a “Per Capita Cap”).

Could Political Backlash Happen with Passage of AHCA?

Last Thursday, Ryan, with sleeves rolled up, urged GOP lawmakers to back AHCA, promising tweaks to address Republican conservatives’ concerns. At the 23 minute news conference, Ryan said: “This is the closest we’ve been to repealing and replacing Obamacare and it’s the closest we will ever get to repealing and replacing Obamacare.” It is either voting for the House bill, or let ACA survive, he said.

President Trump also chimed in to the AHCA debate, too, by calling for the controversial health care proposal’s enactment in an afternoon tweet. “Despite what you hear in the press, health care is coming along great. We are talking to many groups and it will end in a beautiful picture!,” he tweeted.

As the Congressional April recess approaches opposition to AHCA is building as physician, nurse and hospital groups warn that the legislative proposal’s enactment will take health care coverage away from millions of Americans. While Democratic and progressive organizations oppose ACA’s passage, too, a growing number of GOP lawmakers and conservative groups, from the Cato Institute, Americans for Prosperity and Tea Party Patriots, are expressing their concerns.

Days ago, Andrev Ostrovskv, chief medical officer for Medicaid at the Baltimore, Maryland-based Centers for Medicare and Medicaid based, risking the wrath of Trump’s political appointees in his federal agency, tweeted his displeasure and opposition. “Despite political messaging from others at HHS [Health and Human Services], I align with the experts from @aafp @AmerAcadPeds @AmerMedicalAssn in opposition to #AHCA,” he tweeted. Dr. Ostrovskv’s agency oversees the administering of Obamacare.

Even if the GOP House Leadership are able to address conservative lawmaker concerns, one being AHCA does not require an earlier halt to Medicaid expansion enrollment, the GOP’s health care proposal appears to have a rocky road to travel in the upper chamber. Senate. Republications, having just a 52-48 slim majority, can only lose two votes.

Says Senator Tom Cotton (R-Arkansas) in a tweet to House GOP Leadership: “ House health-care bill can’t pass Senate w/o major changes. To my friends in House: pause, start over. Get it right, don’t get it fast.”

With the popularity of Obamacare the GOP’s death wish to repeal and replace the law may well be hazardous to the Republican Party’s political health. We’ll find out for sure in the mid-term elections.

New Budget Deal Protects Seniors’ Pocketbooks

Published in Woonsocket Call on November 1, 2015

Just days after a Republican-controlled House passed legislation with a vote of 266-167 to prevent the U.S. government from going into default on its debt obligations on Nov. 3, also averting a potential federal government shutdown next month, on Friday, Oct.30, the Republican-led upper chamber followed suit.  Just after 3:00 a.m., the Senate voted 64-35 to approve a two-year bipartisan budget plan sending the bill to President Obama for his signature.

Before Friday’s Senate vote, on Thursday afternoon GOP Presidential contender Sen. Rand Paul (R-Ky.)’s 20 minute filibuster fizzled, with Senate leadership moving forward for the budget bills consideration.  The measure had strong support for passage.  Retiring House GOP Speaker John Boehner with Congressional leaders from both political parties and President Barack Obama pulled together, putting aside differences, to craft the bill.

.           Before the companion legislation was taken up by the House and Senate, in a statement AARP CEO Jo Ann Jenkins, representing 38 million baby boomers and seniors, called on Congressional leaders and their members to support the bipartisan agreement, one that financially protect older Americans.   Jenkins detailed a number of provisions within the 144 page bill that would “reduce skyrocketing Medicare Part B premiums and alleviate the challenges faced by the Social Security Disability Insurance (SSDI) Trust Fund.”

Rhode Island Lawmakers Give Thumbs Up

U.S. Senator Jack Reed (D-RI), called the bipartisan budget agreement “a credible compromise,” noting that “It is only a two-year patch, but it puts us on a much better path forward.   Reed, who sits on the powerful Appropriations Committee, called on the House and Senate Appropriations committees to “quickly reach consensus and produce a detailed omnibus spending package by the Dec. 11 deadline.”

“This budget deal will provide much-need relief from harmful sequester cuts and give the nation a measure of certainly we have lacked amid the patchwork of stop-gap spending bills in recent years,” added U.S. Senator Sheldon Whitehouse (D-RI).

Whitehouse noted the bipartisan budget deal provides “much-needed relief from harmful sequester cuts and gives the nation a measure of certainty it has “lacked amid the patchwork of stop-gap spending bills passed in recent years.”

With 37,000 Rhode Islander’s relying on the SSDI program it was easy for Representative David Cicilline (D-RI) to support the bipartisan compromise budget plan because it “prevents a 20 percent cut to SSDI benefits and extends the solvency of this critical program an additional seven years, as well as protecting thousands of Rhode Island seniors from an increase in their Medicare premiums.”

“We need to do more to protect Social Security benefits for seniors, ensure cost-of-living adjustments are calculated in a way that accounts for their needs, and lift the cap on payroll taxes so millionaires and billionaires pay their fair share,” said Rhode Island’s Democratic Congressman.

On the side line, aging advocates were also closely watching the action in both chambers, too.  “We are glad that the Budget passed by Congress this week lets people who rely on Medicare breathe a bit easier – knowing their premiums and deducible will not skyrocket next year,” said Judith Stein, founder and executive director of the Center for Medicare Advocacy. “However, we still have concerns about the way in which the Part B cost-sharing resolution is paid for, and concerns about the expenses underlying the original Part B increases.”

“The Center continues to urge law-makers to join Congressman Courtney (CT-2) in asking Secretary Burwell to investigate and fix the underlying reasons for the huge increase in Part B costs,” said Stein. “Much of the increase seems to come from parallel increases in billing inpatient hospital care to Part B – which was never meant to pay for such care – through the use of so-called ‘outpatient’ Observation Status.”

Older Americans Protected by Enacted Budget Plan

The Bipartisan Budget Act of 2015 would raise the nation’s debt ceiling through March 2017, allowing the government to borrow to pay its debt. During these two years it allow Congressional lawmakers to lift budget caps for defense and domestic programs by $80 billion.

The passed budget plan derails a 52 percent Medicare Part B premium increase to 30 percent of beneficiaries, which would have hit millions of seniors in their wallets next year. Similarly, the deductible was projected to increase for these individuals to $223 next year.  But thanks to the budget agreement passed this week, the deductible will instead have a more modest increase from the current amount of $147 to approximately $167.

A general fund loan to the Medicare trust fund lessens the premium and deducible increases. Beneficiaries will repay this loan by a $3 per month premium surcharge over a five-year period.

According to the enacted budget plan, next year, only the 30 percent of the beneficiaries hit by the premium increase would pay this $3 premium surcharge.  In 2017 and beyond, all Medicare beneficiaries not subject to the hold harmless provision in a given year would pay a $3 monthly surcharge theoretically until the general fund loan is repaid..

The federal Centers for Medicare and Medicaid Services is expected to announce final premiums for 2016 by the beginning of November.

Keeping SSDI Afloat

The enacted budget plan also prevents a 20 percent cut in Social Security Disability Insurance (SSDI) benefits that would have occurred in late 2016 impacting 11 million recipients nationwide.  The enacted law now ensures at least 7 years of certainty that SSDI will pay full benefits.  Now, the passed budget measure “reallocates” a small percentage of the Social Security payroll tax to the SSDI program.  This has occurred 11 times.  But, GOP lawmakers have blocked recent efforts to transfer funds as a bargaining chip to force Congress and the Obama Administration to make cuts to Social Security benefits.

The new law would also tightens up the SSDI review process by requiring a physician or psychologist to review applications before a decision is made.  It ensures that application reviews are uniform nationally.  Finally, it requires the Social Security Administration to reject medical evidence presented in a disability application that was provided by “unlicensed” or “unsanctioned” physicians.

It also attacks Social Security fraud and abuse by providing additional funding to contact case reviews ensuring the applicants are entitled to the benefits, improves the fraud-fighting capacity of the SSA’s Office of Inspector General and increases penalties for those physicians, lawyers, translators who perpetuate fraud.

Finally, the bipartisan budget agreement closes loopholes in the current SSA law that allows higher-income recipients to exploit the rules for applying for benefits, with the goal of receiving large pension checks than Congress intended, and which most retirees are able to receive.

The savings made in the Social Security and SSDI programs remain in the Social Security trust funds and can only be used to pay for future benefits.

With Representative Paul D. Ryan now becoming the 62nd speaker of the House, the nation waits to see if the Wisconsin lawmaker has the special political skills to rein in the ultra-conservative wing of his party.  With only 374 days before the upcoming 2016  presidential and congressional elections America’s federal lawmakers must begin to work together to craft laws that will enhance the quality of life of the nation’s retirees.  Compromise is not a dirty word to those residing outside the Washington, DC beltway.  Gridlock is.