Three GOP Senators Derail ‘Skinny’ Repeal Maneuvers

Published in the Woonsocket Call on July 30, 2017

After seven years of vowing to repeal and replace President Obama’s Affordable Care Act, nicknamed Obamacare, Congressional GOP efforts went down in flames on Friday when Sens. John McCain, of Arizona, Susan Collins of Maine, and Lisa Murkowski, of Alaska, voted nay in supporting the Senate Republican’s “skinny” repeal bill.

Sen. McCain, giving his no vote with a thumb down gesture, left Republican Senators gasping and Democratic Senators clapping. The 80-year old Arizona Senator, recently diagnosed with an aggressive brain cancer, had flown back to vote. The Senator’s vote was considered the decisive vote to derail the GOP’s long-time efforts to repeal and replace Obamacare.

Senate Republicans Begin Efforts to Repeal Obamacare

On July 25, GOP leadership began its efforts to begin debate on the Senate health care bill to repeal AHA. On that Tuesday afternoon, the Senate passed a “motion to proceed” vote by 51-50, the deciding vote being cast by Vice President Mike Pence. The votes outcome allowed the upper chamber to begin debate on the Senate Republican’s Obamacare repeal-and-replace proposal. Sens. Collins and Murkowski had opposed this motion, but McCain, returning to Washington, D.C. after being diagnosed with brain cancer, voted yes to proceed with the debate.

Senators began a 20- hour period of debate, considering various amendments to the House version of the health care bill. By a vote of 43 to 57, the Senate rejected one version that included Sen. Ted Cruz’s (R-TX) controversial amendment that would have allowed those with pre-existing conditions to be separated into plans with much higher premiums. The Senate also rejected, by a vote of 45 to 55, another version that would have repealed the ACA with no replacement but with a two-year delay, giving GOP senators more time to create their replacement.

Late Thursday evening, GOP Senate leadership finally unveil its expected “skinny” repeal bill, formally called the Health Care Freedom Act, that would repeal ACA’s individual and employer mandates, temporarily repeal the medical device tax, and give states more flexibility to allow insurance that doesn’t comply with Obamacare regulations.

CBO’s analysis of the “skinny” repeal bill, estimated that 15 million more people would be uninsured next year than under Obamacare, with 16 million more in 2026, and that premiums would increase 20 percent next year, compared to current law.

Earlier that day, Sen. McCain and Republican Senators Lindsey Graham of South Carolina and Ron Johnson of Wisconsin, held a news conference threatening to oppose the “skinny” repeal bill if the House Speaker did not offer sound guarantees that the House would enter negotiations after the Senate passed it. They feared that the House would end up passing “the skinny bill” rather than a more comprehensive bill hammered out in conference committee.

Ryan’s carefully crafted statement to the concerned Senators that the House would be willing to go to a conference committee did not include a specific guarantee that the House would not vote on the Senate’s proposal. Both Graham and Johnson went on to vote for the legislation. But, after his surprising vote it seems that McCain still had his concerns.

Before the Senate vote, President Trump even tweeted his displeasure of Murkowski’s opposition, her no vote against debating Obamacare repeal, says the Alaska Dispatch News. The state’s daily newspaper reported that Interior Secretary Ryan Zinke called the state’s Senators, Murkowski and Dan Sullivan, to inform them that Murkowski’s vote would “put Alaska’s future with the administration in jeopardy.”

After Zinke’s call, “Murkowski, who chairs the Senate and Natural Resources Committee, sent a message back to the Interior Secretary and Trump. Overseeing the agencies confirmation process, a committee hearing on nominations to the Interior and Energy departments, was “postponed indefinitely” with no reason given, stated the Alaska Dispatch News.

Finally, early Friday, by a vote of 49-51, Senate Republicans failed to repeal Obamacare with three Republican senators — McCain, Collins and Murkowski – joining 48 Democrats to vote against the “skinny” repeal bill. Sen. McCain’s reputation as a political maverick was evident when he voted against GOP Senate leadership. But, this vote will be considered his political legacy.

A Sigh of Relief

Reacting to the defeat of the Senate’s ‘skinny’ repeal bill, AARP Executive Vice President Nancy LeaMond, in a statement, called the vote “a victory for Americans age 50-plus.”

“The ‘skinny’ bill the Senate defeated would have dramatically increased health care costs, caused millions to lose their health coverage, and destabilized the insurance market,” says LeaMond.” She also thanked Senators Collins, McCain, and Murkowski, Senate Democrats and Independents who “called, emailed, rallied and wrote to object to this seriously flawed bill.”

Max Richtman, President and CEO of the National Committee to Preserve Social Security, in a statement stated, “Senators Susan Collins, Lisa Murkowski and John McCain were under extreme pressure from the White House and their colleagues to vote with the party instead of voting for the American people. It’s important to applaud them for stopping this train wreck of a healthcare bill. We have to wonder, however, why other Senators were willing to put their constituents at risk by cutting off their healthcare coverage.”

“We urge the majority party to put raw politics aside and work with Democrats to improve the Affordable Care Act in a way that benefits millions of American families in both blue states and red states. Let’s move forward, not back,” said Richtman.

A Bipartisan Approach

President Trump and Congress must finally listen to listen to their constituents to create policies to bring health care coverage to those in need. It is time to put politics aside and work in a bipartisan manner to hammer out a viable solution to provide affordable health care insurance to millions of Americans without coverage. McCain, Collins, and Murkowski, did just that when they resisted their party’s pressure to vote their own personal conscience not party line. They believed that the bill they voted against would do more harm than good.

Obamacare can be reworked to become more cost effective and to provide more health insurance to those in need of coverage. A recently released USA Today/Suffolk University poll at the end of June says that “just 12 percent of Americans support the Senate Republican health care plan. But, “a 53 percent majority say Congress should either leave the law known as Obamacare alone or work to fix its problems while keeping its framework intact.”

The majority of America says keep Obamacare, but make it better. Hopefully, lawmakers will listen.

GOP Senators Avoid Angry Constituents During July Recess

Published in Woonsocket Call on July 9,2017

With Senate Republican leadership pulling their health care bill, titled “Better Care Reconciliation Act of 2017,” scheduled for vote before the Fourth of July recess, because they were unable find 50 votes, opponents continue their lobby against an anticipated rewrite of the unpopular Senate bill. Mobilization to oppose passage of a GOP health care bill began immediately after the House passed its legislation, titled “The American Health Care Act” in May.

“It is essential that all of those who oppose this dangerous bill have their voices heard,” said Richard Fiesta, Executive Director of the Alliance for Retired American, one of many aging groups mobilizing its membership during the Fourth of July recess. “The fact that most Republicans in the Senate are too afraid to show up in public should tell you everything you need to know. The Senate bill is dangerous to all Americans, particularly older Americans, and must be stopped,” he said.

Lawmakers Choose to Not Face Angry Constituents

Throughout the nation, thousands of constituents of GOP senators made it clear to their lawmakers returning to their home districts, “vote no on the Senate version of the healthcare bill,” that would repeal and replace President Obama’s Affordable Care Act of 2017 (ACA), popularly, called Obamacare. Opponents of Trumpcare held sit-ins (referred to as die-ins) to remind their GOP Senators that 22 million low-and medium-income Americans would lose their health coverage with the slashing of $800 billion from Medicaid, warning that there would be a significant increase in premium costs.

According to the Town Hall project, between January to May, 33 GOP senators have not held a single in person town meeting this year, these lawmakers choosing not to face angry constituents who oppose the Senate health care bill. During this 11-day recess, most Republican senators chose not to hold town meetings, most skipping their community’s Fourth of July parades, to keep away from hostile crowds.

But, Moderate GOP Sen. Susan Collins, of Maine, appeared at Fourth of July parade in Eastport, Maine and was overwhelmingly thanked for her opposition to the Senate health bill. At the parade, the Washington Post stated that spectators urged Collin’s “to stay strong” in opposing the GOP Senate’s version of the health care bill. The Post noted that only three other Republican senators, Ted Cruz, of Texas, Dean Heller, of Nevada, and Lisa Murkowski, of Alaska, also appeared in their community’s Fourth of July parades.

Seeing the Writing on the Wall

Political reality is now setting in for Senate Majority Leader Mitch McConnell, of Kentucky, who has shifted his position on repealing Obamacare if he cannot pull the 50 votes necessary to pass his health care bill. With all Democratic and Independent senators in their caucus opposing passage of the bill, GOP senate leadership can only afford the defection of two Republican senators if they want their bill to pass. Can he revise this legislation to satisfy the concerns of moderate and conservative members of his caucus to ensure passage?

The Washington Post reported, last Thursday, at a Kentucky Glasgow Rotary Club lunch, McConnell admitted to the attending Rotarians that Republicans would have to work with Democrats to stabilize the health insurance markets if they failed to pass the Senate bill.

As predicted with the GOP senators returning from recess, facing angry constituents, a growing number are now publicly withholding their support for the senate bill. At press time, there have been multiple reports that ten senators are now opposing the legislation.

“There have been little to no senator-level discussions on amendments to the Senate health bill during the July recess,” says Dan Adcock, Director of Government Relations and Policy for the National Committee to Preserve Social Security and Medicare (NCPSSM). He expects more negotiations to take place when the Senate reconvenes this Monday.

Adcock says, “there would be a delay between an announced “compromise” bill and Senator floor consideration since the Congressional Budget Office would first need time to perform a cost estimate on the amended sections of the bill.”

Senator Cruz’s Fix for Senate Health Bill?

According to Adcock, that is being most talked about in the corridors of the Capitol is Sen. Ted Cruz’s proposal to replace the existing language in Senate bill — that would allow insurance companies to pick and choose which Obamacare essential benefits they would offer — with a plan to require that insurance carriers offer at least one plan with Obamacare essential benefits and all other plans could decide which benefits to include and exclude.

But, Adcock sees a multitude of problems with the Cruz proposal, making it difficult to be inserted into a final Senate health bill.

“First, it really is not that different from the current language that allows insurance companies to offer plans without the required ACA essential benefits,” says Adcock. “Under the Cruz proposal, healthy people would enroll in health plans that aren’t required to cover all ACA essential benefits, while sick people or enrollees with pre-existing conditions would tend to enroll in plans with all of the ACA essential benefits. As a result, the latter plans would be very expensive and unaffordable for less healthy enrollees,” he says.

Adcock estimates that Texas Senator’s proposal and the Senate health bill’s essential benefits waiver provisions would be particularly harmful to the 40 percent of enrollees age 50 to 64 who have one or more pre-existing condition.

“Second, there is a good chance that the Senate Parliamentarian will rule that the Cruz proposal violates Budget Reconciliation rules because it is superfluous to reducing federal spending,” says Adcock, noting that if this happens his proposal in the form of an amendment would face a 60-vote point of order. The Senate Republicans do not have the 60 votes they need to waive this budget rule.

Another point that is being negotiated between Senate leadership and moderate and conservative senators is provisions that would restructure federal payments to state Medicaid programs, says Adcock, noting that the Senate bill and House-passed healthcare bills would restructure the way federal funding is provided to the states – changing from the current matching rate formula to per capita caps or block grants at state option.

Medicaid Cuts Hit LTC Sector

“Per capita caps limit federal funding for state Medicaid programs to an arbitrary per beneficiary funding level. This would ultimately shift costs to states by eliminating the guarantee of additional federal funds if state costs increase because of underlying health care costs, demography or complexity of care. We are particularly concerned about how these cuts would affect Medicaid long-term care coverage – both home and community and nursing home care,” Adcock added.

Adcock also sees other negatives of the draft Senate health care bill.

“From the year 2025 on, the senate bill bases the per capita cap on an even less generous measure than the House bill. While the House bill used a measure based on medical inflation, the Senate bill would allow Medicaid to grow only at the rate of general inflation. Medical inflation has historically grown at a higher rate than general inflation. And, even the index used in the House-passed AHCA would be unlikely to keep up with growth in health care costs,” notes Adcock.

Adcock added, “some moderate Republican senators object to linking Medicaid payments in 2025 and thereafter to general inflation. However, Sen. Pat Toomey – who drafted this provision – does not want to compromise on it.”

And, Sen.Portman and Capito also continue to express interest in increasing funding for Opioid substance abuse treatment, adds Adcock. The Senate health bill includes $2 billion for this purpose. Portman has called for $40 billion for treating Opioid addictions, he says.

With senators returning to Washington, D.C., after their roughly one-week Fourth of July recess, there are only 14 legislative working days before their month-long August recess begins on July 28 with their return Sept. 5.

Recently, ten Senate Republicans have called on Senate Majority Leader McConnell to cancel the upcoming August recess to allow them to focus on five priorities: fixing health care, funding the federal government by Oct.1 to avoid a shutdown, dealing with the debt ceiling, passing the budget resolution and improving the nation’s tax code.

This will not likely happen due to the Senate’s legislative workload.

According to Adcock, the Senate either needs to approve its health care bill or abandon it by the upcoming August recess because the repeal of Obamacare is holding up consideration of the FY 2018 budget resolution and tax reform.

“That’s because the Senate healthcare bill is being considered in the form of the FY 2017 budget reconciliation bill. There cannot be a conference agreement on the FY 2018 budget reconciliation bill until the FY 2017 budget reconciliation is either enacted or abandoned,” he says.

Finally, Adcock notes, “A conference agreement on the FY 2018 budget resolution is necessary to set in motion consideration of a FY 2018 budget reconciliation bill that would include tax reform and perhaps cuts to mandatory spending programs, like Medicare and Medicaid. Budget reconciliation bills are filibuster-proof in the Senate.”

Calling for Political Compromise

A recently released USA Today/Suffolk University poll at the end of June says that “just 12 percent of Americans support the Senate Republican health care plan. On the other hand, “a 53 percent majority say Congress should either leave the law known as Obamacare alone or work to fix its problems while keeping its framework intact.”

So, now it’s time for the White House and Congress to read the political winds. Americans want health care fixed for the right reasons, not for political reasons. Lawmakers must put aside their philosophical differences and craft a “win-win” compromise to fix Obamacare’s flaws.

It’s the right thing to do.

GOP Health Care Reform Moves to Senate

Published in Woonsocket Call on May 7, 2017

House Speaker Paul Ryan’s words are now coming back to haunt him and GOP leadership that rammed American Health Care Act (AHCA), without procedural safeguards, through the House chamber days ago. “I don’t think we should pass bills that we haven’t read that we don’t know what they cost,” said Ryan in a 2009 interview on MSNBC when Congress was debating President Obama’s 1990-page Affordable Care Act (ACA), or Obamacare.

Last month, the Trump Administration efforts to repeal and replace Obamacare, with the American Health Care Act (AHCA) went down in flames when so many GOP moderates and conservative House lawmakers opposed the bill that the leadership didn’t dare bring it up for a vote. Successful negotiations of the GOP factions crafted a new version that passed last Thursday by a razor-thin vote of 217-213, a slim margin of four votes. All 193 Democrats opposed passage, along with 20 Republican lawmakers. With House passage, the bill moves to the Senate for deliberation.

Before the House vote on the GOP health bill there were no legislative hearings held to debate its merits and its full text was posted on the Web less than 24 hours before the vote. Ryan did not even wait for the nonpartisan Congressional Budget Office (CBO) to provide an updated financial analysis of AHCA. The CBO’s analysis of the original bill, pulled moments before a scheduled vote on March 24, 2017, found that the GOP health care proposal estimated that if passed 24 million or more Americans could be uninsured by 2026.

Opposition Mounting to GOP Health Care Proposal

With the passage of AHCA, Democratic Policy and Communication Committee Co-Chair David N. Cicilline (D-RI) issued the following statement, saying “This is the cruelest and most immoral thing I’ve seen the Republican Party do to the American people. They just passed a bill that they know will result in the deaths of thousands of working people each year. I don’t know how they sleep at night.”

“All you need to know about this bill is that Republicans tried to exempt themselves from coverage [of the GOP health care proposal]] before they got caught. That’s because they know it’s a raw deal,” says Senator Sheldon Whitehouse. This legislation sets us on a path to the bad old days when insurance companies could refuse coverage to those with preexisting conditions and deny people health benefits that should be in every plan – like ‎maternity and mental health care, he says.

Whitehouse warns that AHCA’s passage will leave millions of Americans without access to affordable health insurance. “Rhode Islanders rely on the Affordable Care Act and it’s working here. If they want to improve it, that’s one thing, but this House bill will hurt Rhode Islanders,

Within hours of the House vote on AHCA, a joint statement was issued by six prestigious national medical organizations (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Psychiatric Association American and the American Osteopathic Association), representing over 560,000 physicians and medical students, denouncing the GOP health bill. Dozens of other state and national health care organizations, including the American Medical Association, American Nurses Association and American Hospital Association (and this number grows daily) also gave a thumb down on the Republican health bill that is considered “unworkable and flawed.”

Aging advocacy groups came out swinging, too.

AARP, representing 38 million members and considered to be one of the nation’s most powerful aging lobbying groups, plans to hold GOP House lawmakers accounting for their support of AHCA while gearing up to oppose the Republican health care proposal in the Senate.

In a statement, AARP Executive Vice President Nancy LeaMond reiterated AARP’s opposition to the GOP health bill passed in the U.S. House of Representatives, calling it “flawed” and warning that the legislative proposal “would harm American families who count on access to affordable health care.”

LeaMond says, “the bill will put an Age Tax on us as we age, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care. In addition, the bill now puts at risk the 25 million older adults with pre-existing conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them.”

According to LeaMond, AARP will continue its opposition of AHCA as it moves for Senate consideration because it “includes an Age Tax on older Americans, eliminates critical protections for those with pre-existing conditions, puts coverage at risk for millions, cuts the life of Medicare, erodes seniors’ ability to live independently, and gives sweetheart deals to big drug and insurance companies while doing nothing to lower the cost of prescriptions.

LeaMond warns, “We promised to hold members of Congress accountable for their vote on this bill. True to our promise, AARP is now letting its 38 million members know how their elected Representative voted on this health bill in The Bulletin, a print publication that goes to all of our members, as well as through emails, social media, and other communications.”

Medicaid Takes a Major Blow

“The bill threatens the very heart of the Medicaid program, taking away the guarantee that Medicaid will be there when seniors need it most. By slashing Medicaid funding by over $800 billion, the AHCA will place tremendous strain on state budget, says Kevin Prindiville, Executive Director of Justice in Aging, a nonprofit advocacy group for low-income seniors. “States will be forced to cut services, restrict eligibility, and reduce benefits for seniors, children, people with disabilities, and low-income older adults, he says.

“Congress is forcing families to pay more out-of-pocket when grandparents and other loved ones need nursing home care or home care. Two-thirds of all Medicaid spending for older adults pays for long-term services and supports. The AHCA puts this vital care for seniors in jeopardy,” says Prindiville. “By passing the ACHA, the House chose to cut taxes for the wealthy and pharmaceutical companies while harming Medicare beneficiaries by increasing Part B premiums and reducing the life of the Medicare Trust Fund, he says.

Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare calls the AHCA vote “appalling” for retirees and views the “raid of Medicare, cuts to Medicaid among the most problematic parts of the AHCA.”

“Despite the bill’s name, risking the health of our nation’s most vulnerable citizens to give the wealthy an $ 600 billion tax cut is tremendously uncaring — and does not reflect real American values,” says Richtman. In modifying the original AHCA bill to give reluctant Republicans political cover, the House leadership made a bad piece of legislation even worse,” he says.

No Protection for Pre-existing Conditions

“Recent amendments to this cruel, ill-advised bill could put coverage for older Americans with pre-existing conditions like cancer and diabetes out of reach. The $8 billion (over 5 years) added to the legislation at the last minute to defray the cost of higher premiums is woefully inadequate. It’s a thin veil that covers a head of snakes,” notes Richtman

“Equally inadequate are the meager tax credits that the GOP bill offers older Americans to buy insurance. A $4,000 annual tax credit doesn’t come to close to covering premiums for seniors ages 60-64, meaning millions of older Americans will lose coverage altogether,” says Richtman.

According to Richtman, AHCA slashes nearly $1 trillion from the Medicaid by converting the social health care program into a block grant program or imposing per capita caps. “This would make it harder for impoverished seniors to access long term skilled nursing care and community or home care. Overall, the Congressional Budget Office estimates that 14 million people will be kicked off the Medicaid rolls in the next 10 years if this bill becomes law,” he says.

Richtman observes that the enactment of AHCA would reduce Medicare’s solvency by repealing Obamacare’s 0.9 percent payroll tax on wages above $200,000. This could lead to cuts in Medicare, including privatizing the program — harming current and future beneficiaries, he says.

“Under the GOP bill, insurers can charge older enrollees five times more than younger ones. The Congressional Budget Office predicts that by 2026 this provision will substantially raise premiums for older people by as much as 25 percent,” notes Richtman.

Senate Becomes New AHCA Battle Ground

After the politically decisive House vote to pass AHCA, President Donald Trump and House GOP lawmakers celebrated their major political victory at the White House Rose Garden claiming that they had fulfilled a promise made 7 years ago to repeal and replace Obamacare. But this celebration was short lived. Like House Democratic lawmakers, Democratic and Republican Senators began voicing their skepticism and strong opposition to the House’s passed health bill. Holding a slim 52-to-48 advantage in the upper chamber, GOP Senate Leadership must craft a bill that can win the support of at least 50 of their caucus members.

Washington insiders are now reporting that the House’s unpopular AHCA is “Dead on Arrival” in the Senate. Senate Republicans say they will not vote on the House passed bill and the upper chamber is expected to move slowly in crafting its health bill, starting from scratch. Many GOP Senators opposed AHCA, especially those who want to protect their constituents with pre-existing conditions and others who represent states that have expanded their Medicaid program under Obamacare.

A group of 13 Republican Senators (all men) have begun the process of hammering out their own health bill. Senate rules do not allow a review of the legislation or the determination of the rules of the debate until the CBO provides its official fiscal impact estimate. Because of this the health policy debate may not begin until summer.

Hopefully, Senate Majority Leader Mitch McConnell, a Republican from Kentucky, and his partisan working group will reach across the aisle to Democratic Senators to assist in crafting a bipartisan solution. Won’t that be refreshing.

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.

Republicans Begin a Legislative Assault on Social Security

Published in Woonsocket Call on December 11, 2016

With the dust just settling after last month’s heated presidential 2016 election, the GOP took over the White House and maintained control of both chambers of Congress. With almost 40 days left before Obama leaves office, an emboldened GOP calls for the repeal of Obmacare and the privatization of Medicare. That said, fixing Social Security is now on their short list of domestic policies to address.

Last Thursday, the long-anticipated political skirmish over how to reform and ensure the fiscal solvency of Social Security began with Ways and Means Social Security Subcommittee Chairman Sam Johnson (TX-03) introducing legislation to drastically overhaul the nation’s most popular social insurance program.

In the Eyes of the Beholder

“For years I’ve talked about the need to fix Social Security so that our children and grandchildren can count on it to be there for them just like it’s there for today’s seniors and individuals with disabilities,” Johnson said in his statement introducing H.R. 6439, the Social Security Reform Act of 2016. “My commonsense plan is the start of a fact-based conversation about how we do just that. I urge my colleagues to also put pen to paper and offer their ideas about how they would save Social Security for generations to come,” he said.

Johnson’s legislative proposal seeks to overhaul the nation’s Social Security program by increasing the retirement age from 67 to 69, this change impacting people born in 1968 who will begin retiring in the mid-2030s. The basic Social Security benefit formula would also become less generous for beneficiaries… except for the poorest beneficiaries. The annual cost-of-living adjustment (COLA), using a Chained-Weighted CPI, would put the brakes on generous COLA increases. COLA’s would be cut for those earning over $85,000.

Circling the Wagons to Protect Social Security

Democratic Leader Nancy Pelosi came out swing in a statement after Johnson’s threw his bill into the legislative hopper, charging that it would “inflict deep cuts in Social Security benefits.”

“Apparently nothing upsets House Republicans like the idea of hard-working people getting to enjoy a secure and dignified retirement. While Speaker Ryan sharpens his knives for Medicare, Chairman Johnson’s bill is an alarming sign that Republicans are greedily eying devastating cuts to Americans’ Social Security benefits as well,” Pelosi said.

She warned, “Although current retirees and those close to retirement will receive their Social Security benefits, changes are looming with a Trump administration and a Republican-controlled Congress. For younger generations all benefit cut options are expected to be put on the table.”

Rhode Island Congressman David Cicilline calls Johnson’s legislative proposal a “travesty,” warning that it would “destroy Social Security as we know it by slashing the critical benefits that millions of seniors rely on to live their retirement years with dignity.”

According to Cicilline, the last time Republicans tried to eliminate Social Security during the Administration of President George W. Bush, the American people were outraged and rejected it.”

Max Richtman, President and CEO of the Washington-based National Committee to Preserve Social Security and Medicare views Johnson’s Social Security fix legislation introduced as the 114th Congress is wrapping up, “the first salvo in the ‘War on the Working Class.’”

Rep. Johnson will no doubt re-introduce his bill in the next Congress, he predicts.

According to Richtman, Johnson’s legislative proposal cuts Social Security benefits by one third while raising the retirement age from 67 to 69. It seeks to control costs by changing the benefit-computation formula in a way that cuts benefit amounts. Finally, it cuts COLAs, too.

Richtman charges that this Social Security reform proposal would “irreparably harm the nearly 60 million Americans who currently depend on Social Security as well as future beneficiaries.”

“President-elect Trump will have a veto pen. Now is the time for Mr. Trump to re-affirm his campaign promise “not to touch” Social Security and Medicare. So far, he has been uncharacteristically silent on this vital issue. I promise that we will hold him accountable,” says Richtman.

“No one voted for massive cuts to Social Security, nor to end the program as we know it,” says Nancy Altman, founding co-director of Social Security Works, in a response to Johnson’s legislative proposal to radically change Social Security. “The Johnson plan would gradually but inexorably turn Social Security from a program that replaces wages to one that produces essentially one flat benefit, independent of how much a worker contributed,” she says.

“With Republicans in full control of the federal government, these cuts have a real chance of being passed into law. Trump needs to immediately reassure the American people that he will keep his campaign promise and veto this awful bill. He should tweet that immediately,” adds Altman.

The presidential debates and the platforms of the GOP and Democratic party reveal a stark difference as how to each party will fix the ailing Social Security program. Now is not the time to put Social Security on the chopping block. Congress must come together to hammer out bipartisan approaches to ensure the fiscal solvency for the next 100 years. .

Prominent Oncologist’s Death Wish at Age 75

Published in Pawtucket Times, December 12, 2014

Dr. Ezekiel Emanuel, MD, Ph.D., a nationally-recognized oncologist and bioethicist, definitely marches to a different drummer.  While millions of older Americans pop Vitamins and supplements like M&M Candy, regularly exercise at their local gym, religiously jog and carefully watch what they eat to increase their life span, the chair of medical bioethics and health policy at the University of Pennsylvania, says living past the ripe old age of 75 is not on his bucket list.  We would be doing both society and our loved ones a favor by agreeing with this belief, he says.

When I am 75…

Why not age 80 or even 85?  Emanuel admits that his 75th birthday day was just a randomly chosen number, but the year was selected because scientific studies indicate that increases in physical and mental disability occur around this age, as well as a decline in both creativity and productivity.

The renowned 57-year old breast oncologist is at the top of his professional game.  Emanuel has received dozens of awards from organizations such as the National Institutes of Health and the American Cancer Society, including being elected to the Institute of Medicine (IOM) of the National Academy of Science, the Association of American Physicians, and the Royal College of Medicine (UK). Hippocrates Magazine even selected him as Doctor of the Year in Ethics.

Emanuel is a prolific writer, editing 9 books and penning over 200 scientific articles. He is currently a columnist for the New York Times and appears regularly on television shows including Morning Joe and Hardball with Chris Matthews.  .

The prominent physician, is also considered a key designer of the Affordable Care Act (commonly called Obamacare).  At a personal level, he has two well-known brothers, Chicago mayor Rahm Emanuel, former White House chief of staff, and Hollywood agent Ari Emanuel.

With this prominence, Emanuel’s death wish to die at 75, (the year 2032) before the onset of Alzheimer’s disease and other dementias, and decreased physical stamina (it’s harder to walk a quarter of a mile, even to climb 10 stairs) is drawing the ire of critics who charge that he advocates for health care rationing and legalized euthanasia.

But Emanuel claims that these charges are not true.  Setting his death at 75 is just his personal preference, he says, leaving his mortal coil. In his writings and media interviews he notes that setting the age when he hopes to die just drives his daughters and brothers crazy.

Last October, at the BBC Future’s World-Changing Ideas Summit in Manhattan, Emanuel’s prop, a full-page AARP ad from a newspaper, featuring an older couple hiking above a line of text that read, “When the view goes on forever, I feel like I can, too. Go long.”  Reinforcing his point, Emanuel is not buying AARP’s message pushing the positives of living an extended life.  For him, he doesn’t buy it and most definitely, seventy is not the new 50.

Sharing a Death Wish on the Air Ways

On Dec. 7, on CBC Radio Canada’s Sunday Edition, Emanuel, discussed his controversial October 21, 2014 article published in the The Atlantic, “Why I Hope to Die at 75.”  His Sunday interview detailed his unconventional and controversial stance, especially to AARP, the nation’s largest aging advocacy group, and aging organizations who strongly oppose this type of thinking.

Throughout the 28.12 minute interview with Michael Enright, Emanuel, he warns listeners, “Don’t focus on years, and focus on quality.”

“A good life is not just about stacking up the years and living as long as possible. People need to focus on quality of life,” says Emanuel, noting that “Setting an actual date for a good time to die helps you focus on what is important in your life.”

“It is really about what you are doing to contributing and enriching the world.  I want people to stop focusing on just more years, focusing on quality,” he says.

Emanuel says that you need to be realistic on living forever, your body and mind doesn’t  go on forever.  You should just be satisfied with living a complete life, he says.

By age 75, people will have gone through all stages of life, says Emanuel.  As a child you begin to develop skills and figuring out your place in the world. You go to college, raise a family, work to hone your skills and talents. At the later stages of your life you give advice and mentor people, he says, noting that in your mid-seventies, physical deterioration and mental slowing along with loss of creativity, begin to be felt.

During his radio interview, Emanuel claimed he is very active, recently climbing Mount Kilimanjaro with is two nephews, stressing that he is in relatively good health and doesn’t have a terminal illness and has no plans to commit suicide.   As a matter of fact, the physician even condemned physician-assisted suicide and euthanasia, in a 1997 article published in The Atlantic, a policy allowed in the states of Oregon, Vermont and Washington.  His philosophical view of ending one’s life is to allow the body to age naturally, he stresses.

In eighteen years, Emanuel pledges to refuse all medical procedures and treatments, including taking medications such as statins, cholesterol lowing drugs, and antibiotics that could prevent life-threatening illnesses or extend his life.  He notes that his last colonoscopy will be at 65, to screen for cancer.  No more colonoscopies after 75.  And, he’ll only accept palliative care after that milestone age, too.

“I’m not suggesting people kill themselves at 75 but, rather, let nature take its course,” Emanuel says.

How Others See it

Emanuel’s personal preference not to seek medical procedures or to use medications at age 75 that might lead to his death is not the same as physician assisted suicide, says Rev. Christopher M. Mahar, S.T.L., of the Providence Catholic Diocese, noting that this choice has always been respected by the Catholic Church.

“He is not actively choosing to take his life, and as long as he is not rejecting any of the ordinary means necessary for the preservation of life, such as nutrition and hydration, and is not intentionally destroying his body, he is free to decide for himself, says Mahar.

As Emanuel says, there is a downside to aging.  My 88-year-old mother died after a 14 year battle with Alzheimer’s disease.  At age 89, my father, whose quality of life declined over his later years, died suddenly, by having a pulmonary embolism.

For me, 89 is the year I choose to meet my maker, hanging up my spurs.  Yes, I will let nature take its course, but I will most continue to take Vitamins and antibiotics, even my Lisinopril, for high blood pressure.  I will not turn my back on medical procedures or technology that might enhance the quality of my life, even lengthen it.

I agree with the statement of late Actress Betty Davis stated, “Old age ain’t no place for sissies.”   There is no alternatives, you can only hope for nature to ultimately take its course, and it will.  And so, we all are inclined to pick our own magic number.

Herb Weiss, LRI ’12, is a Pawtucket writer who covers aging, health care and medical issues.

Poll Calls Upon Congress to do “the people’s work”

Published in the Pawtucket Times, January 10, 2014

Four months ago, public anger reached a boiling point when the Republican-led House, controlled by its minority faction of Tea Party members, and the Democratic majority in the Senate failed to agree to an appropriations continuing resolution.
As a result of this budget impasse, a 16 day federal shutdown forced the furlough of 800,000 federal employees and another 1.3 million were required to report to work without known payment dates.

Public polls at that time blamed the GOP for turning its back on the nation by putting partisan politics first rather than doing the People’s business.” The popularity of Congress sank to a new historic low with heated partisan conflict echoing throughout the hallways of Congress.

Hammering Out an 11th Hour Deal

Senator Ted Cruz (R-Texas) with the blessings of conservative groups, including the Heritage Action, the Club for Growth, Freedom Works, and the Senate Conservatives Fund, forcefully pushed House Speaker John Boehner (R-Ohio) to offer continuing resolutions not acceptable to President Obama and Congressional Democrats to politically force a delay or to defund the Patient Protection and Affordable Care Act (called “Obamacare”). Strong GOP opposition, spearheaded by Tea Party lawmakers, to raising the nation’s debt ceiling almost forced the government to run out of money to pay its bills.

After weeks of intense political bickering, Congress finally hammered out a political compromise, one that would open the doors of government, but also raise the debt ceiling to keep the nation from free-falling off the fiscal cliff. A failure to raise the debt ceiling could have resulted in the nation’s credit rating being downgraded. If this occurred, average Americans might have seen higher interest rates for mortgages, car loans, student loans and even credit cards. Higher business expenses, due to expensive borrowing rates, might have forced businesses to stop hiring or even to lay off employees. Housing prices might have drop and retail sales slow. The 11th hour compromise kept the American tax payer and business community from taking a huge hit in their pocketbook.

Although Cruz and Tea Party lawmakers in both chambers viewed shutting down the federal government and not raising the debt ceiling as a way to put excess government spending on the chopping block economy, there was economic damage. According to the economists at Standard & Poors, the total cost of the political gridlock to the nation’s economy that occurred before Christmas was estimated to be $24 billion.
Americans Lack Confidence in Congress

With the new Congressional session beginning this month, a new national poll released last week by AP-NORC Center for Public Affairs reveals that few Americans have faith in the current political status with Congress receiving low marks on its performance of upholding the views of most Americans while only 9 percent say it is doing a good job.

According to the poll that comes months after the first government shutdown in 17 years, 70 percent lack confidence in the federal government’s ability “to make progress on important issues facing the nation in 2014.”

However, the poll findings indicate that the respondents have a little bit more faith in their local and state governments, with 45 percent saying that they are at least moderately confident in their state government and 54 percent having at least moderate confidence with elected officials at the local level.

The federal government receives low marks on its performance. For instance, 55 percent believe the government is doing a poor job of representing the views of most Americans while only 9 percent say it’s doing a good job.

Meanwhile, the poll’s results find Americans are more pessimistic than optimistic on matters such as the nation’s ability to produce strong leaders, America’s role as a global leader, and the opportunity to achieve the American dream.

The People’s preferred agenda for the government in 2014 includes a diverse set of policy issues that range from economic problems to social policies to foreign affairs, notes the poll. Health care reform tops their list of priorities, mentioned by 52 percent of respondents as one of the top ten problems, followed by unemployment (42 percent), the economy in general (39 percent), and the federal deficit (31 percent).

“While it is very easy to ask people to choose a single ‘most important problem’ and to build a list for the answers, the reality is that government has to address many issues at the same time,” said Trevor Tompson, director of the AP-NORC Center. “This survey, with data about the public’s priorities on a range of policy issues, provides policy makers with rigorous data as they seek to understand the public’s outlook on where the country is now and what the action agenda should be for the year ahead.”

Wendy Schiller, Associate Professor of Political Science and Public Policy at Brown University, notes that the AP-NORC poll reveals “broader concerns expressed in national opinion polls, and by the average Rhode Islander “that our country seems to be slipping on lots of levels.”

Schiller, a frequent guest on Rhode Island PBS’s “A Lively Experiment,” notes that aging baby boomers and seniors worry about issues facing the younger generations, personal debt resulting from student loans to national debt. On the other hand, “Younger folks worry about how they will take care of their parents and grandparents, as well as providing for their own retirement,” she says.

“In a state like Rhode Island, which has such a strong family centered culture, these issues weigh heavily on almost everyone’s minds,” observes Schiller.

One of the poll’s positive findings was that the respondents did not cite healthcare for seniors as a pressing issue even though they did express concern over Social Security and health care reform, adds Schiller. “Preserving Medicare is as important, if not more, to the physical and financial well-being of seniors, so I found it striking that it was not as large a concern [as other issues].”

The polls negative findings of a distrust of government, rather than just a disappointment, concerns Schiller, noting that “Democracies do not fare well when the people lose faith in their government.”

As indicated by the poll, Schiller believes that Rhode Island state elected officials are viewed more positively by voters than those serving in Congress. But, 2014 will be a challenging year for them, especially with issues like the 38 Studios debacle, pension reform issues, and Rhode Island job growth. Schiller believes that “If the General Assembly can increase the trend towards greater transparency and accountability, than they might be able to reverse the downward slide of public faith in government.”

As noted in the poll, “public opinion about Congress is at an all-time low,” says Darrell M. West, Ph.D., Vice President and Director of Governance Studies at the Brookings Institution. “People are disenchanted with the hyper-partisanship in Washington, D.C., and the inability of congressional leaders to address major policy problems, he says, noting that the government shutdown was very disturbing to mainstream and people now worry about Congress getting anything done.

West, a former Brown University professor and a prominent Rhode Island political commentator, does not see a major resurgence of bipartisanship in this Congress.
“The parties have incentives to highlight their differences rather than compromise their principles. That will make it difficult for the parties to work together, he says.

But West sees an indicator that the GOP might move away from its ties to the Tea Party that put a damper on reaching across the aisle to get the people’s work done. “The only promising sign is Speaker Boehner’s declaration of independence from the right-wing. A month ago, Boehner criticized outside conservative groups and said they had lost all credibility. If he really believes that, it may embolden him to work on immigration reform and pass needed legislation”, says West.

Because of the complexity of today’s domestic and foreign policy, the People want and need their elected officials to quit this partisan bickering and join together to solve the enormous problems that face the nation, warns well-know Rhode Island activist, Susan Sweet, a keen watcher of state, national, and global politics. “Without the political will to stand together and strengthen the People of America, this great experiment in democracy could decline and fall,” she says.

The AP-NORC national poll was conducted by The Associated Press-NORC Center for Public Affairs Research from Dec. 12-16, 2013, with 1,141 adults. Additional information about how the survey was conducted, including the survey report and the survey’s complete topline findings can be found on the AP-NORC Center’s website at http://www.apnorc.org.

Herb Weiss, LRI ’12, is a Pawtucket-based writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.