Sunday, March 26, 2017

Editorial: Time to Expand Medicare

Republicans have been working to undermine the Affordable Care Act for the past seven years, and the campaign has taken its toll. But Paul Ryan and Donald Trump failed to strike the fatal blow this past week, as Republicans split over the replacement for "Obamacare." They might try again, after Health and Human Services Secretary Tom Price gets a shot at undermining the health exchanges, but if Price succeeds in wrecking the Affordable Care Act through maladministration, the answer should not be another look at the Ryan-Trump proposal to give the insurance companies more flexibility and rely on the “free market” to set things right. Insurance companies had their shot at providing universal coverage, and they failed.

President Obama determined in 2009 that insurance companies had too much clout in Washington to make any headway with a universal health care initiative that did not get the insurance companies to sign on.

Obama managed to get the insurance trade group, America’s Health Insurance Plans, to publicly back the passage of the Affordable Care Act in 2009, but Wendell Potter, a former insurance executive who became a critic of the private insurance system, noted that the insurance lobby secretly funneled tens of millions of dollars to allies like the US Chamber of Commerce to finance anti-Obamacare PR and ad campaigns.“The big for-profit insurers, which gave AHIP the lion’s share of the secret money, arguably are more responsible than any other special interest in turning the public’s attitudes against reform,” Potter wrote for the Center for Public Integrity in April 2015.

The anti-reform advertising blitz in late 2009 and early 2010 helped convince Democrats in Congress to give up on the “public option,” which would have allowed people under 65 to buy Medicare coverage, Potter wrote. Lawmakers also agreed to make the penalty for not buying insurance more painful with every passing year, which would send more customers to the insurance companies.

But Republicans tried to undermine Obama’s assurances to insurance companies that they would not lose money on these new customers, many of whom had been uninsurable because of pre-existing medical conditions. The law provided fodr insurance companies to be made whole, but in 2014 Republicans slipped a “rider” into a spending bill to stop federal funds from being spent to cover “risk corridor” shortfalls for insurance companies during the first three years of the ACA’s rollout. Because of the rider, the government was able to pay only 13% of what insurance companies were expecting to receive from the risk corridors in 2015.

The monkey wrench didn’t kill Obamacare, which was Florida Sen. Marco Rubio’s goal, but it did force premium increases that were announced in the weeks before the 2016 election. Also, Michael Hiltzig of the Los Angeles Times noted, “The lack of full reimbursement contributed to the collapse of a dozen healthcare co-ops that had been created to provide coverage to individuals and families, interfering with coverage of some 800,000 Americans. Many, if not most, of these co-ops likely would have survived if the promised financial cushion was there for them when expected.”

The major insurance companies still made out OK under the new law, with revenue increases from Medicaid and Medicare Advantage customers more than offsetting losses from the exchanges.

UnitedHealth, the nation’s largest health insurer, dropped out of the exchanges effective this year, claiming that Obamacare reduced its 2016 earnings by $850 million. But UnitedHealth had record-breaking profits in 2015, and an even better year in 2016, when UnitedHealth saw total company revenue jump 18% to $185 billion.

Aetna has also celebrated sky-high profits, reporting a record annual operating revenue of over $63.15 billion for 2016, an increase of 5% from 2015, though Aetna said it lost money in its individual products, on and off the health exchanges. But Aetna’s departure from health insurance exchanges in 11 states may also have been motivated by CEO Mark Bertolini’s anger at being denied a merger with Humana, which also scaled back its participation in the exchanges but reported a record $54.38 billion in revenue for 2016. Obama’s Justice Department blocked the $37 billion deal on the grounds that merging two of the nation’s five largest insurance providers was an antitrust violation that would strangle competition in the marketplace.

The Congressional Budget Office on March 13 reported that the Republican health plan would cause 24 million people to lose insurance and increase insurance costs dramatically for older Americans.

Under the current law, in 2026, a 64-year-old earning $26,500 with an insurance policy that costs $15,300 a year would get a tax credit of $13,600, leaving the consumer responsible for $1,700. Under the Republican plan, health insurers could charge older people up to five times more than they charge younger people (compared with three times more under the current law), raising the older person’s premium to $19,500. But the tax credit would be only $4,900, and that older person’s share of the premium would then be $14,600.

By contrast, a single 21-year-old earning $26,500 with an insurance policy that costs $5,100 a year would get a tax credit of $3,400 and would have to pay $1,700 of the premium. Under the Republican bill, that person’s share of the cost would drop to $1,450.

Republicans, who have disputed the success of the Affordable Care Act, played down the CBO analysis. They note that the agency predicted that the ACA, also known as Obamacare, would put eight million more people under insurance than actually signed up. But the number of people who signed up for insurance through the government-sponsored health exchanges was lower than expected, in part, because employers did not drop coverage to the extent that had been anticipated, and many Republican-led states opted not to accept the federal funds to expand Medicaid to provide coverage for the working poor.

The Republican plan also would sharply cut Medicaid and give states more leeway in developing and administering their own program for low-income health coverage. Most savings would go to tax cuts for the wealthiest Americans.

The Affordable Care Act was a good try, but it should be replaced by Medicare for All. Four principals of Physicians for a National Health Program made the case for a single-payer national health program in an op-ed in the American Journal of Public Health in June 2016. They noted that employers have tripled deductibles on insurance policies since 2006 in an effort to restrain their health benefit costs and many of the estimated 11 million Americans who have purchased plans on ACA exchanges face punishingly high copayments and deductibles, which average more than $5,300 in “bronze” plans. That can compromise access to health care and financial well-being. In 2014, 36% of non-elderly adults skipped needed care because of cost (that’s down from 41% in 2010), and more than half of all overdue debts on credit reports were medical.

A single-payer plan, expanding Medicare to cover everybody, could provide comprehensive coverage without copayments or deductibles, replacing the current wasteful patchwork of coverage, and a February 2016 Kaiser Family Foundation poll found that two-thirds of Americans support such a move. Cutting administrative spending to Canadian levels would save 15% off what we now spend on health care, freeing nearly $500 billion annually for expanded and improved coverage. And allowing Medicare to negotiate with drug companies over prices, as do universal health programs in other advanced nations, would result in significant savings. “The greater efficiency and simplicity of the [national health program] would curb inflation in health costs, so that cost savings would grow with time,” the physicians note.

Insurance companies had their chance and they failed. Medicare has been providing efficient health coverage for the most expensive patients in the nation for 50 years and it’s time to give it a shot at covering the rest of us. — JMC

(This editorial has been updated from the version in the printed edition, to reflect the decision of Trump and Ryan to pull their bill on March 24.)

From The Progressive Populist, April 15, 2017

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Saturday, March 25, 2017

Selections from the April 15, 2017 issue

COVER/Sophia A. McClennen
Beware the Trump brain rot

Time to expand Medicare


Dakota pipeline just another Trump deal

RURAL ROUTES/Margot McMillen
Guns and politics don’t mix

Trump sets pace on lies, FBI probes Russian ties;
Trump budget hurts his voters;
Trump budget devastates rural communities;
Repubs seek to bridge impasse on health plan;
White House installs political minders at key agencies;
Trump plan to zero out public broadcasting would hurt 'Trump Country';
Economy grows as CO2 emissions drop, mocking Trump climate policy;
GOP senator thinks EPA cuts will keep agency from 'brainwashing our kids';
Faith leaders aren't happy with Trump budget;
Longtime cop detained by CBP ...

Indivisible: Social action startup 

The press is essential, whether presidents like it or not

From the mind of Steve Bannon? No, Mel Brooks

Let’s give the CIA the credit it deserves

Crikey! Trump grabs attention of British Parliament

Hands off Medicaid!

HEALTH CARE/Joan Retsinas
Proposed: A health-to-income ratio

Regulation isn’t what threatens economy

BOOKS/Seth Sandronsky
Community empowerment

Welcome to conservative health reform

Enemy of your enemy is not your friend: Russia, CIA, and American Democracy 

The power of fame

MOVIES/Ed Rampell
‘Hidden Figures,’ ‘Moonlight’ and ‘Neruda’ all top 2016 Progie Film Award winners

and more ...

Saturday, March 11, 2017

Beware Trump Distractions

Donald Trump was supposed to be basking in the good reviews of his speech to the joint session of Congress on Feb. 28, which included a dozen false or misleading statements (see Dispatches), but he impressed many commentators by sticking to the script better then he has in the past.

However, continuing questions about Russia’s involvement on Trump’s behalf before the election keeps roiling the administration. Before Trump’s big speech, Michael Flynn was forced to step down as his national security adviser when it became clear that Flynn had lied about talking to the Russian ambassador after the election to undermine President Obama’s sanctions on Russia. Then, the day after the speech, Trump’s choice for attorney general, Jefferson Beauregard Sessions III, chairman of the Trump campaign’s National Security Advisory Committee, who had denied during his Senate confirmation hearing that he had talked to Russians before the election, was forced to recuse himself from the investigation of Russian interference in the election because, it turned out, he actually had talked to Russian Ambassador Sergey Kislyak at the Republican National Convention in July, and again in his Senate office in September. Sessions still insists he did nothing wrong.

Trump has had success in using the con-man’s trick of misdirection to distract the public from damaging news, as he creates his own alternative reality.

Still, Trump’s bizarre pre-dawn tweets on March 4 accusing then-President Obama of ordering Trump’s phones tapped before the election had many observers scratching their heads. Trump produced no evidence of such a wiretap; he apparently was relying on claims made by right-wing radio talker Mark Levin and that Obama and his administration used “police state” tactics last fall to monitor the Trump team. Obama’s spokesmen categorically denied that the president had ordered the wiretap, which he could not do on his own, nor did he seek a court order for such a wiretap, as the law would require.

If anything, Trump’s tweets reinforced reports that the FBI in October had obtained a court order authorizing a wiretap of Trump campaign officials, which would have required the investigators to convince a judge there was evidence of illegal activity by the Trump campaign -- if not Trump individually.

Despite the widespread doubt cast on Trump’s claims, he was pleased March 5 that his allegations against Obama were the dominant story in the Sunday newspapers, instead of the Sessions story, the Washington Post reported. Trump was angered later in the day as few Republicans were defending him on the Sunday talk shows.

“The president knows the media cannot ignore him when he says something so inflammatory, and he believes there will be no real consequences for him if it turns out that everything he said was nonsense. After all, there haven’t been up until now,” James Hohmann wrote for the Post.

“Moreover, Trump’s core supporters also got a new talking point. Whenever they’re confronted with the links between Trump associates and Russia, millions of people are now going to reply that the real story is Obama’s wiretapping — even if that claim is shown definitively to have no basis in reality.”

Trump had some success with his controversial executive order on Jan. 27 that effectively barred people from seven Muslim-majority nations and all refugees from entering the US, even if they had visas or “green cards.” A Morning Consult/Politico poll in early February found 55% approval of the travel ban, though other polls showed majorities opposing the ban, but most polls show an overwhelming majority of Trump’s Republican base supports him, many of whom say he is following through on his campaign promises.

After federal courts, including the 9th Circuit Court of Appeals on Feb. 9, blocked enforcement of the travel ban, Trump privately signed a new ban on March 6 that imposes a 90-day ban on the issuance of new visas for citizens of six majority-Muslim nations (letting Iraq citizens in this time). He is also suspending the admission of refugees for at least 120 days and set a cap on 50,000 refugees in a year, down from the 110,000 cap set by the Obama administration. But the order remains a thinly veiled Muslim ban — and it still doesn’t target nations whose citizens participated in the 9/11 attacks.

There is less support for Trump’s order that immigration agents start rounding up undocumented immigrants. A CBS News Poll Feb. 23 found that a majority think not enough is being done to ensure that foreigners who enter the US from other countries are not a risk to security, but 60% think that undocumented immigrants currently living in the US should be allowed to stay and apply for citizenship, while 23% would require them to leave the US. Only 43% of Republicans support deporting all illegal immigrants, but that likely comprises Trump’s base.

A more equitable solution to the immigration problem would be to go after the businesses that employ undocumented people — particularly those who then don’t deduct or pay their share of payroll taxes for the undocumented.

Meanwhile, David Johnson of Campaign for America’s Future noted, the pro-corporate and anti-worker agenda unfolds:

The new head of the Environmental Protection Agency, Scott Pruitt, scrapped a crucial greenhouse gas rule requiring oil and gas companies to report methane pollution, which was part of the Paris climate deal, which Trump wants to scrap. Trump’s budget proposes to pay for a $54 billion increase in military spending with deep cuts to other agencies. A proposed 25% cut to the EPA budget would dramatically cut climate-change programs and those designed to prevent air and water pollution as well as lead contamination.

Trump’s budget would slash the EPA program that pays for Great Lakes pollution cleanup by 97%, from $300 million to $10 million. Trump is reportedly proposing cuts of 90% for programs to restore the Chesapeake Bay, the Puget Sound and San Francisco Bay. Grants to states for lead cleanup would be cut by 30%, to $9.8 mln, Reuters reported. Spending for enforcement of environmental protections would be cut 11% to $153 million..

The Trump administration also proposes a 17% cut in the National Oceanic and Atmospheric Administration, which would require steep cuts to research funding and satellite programs.

The proposed cuts to NOAA, the nation’s premier climate science agency, would eliminate funding for a variety of smaller programs, including external research, coastal management, estuary reserves and “coastal resilience,” which seeks to bolster the ability of coastal areas to withstand major storms and rising seas.

Trump’s FCC chairman plans to undo “net neutrality,” which will help four giant companies consolidate control of the Internet. By undoing the rules that create a level playing field online, Trump’s FCC will empower companies like Comcast to decide who gets Internet access, and at what price. This could have an impact on people’s ability to organize online.

Republicans have introduced the National Right-to-Work Act in Congress. This would defund labor unions by removing requirements that workers benefitting from union contracts pay dues to cover the union’s costs of negotiating, administering and meeting the union’s obligations under the contract.

Populist activists also have reservations about Trump’s commitment to negotiate trade deals that protect worker rights and the environment. “Trump promised to ‘drain the swamp,’ but right now, he seems poised to allow the same corporate leaches that created NAFTA and subsequent pacts to rewrite the new ones,” said Arthur Stamoulis, executive director of Citizens Trade Campaign.

So look beyond the tweets and Trump’s alt-reality to the rest of the damage the Grifter in Chief is planning for America. — JMC

From The Progressive Populist, April 1, 2017

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Selections from the April 1, 2017 issue

COVER/Amanda Marcotte
West Texas says no to wall

Beware Trump distractions


Wisconsin’s image has turned upside down

RURAL ROUTES/Margot McMillen
Homeschoolers want fed check, no balance

‘Trumpcare’ plan would leave millions uninsured;
Trump’s way: always attack, attack, never apologize;
Recess actions spur health care accountability;
Trump’s disregard for truth;
Trump tosses more than 90 regs ...

Putin’s aggression ringing alarm bells 

It’s only my health

The big faker and his big date with big data

The border game

CBP demands ID to get off domestic flight

Is Trump a Populist? 

Coping with Trump stress disorder

Policing America’s plutocracy

HEALTH CARE/Joan Retsinas
Lunchtime for the president

Billions for defense, not one cent for arts

That’s a fact, Jack

Labor loses its way

Trump and his corporate media accomplices 

Oh Canada! Get off our back!

BOOKS/Seth Sandronsky
Cooperators then and now

The cowardly states of America

Bob Dylan finally gets some recognition

MOVIES/Ed Rampell
Life of a Salesman: Is this the enemy?

and more ...