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Posts Tagged 'donald trump'

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Trump's Executive Order on Healthcare is Bad Medicine

With all the skill of a surgeon wielding a machete, President Trump signed an executive order today that could undermine the affordability and quality of health insurance in America.  Republicans in Congress couldn’t enact their ill-considered legislation to repeal Obamacare, so the President hastily reached for his pen, despite admitting earlier this year that he had no idea “healthcare could be so complicated.”

The executive order instructs Trump’s cabinet agencies to look at ways to allow insurers to sell health policies across state lines.  The aim is to open-up association health plans (currently covering employees of various businesses and organizations) to people in the individual market.  These insurance policies would not be subject to Obamacare rules mandating coverage for pre-existing conditions or essential benefits, in theory making them cheaper – but also skimpier.  

These lower-cost, bare bones plans could siphon off younger and healthier enrollees, leaving older and sicker patients in the Obamacare exchanges and driving up their premiums. Ultimately, this could result in a death spiral for Obamacare, as we discussed on today’s Behind the Headlines Facebook Live broadcast. The administration’s own Centers for Medicare and Medicaid Services (CMS) says on its website:

Older Americans between ages 55 and 64 are at particular risk: 48 to 86 percent of people in that age bracket have some type of pre-existing condition. 

To some, the idea of selling insurance across state lines sounds appealing. (Republicans have been proposing this scheme in one form or another since 2005.)  Senator Rand Paul (R-KY) has been pushing it hard this year. But evidence – and history – indicate that the idea doesn’t work.  This Kaiser Health News video briefly and crisply explains why.

Not only does the selling-across-state-lines concept undermine important patient protections and drive up premiums for the most vulnerable, it has never proven viable for insurers or the insured.  According to today’s Hill newspaper:

A few states have opened their borders to out-of-state health insurers, and the response has been a uniform, “Thanks, but no thanks.”

One of Obamacare’s architects, Dr. Zeke Emanuel, told CNN today that, in addition to other concerns, association health plans have a “checkered history” and are especially vulnerable to fraud and scam artists. “Hundreds of thousands of people could be affected by fraud, unreimbursed medical bills,” he warned.  Emanuel also cautioned that patients with employer-provided insurance could see their rates rise “significantly.”

The biggest problem of all, though, is that Trump’s executive order may well be illegal.  The New York Times reports:

Several experts in healthcare and employment law said Trump’s plan could violate the U.S. Employee Retirement Income Security Act (ERISA), a federal law that governs large group plans that must be provided or maintained by employers or employee organizations.

In fact, a coterie of Democratic states attorneys general are poised to sue the administration if it enacts these harmful changes.

For all the Republicans’ talk of federalism, the executive order would actually weaken states’ power to regulate insurance markets, which is one of their primary responsibilities in the health care arena.

But as with the President’s trickle-down tax plan and other haphazard policies, history, precedent and data don’t seem to matter to this White House.  That’s especially troubling when – once again – the most vulnerable members of society will pay the price.


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Summertime No Time to Stop Protecting Seniors' Healthcare

Washington, D.C. is noticeably mellower with Congress beginning its August recess.  Our “worst-in-the-U.S.” traffic is noticeably lighter.  The sidewalks are emptier.  The news from Capitol Hill has slowed to a trickle.  But the summer doldrums are no time for advocates here in D.C. or the 50 states to let our guard down.  (We just discussed this on "Behind the Headlines" from Capitol Hill on Facebook Live.) 

Last week, we narrowly escaped the passage of healthcare legislation that would have been devastating for poorer, older, and sicker Americans. The heroism of three GOP Senators and a united Democratic party pulled us back from the brink by voting against the latest Obamacare repeal bill.  

Make no mistake, intense grassroots activism in Congressional districts across the country played no small part in the defeat of repeal legislation in both houses of Congress.  From New Hampshire to Nevada, everyday Americans challenged their elected representatives to protect their healthcare – and won in a heart-pounding showdown.  

In the end, only Senators Collins, Murkowski, and McCain had the courage to defy party leadership and do the right thing.  That’s a thin reed on which to hang future hopes.  If a single one of those votes had gone the other way, at least 22 million Americans would have been well on their way to losing healthcare coverage – and the Medicaid program would have been decimated.  In fact, it’s disappointing that some of the Republican moderates who seemed to oppose the various repeal bills voted yes in the end.  Perhaps it’s because Senator McCain’s no vote gave them cover.  But where is the courage in that?

While Senate Majority Leader Mitch McConnell says it’s time to “move on,” Speaker Paul Ryan signaled that the House isn’t done trying to repeal the Affordable Care Act.   Meanwhile, President Trump continues to threaten to cut off crucial cost-sharing payments, spooking insurers and threatening to drive up premiums.  As Phil Moeller pointed out in his column for PBS NewsHour, there’s a real danger that the majority party will re-attack Obamacare after August recess ends.  

With Capitol Hill’s largely silent and long-postponed summer vacations underway, there is little appetite for re-engaging in nasty policy fights. But when the leaders and their troops are rested, there is little doubt that [they] will be back at it again. – Phil Moeller, PBS NewsHour

This means that we in the advocacy community cannot simply relax this month – tempting as that may be.  Advocates and everyday activists must continue to deliver the message to our elected representatives that it’s time to stop trying to destroy the Affordable Care Act and work across the aisle to improve it, as National Committee President Max Richtman argued in The Hill newspaper this week.  We must maintain the drumbeat whenever and wherever we encounter members of Congress this summer:  at their district offices, by phone, by email, or around town.

Make no mistake:  the activism we saw last winter and spring made a difference.  Members of Congress heard their constituents loud and clear at contentious town halls.  Phone lines, fax lines, and email accounts were jammed. Congress heard us when we said “Hands Off Our Healthcare!”

But even after all that full-throated activism, several GOP moderates in the House and Senate still caved when it was time to cast crucial votes. We came dangerously close to losing the Affordable Care Act. If anything, we must step up our activism.  We must make the case for protecting the healthcare of seniors – and all Americans – even more vociferously, letting our leaders know in personal terms the true impact of changes to our healthcare coverage. But we must also demand that our elected representatives talk to us. Hold town halls, don’t cancel them.  Keep phone lines open instead of shutting them down.  Hear us instead of hiding. And if there are future votes to undermine our healthcare, we must insist that more GOP moderates stick to their stated principles instead of running with the herd.


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Mr. President, Stop Saying Obamacare Is Imploding (Because It's Not)

updated 7/10/17

During a CNN focus group of Trump voters last week, one educated, white collar professional said that the Republican congress had to repeal and replace Obamacare because it is “imploding.”  That Trump supporter directly mimicked Trump’s own comments about Obamacare – comments which are patently misleading.  This proves once again the effectiveness of demagogic language (“Obamacare is a disaster!”) shamelessly applied to important policy questions that impact almost every American.

Obamacare is most definitely not imploding, but Trump and the GOP in Congress have convinced an awful lot of people that it is – simply by repeating the same falsehoods on a regular basis. Why does this matter?  It matters because the Senate may vote on its Obamacare repeal and replacement plan within the next couple of weeks.

The GOP’s Better Care Reconciliation Act would deprive 22 million Americans of health coverage over the next ten years and gut Medicaid, hitting the old and the sick unusually hard. As long as Republicans continue to justify repeal with false claims that Obamacare is in a “death spiral,” advocates for the most vulnerable members of our society must continue to call them out.

Both the New York Times and the Washington Post this week found it necessary to debunk misleading Republican claims about Obamacare and the Senate bill to replace it.  The Times entitled its piece, “Five Misleading Republican Claims About Health Care,” while the Post went with “Decoding the White House spin on Obamacare ‘failures.’”  The papers’ fact-checkers had plenty of material to work with. 

These and other analyses are crucial to understanding what’s really happening with Obamacare and the GOP repeal and replace legislation:

1) Obamacare is not “imploding” or in a “death spiral.”  Despite recent instability mostly induced by the Trump administration and Congress itself, Obamacare is hardly imploding.  A new study by the Kaiser Family Foundation suggests that Obamacare markets are, in fact, "stabilizing" and "regaining profitability."  The CBO forecasts that the Obamacare system will remain stable for the foreseeable future - if it is not further undermined. 

2) Premiums for Obamacare policies are not generally rising 200-300%.  Though a few states have unfortunately seen triple digit premium hikes, the National Conference of State Legislatures found that average premium increases nationwide were 25% this year.  Because some 84% of enrollees’ premiums are covered by Obamacare subsidies, few feel the effects of the increases.  Their net costs may even decrease.  

As the Post’s fact-checkers point out, “Average insurance premiums in the Obamacare marketplace now are about at the level predicted by the Congressional Budget Office for 2017 when it first evaluated the law in 2009.”  In other words, some premium hikes were predictable as the new marketplaces found their footing – and not likely to be repeated every year.

3) Insurers are not abandoning state insurance exchanges in droves.  The Post reports that an average of five insurers participated in each state’s marketplace in 2014, ranging from one to 16 companies per state. According to the Kaiser Family Foundation, the average number of insurers in 2017 is 4.3, ranging from one to 15 companies per state.  Not a huge decline.  Still, “slightly more than 2 million people, mostly in rural areas, don’t have competitive plans to choose from and are seeing premium increases,” writes the Post’s Dana Milbank.  But again, many of those premium hikes are offset by Obamacare subsidies.

4) The Trump administration and Congress could have done a lot more to stabilize Obamacare; instead they undermined it.  Here’s how:  

*The administration balked at paying cost-sharing subsidies that would have relieved financial pressure on reluctant insurers.

*President Trump signed an executive order soon after taking office instructing federal agencies not to enforce the Obamacare mandate that all Americans have health insurance, discouraging participation in the exchanges.

*The administration ended public outreach efforts to encourage Americans to sign up for health care.

*In fact, President Obama and the Democrats in Congress asked Republicans to work with them to strengthen Obamacare during the    first six years after the law was passed, only to have the GOP Congress vote to repeal it some 60 times.   

5) The President and his allies in Congress have spooked the insurance markets.  They have sown tremendous uncertainty about Obamacare’s future with their attempts to repeal the law and harsh rhetoric, spooking insurance companies and potential customers.  The former chief marketing officer for HealthCare.gov estimated that Trump’s rhetoric alone has deterred nearly 500,000 people from signing up this year.

Furthermore, the Post reports that figures the White House uses to smear Obamacare are often based on comparisons of the insurance markets from before the law took effect and today.  Such apples-to-oranges comparisons are misleading and not useful.

Meanwhile, the Republicans have employed similar demagoguery to promote their own repeal and replace legislation.  The Times found several GOP claims about the Senate healthcare bill to be factually dubious, including assertions that the legislation does not “pull the rug from anyone currently covered by Obamacare” – and that the bill “reduces taxes on the middle class” when, in fact, the top 1% of earners reap most of the benefits.  The cruel truth is that some 22 million Americans would lose health coverage under the GOP bill over the next ten years, including 15 million Medicaid beneficiaries – many of whom are needy seniors who rely on the program to pay for long-term care.  We must not allow the clever manipulation of language by those who would destroy Obamacare to hurt so many millions. 

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Tom Price's "Alternate Reality"

In the Orwellian world that Trump’s Washington has become, we are used to hearing language abused and misused to forward a right-wing agenda.  This week was no different.  As Kaiser Health News reported, HHS Secretary Tom Price was on Capitol Hill Thursday reciting a blatantly false Tea Party mantra:  government programs for our society’s most vulnerable members deserve to be cut because they “don’t work.”  This falsehood flies in the face of evidence - of history, really.  But in an attempt to dismantle the New Deal and Great Society programs that boost up the neediest – which includes millions of older Americans – the administration will literally say anything even if the opposite is true.

Price appeared before two congressional committees yesterday to defend President Trump’s 2018 budget, which calls for drastic cuts to programs benefitting seniors - including Medicaid, Meals on Wheels, and medical research by the National Institutes of Health (NIH).  His testimony included the following whopper:

“The problem with many of our federal programs is not that they are too expensive or too underfunded. The real problem is that they do not work—they fail the very people they are meant to help.”  HHS Secretary Tom Price before the Senate Finance Committee, 6/8/17

In spreading these myths, Price is singing from the same hymnal as other administration officials, most notably Budget Director Mick Mulvaney who defended funding cuts for Meals on Wheels thusly:

“Meals on Wheels sounds great… [but] we're not going to spend [money] on programs that cannot show that they actually deliver the promises that we’ve made to people.” – OMB Director Mick Mulvaney, 3/15/17

With an extra-Orwellian touch, Mulvaney added that draconian cuts in safety net programs are “one of the most compassionate things we can do.”

All of this begs the question:  by what imaginary standard do these programs “not work” or “fail the people they are meant to help?”   How does Medicaid – which allows millions of needy seniors to afford long-term care at home or in skilled nursing care facilities – not work?  Or Meals on Wheels, which provides hot, nutritious meals for 2 million hungry and isolated seniors – not work?  These are programs that undeniably do work.

National Committee President Max Richtman takes Secretary Price to task for telling untruths about these vital federal programs:  

“As a former member of Congress and a physician, Secretary Price should know better.  By maligning programs that have been a lifeline for millions of Americans for decades, Secretary Price is denying history and facts.  He is attempting to create an alternative reality that is patently false and misleading.”  - Max Richtman, NCPSSM President & CEO

Price also resorted to the spurious claim that rising costs in programs like Medicaid demand cuts.  He insisted that cutting $610 billion from Medicaid would lead to “innovations and efficiencies.”  No, cutting billions from Medicaid will result in a shortfall for states facing rising costs, forcing them to cut benefits or kick people off the rolls altogether. 

The truth is that these federal safety net programs are incredibly efficient already. Medicaid’s per capita costs are significantly lower than private insurers’.  Meals on Wheels can feed a senior for an entire year at the same cost as a single day in the hospital.  And those are only two of the safety net programs which fall under the Trump budget axe.

Democrats on the Hill pushed back against Price’s pronouncements and Trump’s budget cuts, too:

It’s mean-spirited. It’s not good for America. We can do much better." - Rep. John Lewis (D-GA)

If Republican budget hawks like Price truly cared about seniors, children, the disabled, and other vulnerable segments of society, they would not be slashing safety net programs.  But they cannot pay for trillions in tax cuts for the wealthy and big corporations without cutting domestic spending, so programs that benefit our neediest citizens go on the chopping block.  The rationale that the Trump budget cutters are simply seeking “efficiencies” is a thin veil for denying needy seniors long term care or hot meals. 

President Franklin D. Roosevelt, father of the New Deal and grandfather of the Great Society (which today’s GOP is fighting to undo) put it best when he said:

"The test of our progress is not whether we add more to the abundance of those who have much, it is whether we provide enough for those who have little."  - President Franklin D. Roosevelt

Unlike Trump’s budget hawks, FDR understood the importance of authentic language that shines a light on fundamental truths.  He would never confuse “compassion” for cruelty, “helping people” for hurting them, or success for failure.  Neither should we.

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Oh, yes: the Trump Budget Definitely Does Cut Meals on Wheels

 

Would the Trump administration and its acolytes please stop saying that the President's budget does not cut funding for Meals on Wheels?

Just today, Budget Director Mick Mulvaney made that very claim at a House hearing on the new budget: 

"Let's talk about Meals on Wheels, because we don't reduce it.” – Mick Mulvaney, Trump Budget Director, 5/24/17

Meals on Wheels is a program that delivers hot meals to more than 2.4 million needy seniors across the country every year. Volunteers not only deliver sustenance; they check in on isolated seniors and provided a much needed human connection.


Anyone looking at the actual numbers can plainly see that the Trump budget does, in fact, slash funding for Meals on Wheels. In addition to cutting Older Americans Act home-delivered meals by $1.5 million, the President’s budget eliminates the Community Services, Community Development and Social Services Block Grants, upon which some Meals on Wheels programs rely for funding.

Because of previous budget cuts, Older Americans Act nutrition programs are already serving 23 million fewer meals than in 2005.  The loss of Community Services Block Grants ($715 million), Community Development Block Grants ($3 billion) and Social Service Block Grants ($1.7 billion) funding for home delivered meals would increase the number of seniors threatened by hunger.

According to Feeding America, 5.7 million Americans over the age of 60 were food insecure as of 2014. That means 9% of all seniors in the wealthiest nation in the world are at risk of going hungry.  Worse yet, the number of food insecure seniors is projected to increase by 50% when the youngest of the Baby Boom Generation reaches age 60 in 2025. There are waiting lists in every state for seniors who need food assistance. Cutting Meals on Wheels funding at a time of growing need is outrageous and dangerous.

In a letter to the editor of the Washington Post on March 20th, National Committee President Max Richtman recounted his days as staff director for the Senate Select Committee on Aging.  He tells the story of a Republican Senator who changed his mind about the program after riding along with a Meals on Wheels van:

“He (the GOP Senator) was impressed by not only the sustenance of the food, but also the seniors’ human connection to the volunteers, and became an enthusiastic advocate for the program.” – Max Richtman, Letter to the Editor of the Washington Post

At the end of the letter to the editor, Max suggested that a certain occupant of the White House follow the Senator’s lead. 

Perhaps Mr. Trump should ride with a Meals on Wheels van and witness the profound benefits to our nation’s most vulnerable seniors.

That suggestion seems even more appropriate today, given that the President obviously has no problem defunding Meals on Wheels in his new budget.  Perhaps Mick Mulvaney should ride along with him.

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