Category: Healthcare

Trump Endorses Repeal-First Strategy if Health Care Deal Not Reached

As Senate negotiations continue over the stalled Republican health care bill, President Donald Trump Friday morning called on senators to pass a simple repeal of Obamacare now and focus on replacing it later this year if no deal is reached.

Trump’s tweet came just after Sen. Ben Sasse, R-Neb., sent a letter to the White House urging the president to support a repeal-first, replace-later strategy if there is no agreement by the time senators return from their week-long Fourth of July recess on July 10.

The idea has been floated by some Republicans since a planned Senate vote on the GOP Better Care Reconciliation Act was postponed Tuesday because leaders were unable to secure the 50 GOP votes needed to pass it.

Sasse has been working quietly with the White House on the idea, according to a Senate Republican aide who said the administration was receptive to the idea.

“You campaigned and won on the repeal of Obamacare. So did every Republican senator. We should keep our word,” Sasse wrote in the letter.

“On the current path, it looks like Republicans will either fail to pass any meaningful bill at all, or will instead pass a bill that attempts to prop up much of the crumbling Obamacare structures,” he added. We can and must do better than either of these — both because the American people deserve better, and because we promised better.”

Sasse also asked the president to call on Congress to cancel its scheduled month-long August recess to work on a replacement bill for a Labor Day vote. “After we gave our word to repeal and replace Obamacare’s monstrosity,” he said, “we should not go back to our states during August as the American people struggle under fewer choices and skyrocketing costs. We should remain in D.C. at work.”

Sen. Rand Paul, R-Ky., who has publicly been advocating starting the idea of starting with a full Obamacare repeal publicly for two weeks, quickly retweeted the president and added his support.

Sasse has kept a low profile throughout the negotiations on health care, refusing to comment or publicly engage on the bill.

The idea was considered by Republican leaders at the beginning of this year when Trump took office but it was quickly dropped when they realized it would be too politically difficult to replace Obamacare outside the reconciliation process where the Senate would need the support of Democrats to pass a replacement.

Senate Republicans continue to discuss a way forward in the health care bill, considering changes to appear both moderates and conservatives to get the support of 50 of 52 Republicans.

[NBC News]

 

Trump posts misleading tweet about Medicaid spending under the Senate Republican healthcare bill

President Donald Trump took exception Wednesday with a Democratic argument regarding Medicaid funding in the new GOP healthcare bill.

“Democrats purposely misstated Medicaid under new Senate bill – actually goes up,” Trump tweeted with a chart.

One of the biggest criticisms of the Senate healthcare bill, the Better Care Reconciliation Act (BCRA), has been the projected cuts to future Medicaid spending under the legislation, which the Congressional Budget Office said would lead to 22 million fewer Americans being insured by 2026.

Trump’s tweet echoes an argument from Republicans that says the legislation doesn’t cut Medicaid spending.

But critics of the legislation note that the projected increase in funding from the federal government will be lower than the current projected rate of increase. This could have serious consequences for Medicaid recipients and state budgets.

Currently, the federal government provides states with a percentage of their Medicaid funding based on a formula of how much a state actually spends. Under the BCRA, states would receive a set amount of money based on the number of people on Medicaid in that state.

In other words, federal funding would grow in raw terms as the US population grows and the total number of people on Medicaid increases, but the amount per person would not be as generous as the current system.

The chart below shows the difference:

Also, the BCRA would end the Medicaid expansion program under the Affordable Care Act, the law better known as Obamacare, which would represent another significant decrease from the current path of funding.

The Congressional Budget Office projected that federal funding for Medicaid would decrease by $772 billion over the next 10 years compared to the current system.

According to analyses from The Brookings Institution, The Kaiser Family Foundation, and the CBO, the formula for the Medicaid growth rate under the BCRA would lead to increased financial stress on states and detrimental outcomes for Medicaid recipients.

[Business Insider]

Reality

Vox fixed the chart:

 

 

Trump has made the Department of Health and Human Services a center of false science on contraception

Contraception policy may not be the biggest target of the anti-science right wing — climate change and evolution probably rank higher — but it’s the field in which scientific disinformation has the most immediate consequences for public health.

So it’s especially disturbing that President Trump and Health and Human Services Secretary Tom Price have stocked the corridors of health policy with purveyors of conclusively debunked claptrap about contraception, abortion, pregnancy and women’s reproductive health generally.

That’s the conclusion of a new article in the New England Journal of Medicine identifying four Trump appointees as carriers of the disinformation virus. What makes them especially dangerous, says the author, bioethicist R. Alta Charo of the University of Wisconsin law school, is that the “alternative facts” they’re purveying could influence an entire generation’s attitude toward contraception, for the worse.

Among their themes is that condoms don’t protect against HIV or other sexually transmitted diseases and that abortions and contraceptives cause breast cancer, miscarriages and infertility. None of these assertions is true.

“The move toward misinformation at the level of sex education is dangerous,” Charo told me, “because you form instincts about what is safe very early in life.”

These appointments are all of a piece with Trump’s habit of staffing federal agencies with people actively in opposition to those agencies’ goals and statutory responsibilities — climate change deniers at the Environmental Protection Agency, corporate executives at the Department of Labor, and so on.

They’re also consonant with policies from the White House and Price’s office aimed at narrowing access to contraceptives by reducing government assistance to obtain them.

As Charo observes, the rate of unintended pregnancies has come down sharply, especially since the advent of the Affordable Care Act, which mandated that health plans make birth control available without co-pays or deductibles.

Price has defended reducing government assistance for contraception on the ground that “there’s not one” woman who can’t afford it on her own, but that’s plainly untrue; some long-lasting contraceptives such as Nexplanon or IUDs, can cost hundreds of dollars, a discouraging obstacle for many low-income patients.

Let’s take a look at the four horsewomen of disinformation on Charo’s list. What characterizes their approach to human reproduction, she says, is “rejection of the scientific method as the standard for generating and evaluating evidence.”

(We’ve asked both Charmaine Yoest, now the assistant secretary for public affairs at Health and Human Services, and the department for comment but have received no reply.)

Charmaine Yoest

Charmaine Yoest is now the assistant secretary for public affairs at HHS. Yoest is the former head of Americans United for Life, a prominent anti-abortion group. She and the organization promoted the claim that abortion increases a woman’s chance of breast cancer, a claim that was conclusively debunked by medical authorities years ago. The National Cancer Institute (a government body), declared in 2003 that thorough scientific studies “consistently showed no association between induced and spontaneous abortions and breast cancer risk.”

The same goes for the claim by Yoest’s group that abortion increases the risk of “serious mental health problems.” This notion is the basis for state laws requiring counseling before a patient is allowed to undergo an abortion. A study by UC San Francisco published last year found that the “greater risk” of “adverse psychological outcomes is faced by women denied an abortion. These findings do not support policies that restrict women’s access to abortion on the basis that abortion harms women’s mental health,” the study concluded.

Yoest was an architect of the strategy that led Texas to enact an anti-abortion law so extreme that it was slapped down by the Supreme Court last year on a 5-3 vote. The law placed heavy restrictions on abortion clinics, ostensibly to protect women’s health, that effectively shut many down. In his majority opinion, Justice Stephen Breyer essentially called that a subterfuge: “There was no significant health-related problem that the new law helped to cure,” he wrote.

Teresa Manning

Teresa Manning was appointed as HHS’ deputy assistant secretary for population affairs. Manning is a former lobbyist for the National Right to Life Committee and a legislative analyst for the Family Research Council. During a 2003 NPR interview, she said: “Of course, contraception doesn’t work. … Its efficacy is very low.” In fact, as Charo observes, hormonal methods are 91% effective, and IUDs are 99% effective.

In 2001, then as Teresa Wagner, Manning was quoted in a Family Research Council news release attacking prescriptions for the morning-after pill, which she characterized as an abortion method. She said doctors prescribing the pill were “accepting — and, in effect, — promoting promiscuity — the cause of the STD explosion, as well as the well known social problems of out of wedlock pregnancy and illegitimacy. We expect more from our doctors than collaboration with abortion advocates!”

Valerie Huber

Valerie Huber was appointed earlier this month as chief of staff to the assistant secretary for health at HHS. Huber is an abstinence advocate and the president of Ascend, a Washington group that advocates for abstinence-only sex education.

The problem there is that birth control experts have consistently found that abstinence education is ineffective at preventing teen pregnancies. In fact, just the opposite — a 2011 study at the University of Georgia reported that the “data show clearly that abstinence-only education as a state policy … may actually be contributing to the high teenage pregnancy rates in the U.S.”

Huber’s approach is moralistic. “As public health experts and policymakers, we must normalize sexual delay more than we normalize teen sex, even with contraception,” she told PBS last year. But studies consistently show that what reduces teen pregnancies is increased use of contraceptives.

Katy Talento

Katy Talento was named to Trump’s Domestic Policy Council. Talento has been the author of frequent anti-birth control screeds, including several that appeared on the Federalist, a right-wing website. Among them was an article whose headline called birth control “the mother of all medical malpractice,” and another asserting that women who took chemical forms of birth control risked “breaking your uterus for good,” ruining it “for baby-hosting altogether.”

Talento’s basis for this claim was what she called a “ground-breaking 2012 study” ostensibly showing that women who used birth control pills for several years had higher rates of infertility and miscarriage than those who did not. But as Jon Cohen of Science Magazine showed earlier this year, the study reported nothing of the kind — as its lead author confirmed. In fact, the researchers cited a study indicating that long-term use of the pill — five years — actually increased a woman’s subsequent fertility.

The lead author, Robert Casper, a Toronto fertility doctor, told Cohen that while his study found that using the pill sometimes led to thinner uterus linings, that wasn’t associated with more infertility or miscarriages — his study group was small and predisposed to fertility problems, he explained.

“The benefits of the birth control pill in preventing unwanted pregnancy or in treating painful menstrual periods far outweighs the rare possible case of thin endometrium,” Cohen wrote. “There is no evidence that the birth control pill is ‘seriously risky’ in terms of future reproductive health.”

As Charo observes, the “alternative science” underlying these appointees’ approach has infected public discussions of birth control and the courts. “Legislatures and even the Supreme court have tolerated individuals making up their own definitions for abortifacient [that is, abortion-producing] and pregnancy,” she writes, and then using them to justify refusing to fill prescriptions or offer insurance coverage for contraceptives.”

That was glaringly true in the Supreme Court’s egregious 2014 Hobby Lobby decision, which allowed owners of private companies to refuse to cover contraceptives under the Affordable Care Act. The Hobby Lobby plaintiffs specifically objected to four birth control methods — including IUDs and the morning-after pill because they produced abortions, which the plaintiffs found objectionable supposedly on religious grounds. But neither medical authorities nor the federal government classified those methods as abortifacients; the plaintiffs’ definition was accepted as gospel by Justice Samuel Alito, who wrote the opinion, which became the basis for allowing businesses to exclude all birth control methods from their health plans.

With adherents of similar viewpoints now ensconced in positions of responsibility in the Trump administration, their approach threatens to spread throughout government policy. But it’s no more based on legitimate science than it ever was.

[The Los Angeles Times]

Mick Mulvaney: The Day of the CBO ‘Has Probably Come and Gone’

During an interview with the Washington Examiner on Wednesday, Office of Management and Budget Director Mick Mulvaney trashed the Congressional Budget Office (CBO) as partisan and made a case that the country would be better off without it.

“At some point, you’ve got to ask yourself, has the day of the CBO come and gone?” Mulvaney said. “Certainly there is value in having that information, especially if they could return to their nonpartisan roots. But at the same time you can function, you can have a government, without a Congressional Budget Office.”

Mulvaney honed in on the CBO’s recently released analysis of the American Health Care Act (AHCA), passed by House Republicans last month and vociferously supported by President Trump. The nonpartisan office estimated that the AHCA will cost 23 million Americans their health insurance while dramatically increasing costs for older Americans and people with pre-existing conditions, in part because of the bill’s $834 billion cut to Medicaid over the next decade.

“Did you see the methodology on that 23 million people getting kicked off their health insurance?” Mulvaney said. “You recognize of course that they assume that people voluntarily get off of Medicaid? That’s just not defensible. It’s almost as if they went into it and said, ‘Okay, we need this score to look bad. How do we do it?’”

Mulvaney characterized the CBO’s analysis of coverage losses as “just absurd” and said, “ To think that you would give up a free Medicaid program and choose instead to be uninsured is counterintuitive.”

The CBO, however, doesn’t assume that people will “give up Medicaid.” Instead, it assumes people will lose Medicaid coverage nonvoluntarily because of eligibility lapses, raises at their jobs, and other developments that under the House Republican plan will cause them to become ineligible. Vox explains:

The AHCA would effectively end the Affordable Care Act’s Medicaid expansion by freezing federal support for it starting in 2020. Under current law, the federal government initially paid 100 percent of costs of Medicaid expansion beneficiaries, a percentage set to wind down to 90 percent in 2020 and stay at that level permanently. Under the AHCA, the federal government would keep paying for people who signed up for Medicaid expansion coverage before January 1, 2020, but not anyone who signs up after that.

Over time, this would also lead people currently enrolled to lose their benefits, and they wouldn’t be able to go back on the program thereafter. The AHCA drops funding for enrollees whose eligibility lapses for two or more months, and many working poor people cycle in and out of Medicaid as their income changes: They get a raise and no longer qualify for Medicaid; then they lose that job or take a pay cut and enroll again.

Mulvaney’s vision for a post-CBO America would involve his office taking the lead on estimating the impacts of major legislation — “I would do my own studies here at OMB as to what the cost and benefits of that reg would be,” he said.

But the danger of that approach was illustrated just last week by Trump’s budget proposal, which included a glaringly basic arithmetic error involving double-counting the estimated economic impact of tax cuts. Instead of acknowledging that double-counting the $2 trillion in savings was a mistake, Mulvaney told reporters that he and other Trump administration officials who worked on the budget did it on purpose.

When the first version of the AHCA was unveiled in March, Mulvaney tried to discredit the CBO before it even had a chance to release its analysis of the bill, arguing on ABC’s This Week that the CBO’s analysis of the Affordable Care Act (ACA) was off.

It wasn’t. FactCheck.org concluded that despite overestimating the number of people who who get subsidized insurance through ACA exchanges, the CBO “actually nailed the overall impact of the law on the uninsured pretty closely.”

The CBO “predicted a big drop in the percentage of people under age 65 who would lack insurance, and that turned out to be the case,” FactCheck.org wrote. “CBO projected that in 2016 that nonelderly rate would fall to 11 percent, and the latest figure put the actual rate at 10.3 percent.”

In short, Mulvaney, Health and Human Services Director Tom Price, and other AHCA-supporting Republicans are attacking the CBO simply because of its tough assessment of their preferred health care plan, which involves a huge tax cut for the rich.

What Republicans like Mulvaney are saying about the CBO during the Trump era is the opposite of what GOP members of Congress said when Bill Clinton was president. In the 1990s, Congressional Republicans demanded that the CBO score President Clinton’s budgets, dismissing his Office of Management and Budget as partisan.

During congressional testimony last week, Mulvaney, defending Trump’s budget proposal, made a case that the fiscal interests of the unborn should take precedence over the lives of present-day Americans — or at least those who rely on food stamps to eat or public schools to educate their children.

[ThinkProgress]

Reality

Mick Mulvaney trashed the CBO because they scored Trumpcare saying it would kick 24 million people off of their healthcare. That’s totally crazy because Mulvaney’s Office of Budget Management did their own calculations and came to the exact same conclusion.

It would be nice if The Washington Examiner called Mulvaney on his bullshit.

Trump: Senate Republicans Should Use the ‘Nuclear Option’ to Pass Healthcare and Tax Cuts

President Donald Trump on Tuesday said the Senate should get rid of the legislative filibuster so that it could pass healthcare and tax-cut bills.

“The U.S. Senate should switch to 51 votes, immediately, and get Healthcare and TAX CUTS approved, fast and easy,” Trump tweeted. “Dems would do it, no doubt!”

The filibuster allows senators to hold up legislation without a 60-vote threshold.

Changing the floor rules to end the filibuster has been considered a “nuclear option” for lawmakers, as it could come back to bite the GOP if the Democrats were to retake the Senate.

In recent years, however, the party in control of the Senate has done away with other filibusters in an attempt to circumvent the opposition. Democrats eliminated the filibuster for executive and judicial nominees in 2013. And in April, Senate Majority Leader Mitch McConnell scrapped the filibuster for Supreme Court nominees to confirm Trump’s nominee, Neil Gorsuch.

The GOP is circumventing a possible filibuster for its healthcare bill by introducing it using a process known as budget reconciliation. As long as the bill cuts the federal deficit, it is not subject to a 60-vote threshold.

Both the GOP healthcare bill, the American Health Care Act, and Trump’s tax proposals have faced unanimous opposition from Democrats.

Trump’s suggestions followed a series of tweets Tuesday in which he criticized Germany and attacked reports on ties between his campaign and Russian officials.

[Business Insider]

Donald Trump Thinks Health Insurance Costs $15 a Month

Donald Trump, the President of these United States of America, either believes that health insurance currently costs $15 a month or he believes that’s how much it should cost. This is according to an interview he did with The Economist on May 4, the same day the American Health Care Act passed the House. A transcript of the interview was published yesterday.

The interview was about economic policy, but they also discussed healthcare and the AHCA. One of the Economist editors pointed out that “some people will look at this bill and say, ‘hang on, a lot of people are going to lose their coverage.'” In Trump’s response, he said [emphasis added]:

You’re going to have absolute guaranteed coverage. You’re going to have it if you’re a person going in…don’t forget, this was not supposed to be the way insurance works. Insurance is, you’re 20 years old, you just graduated from college, and you start paying $15 a month for the rest of your life and by the time you’re 70, and you really need it, you’re still paying the same amount and that’s really insurance.

But I believe it’s very important to have this. Because one thing Obamacare did, is it gave that and it was a concept that people hadn’t heard of. And now I don’t want to end it. I don’t want to end it for somebody that…first of all I don’t want to end it for the people that already have it. And I don’t want to end it for somebody that hasn’t been buying insurance for all of his life where he has a guarantee that for all of his life he’s been buying the insurance and he can buy it inexpensively when he turns 65 or 70 years old. So we put in a tremendous amount and we’re…you know, for the pre-existing conditions. We are going to have a great pool for pre-existing conditions.

Before we even talk about the $15 figure, it bears repeating that the AHCA guarantees coverage for pre-existing conditions in name only, not in practice: The version that passed the House said people couldn’t be denied coverage but that states could choose to let insurers charge people more if they have pre-existing conditions. It would also let insurers charge older people up to five times more than younger people (the current limit is three times more). Trump and other Republicans swear up and down that additional money for high-risk pools will prevent people from being priced out, but multiple think tanks say it’s not nearly enough money.

Now, back to premiums. Trying to decipher exactly what Trump means is often a fool’s errand, but this response seems to have several possible interpretations. Is Trump confusing health insurance with life insurance, which could cost a healthy, 20-something person about $15 a month, according to Mother Jones? Possibly.

Or maybe he thinks people pay $15 a month for health insurance right now, but that is demonstrably false. The average monthly premium for people buying their own insurance was $235.27 in 2013, according to the Kaiser Family Foundation, and many people’s premiums have increased since then. But if it is $15 then why would premiums need to be lower, a point he’s been hammering since the start of his campaign? He even parroted that line later in his response to the question about people losing coverage, saying: “We’re going to have much lower premiums and we’re going to have much lower deductibles.”

Yet another possibility is that this is how much he thinks health insurance premiums should cost, as Sarah Kliff argues at Vox. Fifteen-dollar-premiums would certainly be much lower than what people are paying now, but it’s totally unrealistic and suggests he has no idea what he’s talking about. Unless, of course, he wants to bring something like Australia’s universal healthcare system to the US. After all, he told the Australian prime minister that it’s better than what we have.

[VICE]

Trump Attacks News Media Over ObamaCare Repeal Coverage

President Trump attacked the news media Friday night on Twitter over perceived negative coverage of the House GOP’s passage of legislation aimed at repealing and replacing ObamaCare.

“Wow,the Fake News media did everything in its power to make the Republican Healthcare victory look as bad as possible,” Trump tweeted. He also predicted the Republican plan would be “far better” than the Affordable Care Act.

In a second tweet, Trump questioned why the news media “rarely reports” that ObamaCare “is on its last legs and that insurance companies are fleeing for their lives?”

“It’s dead!” Trump declared, reiterating a longstanding position.

(h/t The Hill)

Reality

Maybe the Republicans should have put forth a bill that didn’t kick 24 million people off of healthcare, raise rates for the elderly, and allow insurance companies to discriminate based on preexisting conditions?

The reality is, when the CBO had a chance to score the first version of Trumpcare, it was very clear the insurance markets are stable. This idea that Obamacare is in a “death spiral” is pure fiction.

 

 

 

Trump: ObamaCare Will Die Without ‘Big Money’

President Trump said early Sunday that ObamaCare will die “far sooner than anyone” thought if it doesn’t receive federal funds to keep it going.

The president’s message comes just days before the Democrats and Republicans must agree on a federal budget or face a government shutdown.

Both parties are pushing for funding of their own priorities. The White House is pushing for funds to build a wall along the Mexican border and enhance border security, while Democrats hope to make more inroads in healthcare coverage.

White House officials have been publicly talking about the negotiations Sunday morning.

Office of Management and Budget Director Mick Mulvaney said Sunday that a government shutdown is not a “desired end.” He dodged questions about what would be acceptable to the administration in negotiations.

Secretary of Homeland Security John Kelly said the president will be “insistent” on border wall funding.

Congress must pass a spending bill by Friday to avoid a government shutdown.

Reality

This is an apparent threat to the possibility of ending federal subsidies to help lower-income people buy health insurance. This will remove 24 million people from health care.

 

Trump: ‘Nobody Knew That Healthcare Could Be So Complicated’

President Trump said Monday that “nobody knew that healthcare could be so complicated,” as Republicans have been slow to unite around a replacement plan for ObamaCare.

“I have to tell you, it’s an unbelievably complex subject,” Trump said after a meeting with conservative governors at the White House.

The GOP governors were in town this weekend for their annual conference and met with Trump to talk about a variety of things, but it’s likely the conversation largely focused on healthcare.

Governors have been split on what should be done with ObamaCare’s Medicaid expansion, which brought health coverage to many even in deep-red states.

Trump didn’t publicly address that issue Monday morning, but said ObamaCare’s repeal and replacement will give states more flexibility “to make the end result really, really good for them.”

“We have come up with a solution that’s really, really good I think. Very good.”

Trump also dismissed polls that show support for ObamaCare is at an all-time high.

The latest tracking poll from the Kaiser Family Foundation showed that 48 percent view the law favorably compared to the 42 percent who don’t.

“People hate it but now they see that the end is coming and they say, ‘Oh ,maybe we love it.’ There’s nothing to love. It’s a disaster, folks.”

(h/t The Hill)

Trump’s Tweet That ObamaCare Doesn’t Work Is Full Of Shit

Trump sent out an early morning tweet blasting the Affordable Care Act, also known as ObamaCare, by pointing out the increases in average prices from last year using one state as an example:

People must remember that ObamaCare just doesn’t work, and it is not affordable – 116% increases (Arizona). Bill Clinton called it “CRAZY”

However Trump used a state that decided not to fully implement ObamaCare, by neglecting to set up its own state-run insurance marketplace, which lead to higher rates. So this isn’t because of the design of ObamaCare, but how some mostly Republican states refused to fully implement it.

For comparison, states who fully implemented ObamaCare, such as California, saw only a 2% or less increase in rates, while Massachusetts and Indiana’s implementation was done so well they will actually see a drop in prices this year. States that were adversarial to a full implementation of Obamacare, like Arizona and Pennsylvania, will see the biggest price hikes, driving up the national average to a 22% increase nationally.

So don’t blame Obama for a massive price hike, but your state’s Republican governor.

But what Trump is also neglecting is that most Obamacare participants won’t feel the full price hike or anything near it, even in his cherry-picked state of Arizona.

Nationally, 85% of those enrolled receive a tax credit, which is based on the price of the second-lowest cost silver plan and an enrollee’s income. These subsidies put a limit on how much you have to pay.

Enrollees can also use their subsidies to buy lower-priced bronze or silver plans. That will allow more than three-fourths of current enrollees to pick a plan for $100 or less a month on the federal Healthcare.gov exchange.

 

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