Wednesday, April 26, 2017

Last Call For A Plan So Bad Congress Doesn't Want It

There's really no more proof necessary that the House Republican health care plan know what, I can't even keep track at this point...the latest version, we'll call it, is so awful for ordinary Americans that House Republicans refuse to subject themselves to it. Vox's Sarah Kliff explains:

House Republicans appear to have included a provision that exempts Members of Congress and their staff from their latest health care plan.

The new Republican amendment, introduced Tuesday night, would allow states to waive out of Obamacare’s ban on pre-existing conditions
. This means that insurers could once again, under certain circumstances, charge sick people higher premiums than healthy people.

Republican legislators liked this policy well enough to offer it in a new amendment. They do not, however, seem to like it enough to have it apply to themselves and their staff. A spokesperson for Rep. Tom MacArthur (R-N.J.) who authored this amendment confirmed this was the case: members of Congress and their staff would get the guarantee of keeping this Obamacare regulations. Health law expert Tim Jost flagged me to this particular issue.

A bit of background is helpful here. Obamacare requires all members of Congress and their staff to purchase coverage on the individual market, just like Obamacare enrollees. The politics of that plank were simple enough, meant to demonstrate that if the coverage in this law were good enough for Americans than it should be good enough for their representations in Washington.

That’s been happening for the past four years now. Fast-forward to this new amendment, which would allow states to waive out of key Obamacare protections like the ban on pre-existing conditions or the requirement to cover things like maternity care and mental health services.

If Congressional aides lived in a state that decided to waive these protections, the aides who were sick could be vulnerable to higher premiums than the aides that are healthy. Their benefits package could get skimpier as Obamacare’s essential health benefits requirement may no longer apply either.

This apparently does not sound appealing because the Republican amendment includes the members of Congress and their staff as a protected group who cannot be affected by this amendment.

Oh and it gets better: that state waiver excepting the ban on pre-exsting conditions?  States have to opt-in as a default, which means the House's latest version of Trumpcare would allow states that implemented Obamacare but who are now controlled by Republicans dismantle protections for people preventing them from being charged extra for pre-existing conditions simply by doing nothing for 60 days.

House Republicans and their staff would of course remain protected.

But not the vast majority of Americans.

Fun, huh?

You're Outta Touch, I'm Outta Time

If these ABC/Washington Post poll numbers are true, then the Democrats have a massive problem on their hands heading into 2018, and it's one they'd better figure out how to solve, and fast.

Sunday’s Washington Post-ABC News poll did not contain a lot of surprises. President Trump remains historically unpopular, but the GOP almost universally supports him. Most voters still do not believe that Trump has the temperament to serve effectively as president. And like past presidents, respondents are split on whether Trump is keeping his promises. So far, so expected. 
But one finding in Sunday’s poll is a departure from past polls: The vast majority of Americans now think the Democratic Party is not “in touch with the concerns of most people in the United States.” The current number — only 28 percent think the party is in touch — has been noted elsewhere, and that number is concerning enough on its own: It’s 10 percentage points less than the number of people who think Trump is in touch and 4 percent less than the number who think the GOP is. But what hasn’t been commented upon is even more worrying for Democrats: In 2014, 48 percent of voters felt the party was “in touch,” a 20-percentage-point collapse in just three years
Yes, just three years ago the country was split down the middle about whether Democrats understood voters’ concerns, while only a quarter of voters thought the same about Republicans. Any reckoning of where the party goes from here has to account for this change in the public’s image of the blue party. Worse, it’s likely that the collapse has mostly come among independents and Democrats themselves — three quarters of independents and nearly half of Democrats think the party is out of touch, which can’t help turnout. Politics should not be about blindly following poll numbers, but when so many of your own supporters are rejecting the direction Democrats are moving, they may want to reconsider the course.

People understand that the Republicans are the problem right now.  What they don't believe, and overwhelmingly so, is that the Democrats offer more than zero solutions.  Right now more people believe Donald Trump, a possibly senile reality TV star who regularly lies whenever he can, is more in touch with America than the Democrats.

That's a problem.

That's not true, and not fair, but politics over the last 25 years hasn't exactly been fair, has it?   Dems need to get it in gear, and being mired down in internecine fights between factions since July hasn't helped.  It's time to get a unified message out there, and right now.

Luckily, I'm thinking that the Trump regime is the best ally for the Dems here, by constantly screwing up they'll start to become losers that nobody likes.

We'll see.

Meanwhile Here In Bevinstan

Since Republicans in Washington can't wreck Medicaid fast enough for Kentucky GOP Gov. Matt Bevin, his plan is to take the nation's most successful Medicaid expansion under Democrat Steve Beshear and turn it into some crazy deal involving coupons and rewards, because your health care should completely be like your grocery store loyalty card.

From a glance at Bevin’s proposal, it’s easy to mistake the “MyRewards” idea for an expansion of coverage. The changes are described as “benefit enhancements” in a new, detailed implementation proposal from the consulting firm Deloitte. 
Bevin’s plan is in fact a benefit cut. Kentucky’s Medicaid program currently includes vision and dental. If you’re eligible for Medicaid in Kentucky, then you’re eligible for coverage of regular tooth checkups and eye exams under state law. 
Bevincare would “enhance” Medicaid benefits by taking several of them away. You will lose the security of knowing your eye doctor and dentist will see you when you need them, and gain the exciting new opportunity to earn chits toward the cost of those same services. 
But to accrue those chits, you must live by Bevin’s rules. MyRewards points accumulate based on the enrollee’s participation in job training, health screening, smoking cessation, volunteer, and educational programs, at the rates listed below: 
CREDIT: Kentucky HEALTH Program Requirements Specification 
Bevin’s behavioral incentives effectively convert his definition of good character into a state-enforced moral code which everyone who can’t afford health insurance must follow — and whose compliance the state must monitor. 
This requires building a massive database about people’s individual behaviors, and then keeping it up. Never mind that it’s massively expensive, it also feels very invasive,” former Centers for Medicare and Medicaid Services (CMS) administrator Andy Slavitt said in an interview. “I’m not sure the government should be tracking if I put on five pounds, or if I’m advancing in my job, or what grade I got on my GED exam.”

It's weird, it's almost like the notoriously "libertarian" Bevin has a plan set up to make a government program so invasive and obnoxious that people won't want to put up with the hoops required to stay on Medicaid.  Why, it's almost like the GOP response to legal goods and services that they don't think the poor deserve is to make the requirements for getting it so impossibly high that few ever bother with the attempt.

Now if you want Medicaid services, you have to check in with Kentucky and sign up for job skills coaching, community service, job searching and more.  After all, the real goal isn't to get you healthy, the goal is to get you to the point where you no longer qualify for Medicaid and are no longer the commonwealth's problem.

We've got to gamify health care, after all.  And if you can't actually perform these activities, well, too bad.  No vision and dental coverage for you, in a state that already has one of the worst dental coverage rates in the nation.  Good job!

But that's the new game in town here in Bevinstan.


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