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U.S. Healthcare


2017-SEP/OCT:
One Last Try to repeal Obamacare Fails.
Federal funding for the Children's
Health Insurance Program
(CHIP) lapses.

Part 20

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Medical symbols 1

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This topic is continued here from the previous page

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2017-SEP-25: Senator Susan Collins (R-ME) announces her firm opposition to the healthcare bill:

Her main concerns were the drastic cuts to Medicaid and the limits to protection of persons with pre-existing medical conditions.

With Senators John McCain (R-AZ), Rand Paul (R-KY), Susan Collins (R-ME) ready to vote against the bill, and Ted Cruz (R-TX) asking for changes before he would vote for the bill, its probability of passage appeared to be remote.

Thomas Kapland and Robert Pear of the New York Times wrote that Senator Collins' decision:

"... effectively dooms what had been a long-shot effort by Republicans in the Senate to make one more attempt at repealing the health law after failing in dramatic fashion in July.

For seven years, Republicans have said they would repeal President Barack Obama’s signature domestic achievement and replace it with a new health care system more palatable to conservatives. But they were never able to formulate a replacement that was both politically and substantively viable."

After the inauguration of President Trump, the Senate Republicans hoped to pass a number of laws, overturning many of the changes implemented by the Obama administration. But after almost eight months, even while holding control of the Presidency, Senate, and House, their accomplishments have been essentially zero. 2

There does not appear to be any wording for a healthcare law that would obtain the support of a majority of Senators at this time.

The article in The New York Times gathered 784 comments over night. Reader Jim Dickinson posted the following remark:

"So once again Senate Republicans appear destined to walk blindly into a wall, fall on their faces, and accidentally do the right thing. I find it amazing that only three among them seem to care at all about the health and welfare of the people who elected them. Even with a majority in both houses of Congress Republicans are unable to faithfully represent their constituent's best interests.

How pathetic, sad and depressing it is to be a citizen of the US in the age of Trump." 2

By late 2017-SEP, only a small handful of Republican Senators --  John McCain, Susan Collins, Lisa Murkowski, and Rand Paul -- were concerned about their constituents' loss of health care and premature death if the bill were passed. They had indicated that they would vote against the bill, thus making its passage impossible.

President Trump tweeted on the morning of SEP-27 that Republicans actually had the votes needed to pass the bill, except that one supporter was in the hospital and thus was unable to vote.  Matthew Yglesias, updating an article at Vox, responded:

"In reality, there is no hospitalized senator. But Trump has constructed for himself an alternative version of reality in which not only is there a hospitalized senator but the budget reconciliation instructions which expire tomorrow somehow return early next year, meaning that when the fake senator’s hospitalization ends they’ll be able to come back and pass the bill." 3

Also on SEP-27, Senate majority leader Mitch McConnell (R-KY) confirmed that there would be no vote on the Graham-Cassidy bill. It is now dead in the water. 3

Perry Bacon Jr, writing for Fivethirtyeight.com summarized the problems with all of the 2017 attempts to modify health care:

"Graham-Cassidy failed for the same reasons the various other Obamacare repeals have: It was too conservative for senators like Maine’s Susan Collins, insufficiently conservative for people like Kentucky’s Rand Paul and written in too much of a slapdash, partisan way for people like Arizona’s John McCain." 4

A preliminary assessment of the Graham-Cassidy bill by the Congressional Budget Office indicates that if the bill were passed into law:

  • Millions more people would lose their insurance, but an accurate number is unknown at this time.

  • Expenditures under Medicaid would be reduced by about $100 billion a year during the first decade.

  • Total federal expenditure on health care would be reduced by about 13.3 billion a year during the first decade.

  • Preserving the current regulations on insurance markets while reducing the funding that helps people pay for it would lead to an "unsustainable spiral." 4

  • In addition, the reduction in expenditures on health care by the federal government would have enabled a reduction in the income tax rate for the very rich. This, in turn, would keep campaign money flowing to individuals members of Congress from he rich.

On OCT-01, the reconciliation process ended. Any future attempts to revise the Affordable Care Act will require 60 votes in the Senate -- an impossible hurdle to overcome with the current makeup of the Senate. The bill has failed. The federal government is broken.

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2017-SEP-30: Congress allows federal funding for the Children's Health Insurance Program (CHIP) to lapse:

The federal CHIP program covers about 9 million children and 370,000 pregnant women per year who are in lower and middle income families and earn too much to be eligible for Medicaid. It is mainly paid for by federal funding.

Phil Galewitz. writing for National Public Radio, said:

"Though current authorization for spending has expired, states can use some of their unspent federal funding to continue their programs. Several states are expected to run out of money before the end of 2017, and most of the rest will run out by next summer. CHIP has been in this fix only one other time since it was established in 1997. In 2007, CHIP went weeks without funding authorization from Congress. 5

That lapse ocurred under the previous Republican presidency, George W. Bush.

Minnesota and Oregon will run out of funding at the end of October; Nevada perhaps by the end of NOV; Arizona, California, and a few other states by the end of 2017.

The Senate Finance Committee and the House Energy and Commerce Committees scheduled votes for early November, on a bill to extend CHIP funding. If passed, it would extend the program through 2022, but with a 23% reduction in funding starting in 2020. 6 Pregnant women and children appear to be a low priority for this administration.

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2017-OCT-12 to 16: President Trump attacks "Obamacare," and issues a false claim about it:

On OCT-12, he announced that subsidies for low income Obamacare users will be terminated. Senator Susan Collins (R-ME) said that this would threaten:

"... the ability of vulnerable peoplle to receive health care."

President Trump claimed that the Affordable Care Act (ACA) no longer exists. Addressing a meeting of his Cabinet, he claimed:

"Obamacare is finished. It’s dead. It’s gone. You shouldn’t even mention it. It’s gone. There is no such thing as Obamacare anymore."

In reality, Obamacare is still the law of the land. A sign-up period will run from 2017-NOV-01 to DEC-15 in most states. 7

Sadly, many uninsured people will probably interpret President Trump's statement literally, will not bother to try to enroll in Obamacare, and remain uninsured and vulnerable to untreated illness and death.

Jonathan Cohn, writing for Huffington Post, said:

"A critical mass of insurers has remained in the [ACA] program because, as of this year, their financials were finally improving and they could see the makings of the stable, profitable market that the law’s architects always envisioned. But that future was dependent on an administration that wanted the program to succeed. The Trump administration feels differently, and insurers will be thinking about that, hard, in the spring when they make their decisions about whether to stay in the program for 2019 and beyond. ..." 8

Trump has also reduced the ACA's advertising budget and the length of the signup interval, with the apparent intent of making the death of the ACA a self-fulfilling prophecy.

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More developments are probable.

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References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. Image © Gorelova downloaded from Dreamstime Stock Photos & Stock Free Images, image #9044646.
  2. Thomas Kapland & Robert Pear, "Health Bill Appears Dead as Pivotal G.O.P. Senator Declares Opposition," 2017-SEP-25, The New York Times, at: https://www.nytimes.com
  3.  Matthew Yglesias, "Trump keeps saying Graham-Cassidy failed because a senator’s in the hospital," Vox, 2017-SEP-28, at: https://www.vox.com/
  4. Perry Bacon Jr, "What Went Down In The Debate Over Graham-Cassidy," FiveThirtyEight, 2017-SEP-25, at: http://fivethirtyeight.com/
  5. Phil Galewitz, "Lapse In Federal Funding Imperils Children's Health Coverage," National Public Radio, 2017-OCT-03, at: http://www.npr.org/
  6. Jessie Hellmann, "House to vote on funding for Children's Health Insurance Program next week," The Hill, 2017-OCT-26, at: http://thehill.com/
  7. Igor Bobic, "Trump Says There's 'No Such Thing As Obamacare Anymore' One Month Before Enrollment Starts," Huffington Post, 2017-OCT-16, at: https://www.huffingtonpost.com/
  8. Jonathan Cohn, "Trump’s Latest Health Care Move Will Cause Pain, But Not For The Poor," Huffington Post, 2017-OCT-16, at: https://www.huffingtonpost.com/

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Copyright © 2017 by Ontario Consultants on Religious Tolerance
Originally posted on: 2017-SEP-24
Latest update: 2017-OCT-30
Author: B.A. Robinson
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