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U.S. Healthcare

2017-SEP/to mid-2018:
One Last Try to repeal Obamacare Fails.
Federal funding for the Children's
Health Insurance Program
(CHIP) lapses.
Feds will no longer defend key provisions
of the Affordable Care Act in court.

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 having 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 overnight. 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

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 estimate 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. In spite of every effort, Republicans have failed to reduce access to healthcare, to significantly reduce the average life span of people in the U.S. and to lower the taxes of the super rich. They must feel very frustrated.

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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 occurred under the previous Republican presidency of 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 people 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 his expectation of the death of the ACA into a self-fulfilling prophecy.

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2017-OCT-12: President Trump terminates some important payments to health insurance companies:

These payments were paid to health insurers so that they could offer lower health care premiums under Obamacare for low and middle income customers. Insurance companies had expected to receive about $10 billion in payments during 2018. This will force companies to increase premiums. This will undoubtedly cause many customers to cancel their health insurance.

Chuck Schumer, (D-NY) issued three tweets on the same day:

  • "Sadly, instead of working to lower health costs for Americans, it seems [that the President] ... will single handedly hike Americans’ health premiums."

  • "It is a spiteful act of vast, pointless sabotage leveled at working families and the middle class in every corner of America."

  • "Make no mistake about it, [the President] ... will try to blame the Affordable Care Act, but this will fall on his back and he will pay the price for it." 9

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2018-JUN-07: The Federal Justice Department announces that it will no longer defend important parts of the ACA (Affordable Care Act) in court:

Congress recently repealed that part of the ACA that fines individuals who have chosen to do without health care insurance coverage. In response, Texas and 19 other Republican-led state governments are suing the federal government. They claim that without this "individual mandate" payment, the entire ACA is unconstitutional. Meanwhile, California and some other Democrat-led states are defending the law in its original form.

One of the important functions of the Federal Justice Department is to defend all federal legislation whenever it is attacked in a court. On JUN-07, in a very unusual move, the Justice Department filed a brief in a Texas federal court announcing that they would no longer defend parts of the ACA, including:

  • The ACA's "individual mandate" requirement that everyone be protected under a health care plan, and

  • The requirement that insurance plans must cover all medical conditions.

Attorney General Jeff Sessions informed Congress that President Trump approved this withdrawal of support by the Justice Department.

The Trump administration agrees that -- by deleting the fine -- that part of the ACA that requires persons to have health insurance coverage is also unconstitutional. It, and other provisions should be removed. But they would like to retain that part of the ACA that covers the Medicaid expansion and retain some other parts of the law as well.

America’s Health Insurance Plans is a trade group organized by U.S. health insurance companies. They issued a statement saying that:

"Zeroing out the individual mandate penalty should not result in striking important consumer protections. Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019."

Lawyer Donald Verrilli Jr. once defended the ACA at the U.S. Supreme court during the Obama administration. He said that the Justice Department's policy is:

"... a sad moment. ... I find it impossible to believe that the many talented lawyers at the department could not come up with any arguments to defend the ACA’s insurance market reforms, which have made such a [positive] difference to millions of Americans."

Webmaster's comment:

I am certain that these "talented lawyers" are quite capable to reform the ACA. However, to create a path forward that Republicans and Democrats in Congress would accept is probably an impossible task.

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2018-JUN-08: Federal Justice Department attacks still another aspect of health care in court:

Back before the Affordable Care Act (ACA) was passed, health insurance companies would often refuse to insure people with some ongoing medical conditions or recent illnesses. Often, when they did offer insurance plans to those with pre-existing medical conditions, they excluded coverage for those illnesses, and/or made the premiums extremely high -- beyond many people's ability to pay.

The Affordable Care Act made these practices illegal. This has been a very popular feature of the ACA. As many as 130 million adults in the U.S. have pre-existing conditions. Jen Christensen, writing for CNN, said:

"As many as one in two Americans has some kind of illness or condition that was, at one time, considered a pre-existing condition by insurance companies before Obamacare. For older Americans, that percentage is even higher: About 86% of your aging parents and grandparents, Americans between the ages of 55 and 64, have one, according to government estimates.

A Kaiser Family Foundation poll in mid-2017 found that 70% of U.S. adults favored the protection of people with pre-existing medical condition(s). They felt that:

"The federal government should continue to prohibit health insurance companies from charging people with pre-existing health conditions more for their coverage." 11

In contrast, the poll found that only 26% felt that individual:

"States should be able to decide whether insurers can charge people with pre-existing health conditions more if they don't have continuous coverage." 11

Nicholas Bagley, formerly a Justice Department lawyer and currently a professor at the University of Michigan Law School, said that DOJ's move is troubling. He said:

"The Justice Department has a long-standing, durable, bipartisan commitment to defend [all] acts of Congress. It's a cornerstone of what they do. For the Trump administration to crumple that up and throw it out the window is galling." 12

By refusing to defend the ACA in court, the Justice Department is increasing the probability that future health care protection of many, most, or all people with pre-existing conditions will vanish or be priced out of reach.

Polls have been showing that the ACA is a major concern among voters. As November's midterm elections approach, Democrats in Congress are focusing on this topic as a major election issue.

, writing for the Washington Post, said:

"Now, the Justice Department’s stance in a federal-court case in Texas will allow Democrats to argue that Republicans want to deny affordable health coverage to some of the people who need it most. ..."

"The administration’s legal stance injects profound uncertainty into the political debate and the health-care landscape at a critical moment, just as insurance companies are developing rates for the coming year [2019] and as candidates head into a summer campaign season that both parties will try to use to solidify a foothold for their agendas. ..."

"Republicans on Capitol Hill had no advance warning that the administration was going to assert that protections for people with preexisting conditions is unconstitutional — a position that defies President Trump’s promises to maintain those protections." 13

Rep. Leonard Lance (R-NJ) said:

"I certainly do not believe the provision on preexisting conditions is unconstitutional. I don’t even understand what the legal argument would be. I have always favored coverage for preexisting conditions and will continue to do so." 13

Larry Levitt, a senior vice president at the Kaiser Family Foundation said:

"This lawsuit is less about altering the law and more about blowing it up." 13

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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/
  9. Dan Mangan, "Obamacare bombshell: Trump kills key payments to health insurers," CNBC, 2017-OCT-12, at: https://www.cnbc.com/
  10. "Justice Department takes aim at heart of health law," One News Now, 2018-JUN-08, at: https://www.onenewsnow.com/
  11. "Kaiser Health Tracking Poll - June 2017: ACA, Replacement Plan, and Medicaid," Kaiser Family Foundation, 2017-JUN, at: https://www.kff.org/
  12. Alison Kodjak & Susan Davis, "Trump Administration Move Imperils Pre-Existing Condition Protections," NPR/KPCC-FM Pasadena, CA, 2018-JUN-08, at: https://www.scpr.org/
  13. , " 'You’ve handed us an issue:' Democrats pounce on Trump administration’s health-care move," Washington Post, 2018-JUN-08, at: https://www.washingtonpost.com/

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Copyright © 2017 and 2018 by Ontario Consultants on Religious Tolerance
Originally posted on: 2017-SEP-24
Latest update: 2018-JUN-09
Author: B.A. Robinson
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