Trump's Full Court Press on healthcare

[Holman]

Telling voters that you're going to take away their insurance is a risky proposition. Most who have employer-subsidized insurance like their plans. If you're going to nuke that, you have to be able to tell them what will replace it and how much it will cost. Democrats were treading on shaky ground until Trump said "I'm going to take away your insurance and replace it with something great. I have no idea what. Hey Congress, I command you to write something great now, mkay?"

The dilemma for Republicans is that Obamacare WAS their best plan. I don't think it's possible to design a better market-based model, given that the profit motive drives most of our system's excessive cost. If forced to invent another system based on private insurance, it's likely to look a lot like the ACA.

Expect them to do to the ACA what they did (but haven't yet, actually) to NAFTA: slight tweak + new name = MAGAcare!

[Isgrimnur]

WaPo

A federal judge in Washington threw a significant roadblock into the Trump administration’s efforts to compel poor people on Medicaid to work in exchange for health benefits, rejecting a Kentucky program for a second time while saying that rules in effect in Arkansas “cannot stand.”

The twinned opinions Wednesday afternoon, in a pair of states that have been national leaders in the move toward Medicaid work requirements, cast doubt on the Trump administration’s approvals of efforts to re-envision the public insurance program. The opinions undo the permissions that the U.S. Health and Human Services Department gave those two states, telling the agency it must reconsider the applications with an eye on the effect on poor people who depend on the coverage.

Judge James E. Boasberg of the U.S. District Court for the District of Columbia concluded that in letting Kentucky go forward with its requirements, HHS had been “arbitrary and capricious” — the same criticism he leveled once before. He wrote that he “cannot concur” that Medicaid law leaves the HHS secretary “so unconstrained, nor that the states are so armed to refashion the program Congress designed in any way they choose.”

The 48-page Kentucky opinion is the more emphatic of the two rulings. The judge walks through the reasons he remains unpersuaded by even a second set of arguments by the administration as to why the program should be allowed to go forward.

But the 35-page Arkansas decision has more immediate impact. It strips away the federal basis on which that state added work requirements last June that apply to more than 115,000 poor and working-class Arkansans under a part of Medicaid, known as Arkansas Works, that was expanded under the Affordable Care Act. So far, about 18,000 people have lost coverage for failing to meet the rules or failing to report to the state that they complied.

[gbasden]

Telling voters that you're going to take away their insurance is a risky proposition. Most who have employer-subsidized insurance like their plans. If you're going to nuke that, you have to be able to tell them what will replace it and how much it will cost. Democrats were treading on shaky ground until Trump said "I'm going to take away your insurance and replace it with something great. I have no idea what. Hey Congress, I command you to write something great now, mkay?"

The dilemma for Republicans is that Obamacare WAS their best plan. I don't think it's possible to design a better market-based model, given that the profit motive drives most of our system's excessive cost. If forced to invent another system based on private insurance, it's likely to look a lot like the ACA.

Expect them to do to the ACA what they did (but haven't yet, actually) to NAFTA: slight tweak + new name = MAGAcare!

I would swallow my pride and accept that in a heartbeat if it meant both parties cooperating to make the ACA actually work. And not try to actively sabotage it.

[Isgrimnur]

WaPo

President Trump signaled Monday night that he will not press for a vote on a bill to replace the Affordable Care Act until after next year’s elections, apparently heeding warnings from fellow Republicans about the perils of such a fight during campaign season.

In a series of late-night tweets, Trump continued to bash President Barack Obama’s signature health-care law but said a vote on a replacement would not occur until after the elections — suggesting that he believes he would still be in the White House and that Republicans would control both chambers of Congress at that point.

“Vote will be taken right after the Election when Republicans hold the Senate & win back the House,” Trump wrote. “It will be truly great HealthCare that will work for America.”

[Smoove_B]

I hope that anyone voting for the GOP thinking that they're going to reveal an awesome healthcare plan for American after repealing the ACA gets what they deserve.

[Kurth]

I hope that anyone voting for the GOP thinking that they're going to reveal an awesome healthcare plan for American after repealing the ACA gets what they deserve.

What? You don't think Trump has something really great he's about to roll out after 2020? You don't think he's been burning the midnight oil with the top people coming up with an innovative plan to address one of our most challenging and intractable problems?

[Zaxxon]

I hope that anyone voting for the GOP thinking that they're going to reveal an awesome healthcare plan for American after repealing the ACA gets what they deserve.

I think we're a little beyond hoping that the folks voting for the Leopards Eating People's Faces Party will ever overcome the cognitive dissonance involved in order to see whose faces are being consumed, aren't we? It's pretty clear that's never, ever going to happen.

[Smoove_B]

Most days all I have left is schadenfreude. It's not healthy, but it's been carrying me since 2016.

What? You don't think Trump has something really great he's about to roll out after 2020? You don't think he's been burning the midnight oil with the top people coming up with an innovative plan to address one of our most challenging and intractable problems?

It really cements my thought that he's a political carnival barker. Want to see what we have in store? Vote for us and I'll show you after we win - and not a moment sooner. But it's good - so good.

[The Meal]

Reality TV President.

[gbasden]

It really cements my thought that he's a political carnival barker. Want to see what we have in store? Vote for us and I'll show you after we win - and not a moment sooner. But it's good - so good.

Again, one would think that after he made this promise before and then had nothing to propose for the first two years of his administration that people would learn. But it's been proven over and over that people are stupid.

[Smoove_B]

Again, one would think that after he made this promise before and then had nothing to propose for the first two years of his administration that people would learn. But it's been proven over and over that people are stupid.

No, no. You're not remembering things correctly:

I was never planning a vote prior to the 2020 Election on the wonderful HealthCare package that some very talented people are now developing for me & the Republican Party. It will be on full display during the Election as a much better & less expensive alternative to ObamaCare...

[$iljanus]

Again, one would think that after he made this promise before and then had nothing to propose for the first two years of his administration that people would learn. But it's been proven over and over that people are stupid.

No, no. You're not remembering things correctly:

I was never planning a vote prior to the 2020 Election on the wonderful HealthCare package that some very talented people are now developing for me & the Republican Party. It will be on full display during the Election as a much better & less expensive alternative to ObamaCare...

Damn, the fluidity of Trumpspeak is something out of 1984. Except the rulers in the book have a malevolent intelligence about them. The Donald is just, well, a dimwit.

[Smoove_B]

Damn, the fluidity of Trumpspeak is something out of 1984. Except the rulers in the book have a malevolent intelligence about them. The Donald is just, well, a dimwit.

Weird, right?

"My first day in office, I am going to ask Congress to put a bill on my desk getting rid of this disastrous law and replacing it with reforms that expand choice, freedom, affordability," said Trump on Oct. 25, a day after he St. Augustine speech, in Sanford, Florida. "You're going to have such great health care at a tiny fraction of the cost. And it's going to be so easy."

and then right before the election:

“When we win on November 8th and elect a Republican Congress, we will be able to immediately repeal and replace Obamacare -- have to do it," said Trump, who also added, "Obamacare has to be replaced and we will do it and we will do it very, very quickly."

A campaign press release on the speech doubled down on the promise in its title: "Donald J. Trump pledges to immediately repeal and replace Obamacare."

So based on what he's saying now, I guess we can only assume then that he fully planned on repealing it the first day he was in the Oval Office, and then replacing it at some point in 2020?

[LordMortis]

I don't understand how he can use the same medium to flat out contradict himself and a single reasonable person can accept anything he says. Ever. I can't. It makes no. I.

[LawBeefaroni]

the wonderful HealthCare package that some very talented people are now developing for me & the Republican Party.

They're developing a health care package for the Ameican people.

[$iljanus]

the wonderful HealthCare package that some very talented people are now developing for me & the Republican Party.

They're developing a health care package for the Ameican people.

I suppose health care would be quite affordable if it only needed to cover the Leader and those in good standing with the party.

[Blackhawk]

Any health care plan is going to save a fortune if you can delay it long enough for the poor and those with preexisting conditions to die off.

[Unagi]

I'd think his proclamation that 'he isn't going to, and never even planned to implement or even discuss his solution to Healthcare until 2020, would be a great point for Dems to drive home to anyone that is currently struggling with healthcare.

It's an example (yet again) of Trumps seriously inferior negotiating/political skills (to declare his position like this, if nothing else) , and yet the Dems are very unlikely to make any political use of this tactical blunder.

[LordMortis]

It's an example (yet again) of Trumps seriously inferior negotiating/political skills (to declare his position like this, if nothing else) , and yet the Dems are very unlikely to make any political use of this tactical blunder.

You'd think George Soros would create a superpac that does nothing but broadcast his tweets on TV and Radio and Internet ads. Just a barrage that nothing but quote him.

[Skinypupy]

'Conscience Rights' for health care workers.

Moral and religious objections to providing health care sometimes arise in medicine: A medical assistant might not agree with blood transfusions. A nurse might not want to assist in sex reassignment surgery.

Last month, the U.S. Department of Health and Human Services put out a new rule that "implements full and robust enforcement" of existing laws that protect what the administration calls "conscience rights" for health care workers. The rule is set to go into effect on July 22.

As NPR has previously reported, the new rule expands the kinds of workers who are covered by those laws — to include, for example, reception and billing staff. Even though relatively few of these complaints get submitted to HHS each year, this emphasis on religious freedom has been a hallmark of the department under the Trump administration.

So what's the harm of a rule designed to affirm health workers' right to exclude themselves from providing medical care that they say violates their religious or moral beliefs?

"If the rule goes through as it's written, patients will die," says Santa Clara's county executive, Jeff Smith, who is a physician as well as an attorney by training.

"We will have a guaranteed situation where a woman has had a complication of an abortion, where she's bleeding out and needs to have the services of some employee who has moral objections," Smith predicts. "That patient will die because the employee is not providing the services that are needed."

So, do no harm...unless I believe that you're a filthy sinner according to my specific interpretation of my holy book of choice. In which case, fuck you, you're on your own.

[Jeff V]

So, do no harm...unless I believe that you're a filthy sinner according to my specific interpretation of my holy book of choice. In which case, fuck you, you're on your own.

You've nailed the essence of every religion that ever was. Intolerance is baked into every religion -- and something like this won't stop at workers refusing to treat abortion complications, but also homosexuals, other races, and above all other religions. People best not be outliers in their own community because if shit goes bad, they're on their own.

[Skinypupy]

So, do no harm...unless I believe that you're a filthy sinner according to my specific interpretation of my holy book of choice. In which case, fuck you, you're on your own.

You've nailed the essence of every religion that ever was. Intolerance is baked into every religion -- and something like this won't stop at workers refusing to treat abortion complications, but also homosexuals, other races, and above all other religions. People best not be outliers in their own community because if shit goes bad, they're on their own.

As a non-Mormon living in Utah, I’m keenly aware of this fact.

Thankfully, Mrs Skinypupy is still a member of the “tribe”, so we won’t get completely shunned if shit goes sideways.

[LawBeefaroni]

As NPR has previously reported, the new rule expands the kinds of workers who are covered by those laws — to include, for example, reception and billing staff.

That's insane. It's also unworkable.

[Isgrimnur]

As NPR has previously reported, the new rule expands the kinds of workers who are covered by those laws — to include, for example, reception and billing staff.

That's insane. It's also unworkable.

I'm fine with them not billing me for a procedure that they disagree with.

[Smoove_B]

Next up: protections for vegan and vegetarian butchers.

[Jeff V]

I would hope that it will at least be legal to ask if you have any moral objections that might prevent you from performing essential job-related tasks. If they say yes, have a nice day, bub-bye. If they say no and then come up with something after the fact, fire them for lying on their application (you are not, to be clear, firing them for their religious views).

[LawBeefaroni]

As NPR has previously reported, the new rule expands the kinds of workers who are covered by those laws — to include, for example, reception and billing staff.

That's insane. It's also unworkable.

I'm fine with them not billing me for a procedure that they disagree with.

Are you cool with them looking at your medical records to determine if a procedure code was for service related to a procedure they disagree with? Or just making blanket assumptions to be safe?

Example: an ob/gyn office visit could be routine or post abortion follow up. A D&C could he related to a miscarriage or an abortion. Do we want pearl-clutching, religious zealot office staff combing over dx codes to determine if they object to a 99213 or not?

[Isgrimnur]

That works fine in the big cities. Less so in one-doctor towns.

[Isgrimnur]

As NPR has previously reported, the new rule expands the kinds of workers who are covered by those laws — to include, for example, reception and billing staff.

That's insane. It's also unworkable.

I'm fine with them not billing me for a procedure that they disagree with.

Are you cool with them looking at your medical records to determine if a procedure code was for service related to a procedure they disagree with? Or just making blanket assumptions to be safe?

Example: an ob/gyn office visit could be routine or post abortion follow up. A D&C could he related to a miscarriage or an abortion. Do we want pearl-clutching, religious zealot office staff combing over dx codes to determine if they object to a 99213 or not?

I was being flippant. If you refuse to do your job, you need to be given the opportunity to find a different one, post haste. The protections of public accommodations should be extended to all healthcare services.

[LawBeefaroni]

I would hope that it will at least be legal to ask if you have any moral objections that might prevent you from performing essential job-related tasks. If they say yes, have a nice day, bub-bye. If they say no and then come up with something after the fact, fire them for lying on their application (you are not, to be clear, firing them for their religious views).

It's not legal and this new rule is set to increase enforcement and make it more difficult to get around.

[Isgrimnur]

Feds set to allow states to impose work requirements on Medicaid enrollees. Yes, there will be exemptions but this adds a ton of bureaucracy to the system and will dissuade many of the most vulnerable recipients (opioid addicts, mentally ill, etc) from enrolling and getting care.

New Hampshire

A federal judge on Monday blocked Medicaid work requirements in New Hampshire, ruling for a third time that the Trump administration hasn't adequately addressed the potential loss of health coverage for low-income residents.

The ruling by U.S. District Judge James E. Boasberg in Washington comes four months after he blocked similar work requirements in Arkansas and Kentucky.

The judge said "we have all seen this movie before" and criticized U.S. Secretary of Health and Human Services Alex Azar for acknowledging the potential impact without analyzing it.
...
While supporters argue that work requirements help participants achieve self-sufficiency, the judge ruled that they undermine the Medicaid program's mission of providing health care for the needy. In Arkansas, more than 18,000 people lost coverage last year, but were eligible to re-enroll in January. Boasberg said New Hampshire's program likely presents even greater coverage-loss concerns because it requires more monthly hours of work and applies to a wider age range of participants.
...
The Trump administration is appealing the earlier rulings involving Kentucky and Arkansas. A spokesman for the Centers for Medicare and Medicaid Services declined to comment Monday.

[Skinypupy]

And for today's news from Opposite Land, I bring you Senator John Cornyn:

Again and again, Democrats have refused to join Republicans in guaranteeing coverage for pre-existing conditions

Can these assholes just stop blatantly lying for even a single moment?

[LawBeefaroni]

And for today's news from Opposite Land, I bring you Senator John Cornyn:

Again and again, Democrats have refused to join Republicans in guaranteeing coverage for pre-existing conditions

Can these assholes just stop blatantly lying for even a single moment?

Can you blame them? It works. I don't know if it's because people are dumb enough to believe it or because they are willing to just accept the lies because it's their sportsball team. Doesn't matter, it works.

[Isgrimnur]

NPR

The Trump administration is outlining two possible ways certain drugs that were intended for foreign markets could be imported to the U.S. — a move that would clear the way to import some prescription drugs from Canada.
...
In one initiative, the Food and Drug Administration and HHS will rely on their rulemaking authority to use existing federal law to set up pilot projects from states or wholesalers "outlining how they would import certain drugs from Canada that are versions of FDA-approved drugs that are manufactured consistent with the FDA approval."

Separately, the FDA will work on safety guidelines for drug manufacturers who want to import any drugs they sell in foreign countries to the U.S. market. The HHS statement says manufacturers would use a new National Drug Code that could allow them to price drugs lower than what is required by their current distribution contracts.
...
Wednesday's announcement marks the first step in the process. It could take years to implement the plans — which could also be challenged in court.

A growing number of U.S. states have been considering their own plans to import prescription drugs from Canada, hoping to bargain for better deals than the current system allows.
...
There are already signs that some in Canada's medical industry would balk at the idea of sharing its supply of pharmaceutical drugs with the U.S.

"The Canadian medicine supply is not sufficient to support both Canadian and U.S. consumers," a coalition of health, hospital and pharmacy groups said in a letter to Canadian Minister of Health Ginette Petitpas Taylor.

The letter noted that Canada is allocated certain quantities of drugs based on national estimates, and warned that the county's prescription drug shortages could grow even worse if the U.S. begins to tap into its neighbor's supply.

[Smoove_B]

72% of All Rural Hospital Closures Are in States That Rejected the Medicaid Expansion:

Roughly 20 percent of Americans live in rural areas, including more than 13 million children, according to the last U.S. census. And, according to research and reporting by the Pittsburg Morning Sun and its parent company, GateHouse Media, those people have been steadily losing access to hospitals for years.

In Oklahoma, Georgia, South Carolina, and Mississippi, at least 52 percent of all rural hospitals spent more money than they made between 2011 to 2017. In Kansas, it's 64 percent, and five hospitals there shut down completely in that time. Since 2010, 106 rural hospitals have closed across the country. (Another 700 are "on shaky ground," and about 200 are "on the verge of collapse," according to Gatehouse.) Of those 106 that closed, 77 were in deep red states where local politicians refused the Obama administration's Medicaid expansion that came about as a result of the Affordable Care Act.

Everything is fine.

[Isgrimnur]

If the city dwellers won't move to the sticks to combat the rural red, eventually what's left of them will be forced to move into the cities.

[Jeff V]

If the city dwellers won't move to the sticks to combat the rural red, eventually what's left of them will be forced to move into the cities.

Oddly, I moved to a formerly red county that is on the fringe of civilization (my subdivision is surrounded by cornfields) and it did just that..,flipped blue in the midterms. The majority of political chatter on the county, town, and subdivision FB pages was very pro-blue.

[Smoove_B]

NPR

The Trump administration is outlining two possible ways certain drugs that were intended for foreign markets could be imported to the U.S. — a move that would clear the way to import some prescription drugs from Canada.

If only the Trump administration actually spoke with Canada before announcing their master plan:

The office of Health Minister Ginette Petitpas Taylor says while it remains in regular contact with counterparts from the U.S. Department of Health and Human Services about their “mutual interest” in fostering lower drug prices, details of the surprise announcement by Health and Human Services Secretary Alex Azar were not discussed beforehand.

“While we’re aware of ongoing state-led initiatives to import Canadian drugs, we weren’t consulted on specifics,” the office said in a statement.

...

“We may not have all the necessary tools in place,” Adams said. “If not, let’s be honest about that and let’s call Parliament back to a special session before the election to create the legal tools to protect the supply of patented medicines for Canadians and their health needs.”

Must have been a chapter in The Art of the Deal that I've never heard mentioned.

[malchior]

If Trump knows anything, it is 'Beggar Thy Neighbor'.

[Pyperkub]

A good look at employer sponsored health care as a tax:

The third source is employer-sponsored insurance, which covers about 159 million workers, spouses, and children. Employer insurance is very costly, with the average family premium running just under $19,000 a year. For average wage workers living in a family of four, this premium is equal to 26.4 percent of their total labor compensation. If you count this premium as taxes for international comparison purposes, the average wage worker in the United States has the second-highest tax rate in the developed world, behind the Netherlands. As with Medicaid, employer insurance is very unstable, with people losing their insurance plan every time they separate from their job (66 million workers every year) or when their employer decides to change insurance carriers (15 percent of employers every year).