Body Health, Mental Health, Politics

THE SENATE RELEASES THEIR HEALTHCARE BILL

Read my articles about the CBO analysis for the House bill here and the March AHCA bill here

In other news, before we get started—President Trump took to Twitter today to confirm that there were no tape-recordings of his conversations with former FBI Director James Comey; tapes he insinuated weeks ago he had.


Written when I was going to write about using self-tanner in preparation for New York Pride, and the realization that the healthy, sun-kissed glow I actually needed was for my soul—but more pressing matters have arisen.

This morning—Thursday June 22, 2017—the new healthcare plan was released after a cloud of mystery while it was being written in private by Senate Majority Leader Mitch McConnell and a small group of colleagues. The bill’s mystery was protested by Democrats and Republicans alike, who feared that this bill would be introduced and forced into a hasty vote before anyone had a chance to read it. according to CNN, the bill will have a one-week-turnaround, meaning that McConnell hopes to get it voted on within a week.

After a disastrous first attempt to vote on the original bill, the American Health Care Act, in March (the bill was pulled when it became clear that there were not enough votes for it to pass), the revised bill passed in the House of Representatives in early May. The next step was to bring it to the Senate for a vote, where GOP lawmakers such as McConnell revised and reworked the bill in an attempt to get it to pass in the Senate. If it passes the Senate, and then gets affirmed by the House, the bill would go to President Trump’s desk and, at his sign-off, become law. We good?

So, this morning, the bill was released. CNN also released an article comparing the three (the ACA, the AHCA, and the new bill) on key issues such as Medicaid expansion, coverage for pre-existing conditions, essential health benefits, Planned Parenthood and more. If you’re too lazy to read the article, here’s the major breakdown on some issues.

The Senate bill provides “skimpier coverage” for pre-existing conditions in states that get waivers for “essential health beneifts.” It allows states to redefine essential health benefits, which under the ACA were required for insurers to cover. These include mental health, maternity care and prescription drugs. The Senate bill cuts funding for Planned Parenthood for one year, which isn’t a surprise because the AHCA did that as well. It eliminates tax cuts for the wealthy and for insurers, taxes the ACA imposed to expand healthcare coverage. The ACA put a 3.8% tax on incomes $200,000 and higher ($250,000 for married couples). It gets rid of the individual insurance mandate, keeps the ACA provision for young people to remain on their parents’ insurance until 26, and removes the employer mandate to provide affordable healthcare to their employees.

At the moment, the bill can only afford to lose the support of two Republicans, which would put it at 50-50 and require a tiebreaking vote from Vice President Pence. As of writing this, four Republicans said they would oppose the bill in its current form and two more have withheld support.

The nonpartisan Congressional Budget Office is expected to release their independent findings on the bill early next week, a key component for some senators while considering their vote. The CBO will look at how many people could lose insurance under the new plan (24 million in the AHCA, and 23 in the House version) and the effects on the overall federal budget (the House bill would reduce the deficit by $119 billion).

In the near future, the bill will go into several hours of debate as well as something called the “vote-a-rama” where senators can suggest amendments that are relevant to the dialogue. The vote-a-rama can potentially go on indefinitely, but is largely centered on how long it takes for the senators to burn out and get tired. After all of that, the bill goes back to the House for affirmation, and if the House votes yes on it, then it goes to the White House. At the moment, it’s unclear if there’s enough support in the House for the bill to pass.

In the meantime, the public is reacting. Several dozen protestors were arrested Thursday after they staged a “die-in” outside of McConnell’s office. The protest was organized by the national disability rights group ADAPT. The cuts to Medicaid would greatly reduce access to medical care and services for the elderly and disabled. According to the police statement, several protestors removed themselves to “lay themselves on the floor, obstructing passage through the hallway and into nearby offices.”

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CB-OH NO: The Latest on the AHCA

The Congressional Budget Office releases its estimates on the new AHCA bill.


On May 24, 2017, the Congressional Budget Office (CBO) released new scoring for the latest iteration of the American Health Care Act. In their findings, the CBO and the Joint Committee on Taxation (JCT) estimated that over the next decade, the federal deficits would be reduced by $119 billion and that by 2026 23 million more people would be uninsured compared to the current law. Most of that 23 million would occur within the first year, with the CBO estimating that in 2018, 14 million people would be uninsured under the new bill (H.R. 1628).

The bill was passed in the House on May 4, 217 to 213 with 20 Republicans voting against and no Democrats voting for. The first attempt to pass the AHCA ended with Speaker of the House Paul Ryan (R-Wis.) pulling the bill hours before it was about to be voted on because it lacked the numbers to pass.

The new version passed without an official CBO score, having had mostly cosmetic tweaks to garner more support. According to The Atlantic, the AHCA stops states from “enrolling new people under Medicaid expansion” and it “incentivized states to drop the expansion altogether.” The new bill would also introduce per-capita caps on federal spending, reducing the number of people covered and their benefits. The AHCA also removes the employer mandate, which forces employers to provide affordable health insurance to 95% of their full-time employees and children up to the age of 26.

The bill also removes the individual mandate, which penalizes people who don’t sign up for health insurance. What this does, essentially, is take the burden off of healthy people who might not necessarily need insurance. But without those people paying into the system, the onus is on the sicker, older people to pick up the deficit.

The new bill also introduces a set of waivers: one that would allow states to “modify the requirements governing essential health benefits” (Remember that from last time?) and one that would allow insurers to “set premiums on the basis of an individual’s health status.” Roughly 1/6 of the population resides in areas where states would utilize those waivers and the result would be increasing difficulty for less healthy people to purchase insurance on account of rising premiums.

The waivers were the result of an amendment from Representative Tom MacArthur. Business Insider reported that it was the MacArthur amendment that gathered the support of 20 members of the Freedom Caucus, the conservation caucus that largely withheld support for the first AHCA on account of it being too lenient.

A CNBC article quoted Dr. Andrew Gurman, president of the American Medical Association, as saying, “Today’s estimates from the nonpartisan Congressional Budget Office show that last-minute changes to the AHCA made by the House offered no real improvements.”

The bill will now go to the Senate, where it requires at least 50 votes for it, thus leading to Vice President Mike Pence acting as a tiebreaker. Even with majorities in both chambers of Congress, and a 52-percent majority in the Senate, there is still the likelihood that the AHCA will not pass. Or that if it does, it will have to be severely rewritten to get any support.

Bottom line, even after months of rewriting, the AHCA bill has barely improved and, if anything, has gotten crueler by allowing states waivers on essential health benefits. Older, sicker Americans will see increased premiums and restricted care, and younger, healthier Americans won’t see any incentive to buy insurance. The GOP was more concerned with cosmetic Band-Aids to get conservative support than they were with crafting a bill that would benefit their constituents.

There is one bright side to the AHCA passing: this is probably the first time in months that Paul Ryan hasn’t had violent diarrhea from Congressional stress. Unfortunately, Congress-related diarrhea is no longer covered under the new plan.

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YES, IVANKA TRUMP IS COMPLICIT

News has broken that Ivanka Trump, the First Daughter with security clearance and an untitled job in the West Wing, met secretly with Cecile Richards, the president of Planned Parenthood, in what Richards described as an “explainer” meeting. According to Politico, the First Daughter has been doing several of these meetings, having “quietly met with other leaders of the progressive women’s movement.”

 

In a recent interview with Gayle King, Ms. Trump has this to say about her critics: “If being complicit is wanting to, is wanting to be a force of good and to make a positive impact, then I’m complicit…I don’t know that the critics who may say that of me, if they found themselves in this very unique and unprecedented situation that I am now in, would do any differently than I am doing.”

The “complicit” of it all refers to the Saturday Night Live sketch were Scarlett Johansson played Ivanka in a perfume ad (“Complicit: The fragrance for the woman who could stop all of this—but won’t.”).

Ivanka assured Gayle and the public at large that just because she hasn’t been vocal doesn’t mean she hasn’t been active. “I would say not to conflate lack of public denouncement with silence,” she told King. “I think there are multiple ways to have your voice heard.” And how has Ivanka made her voice heard?

 

Since Trump has been in office, he has rescinded federal protection for transgender students re bathrooms, defended Bill O’Reilly (who is accused by multiple women of sexual harassment), accused President Barack Obama of wiretapping, voiced his support for the American Health Care Act and even tried to dispense with maternity and pediatric care as a bargaining chip, and told Planned Parenthood that he wouldn’t defund them if they stopped performing abortions.

If Ivanka Trump is truly a “moderate” influence on her father, then either she’s doing a horrible job of it, or he’s way more batshit than we think and this is him “moderated.”

Either way, make no mistake—Ivanka is complicit. Because to not be complicit would be to actively speak out for what she believes in. “Complicit” looks like secret meetings with Planned Parenthood or quietly reaching out to women’s movements—when you arguably have one of the biggest platforms in America right now, and unprecedented access to the president and the private sector.

I find issue with organizations like The Hill who tweet out headlines like “Ivanka Trump: “I don’t know what it means to be complicit”.” Yes, that is a quote, but it’s taken out of context. And in addition to being misrepresentative and clickbait-y, it paints Ivanka Trump as an idiot. And the dangerous part—she’s not an idiot. She’s deadly smart. That’s why she’s dangerous: because she’s incredibly smart and savvy and still won’t do anything. In the same way that Kellyanne Conway is portrayed as ditzy—it’s a mistake to underestimate them. Kellyanne Conway is incredibly smart—she was able to see something in Middle America that everyone else, including (and especially) the Clinton campaign, did not.

Don’t let her off the hook because in comparison to everyone else in the White House, she’s moderate and progressive. Because she’s pretty and slim and wealthy and white. Because she’s a “working woman.” She’s not your friend, she’s not my friend. She’s not with us.

Yes, Ivanka Trump is complicit because “quietly” and “secretly” meeting with progressive feminists does not seem to be mitigating her father’s harmful rhetoric and policy. Because when you’re the First Daughter (and de facto First Lady) and your husband is a senior adviser to the President, you don’t get to do anything secretly and quietly. Everything you can be doing needs to be loud and outward. Because while you quietly chat with Cecile Richards, who later blasted Trump on her silence, women are having their bodies debated over by cisgender, privileged white men, and trans kids are holding in their pee to avoid physical assault, and your father is protecting the reputations of those accused of sexual harassment.

If this is your moderating force, it’s not going that well.

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THE AMERICAN HEALTH CARE ACT GOES TO VOTE TODAY, FRIDAY MARCH 24

Update 3/25: the American Health Care Act was pulled from the floor and did not go through the voting process. Speaker Ryan has stated that the Affordable Care Act will be the law for the “foreseeable future.” President Trump has since stated that he will wait for the ACA to “explode” and then create a “greater healthcare plan.”

Today, Friday, March 24, 2017, the House of Representatives will vote on the Affordable Care Act replacement bill—the American Health Care Act—with significant changes having been made last night and without the Congressional Budget Office analyzing those changes. Previously the CBO offered projections of, despite a decrease of ~$337 billion in the deficit, roughly 24 million people without coverage by 2026. Even by just repealing the ACA leaves 18 million people uninsured.

The bill underwent multiple changes after receiving severe blowback from all Democrats and several factions of Republicans. GOP moderates felt that the plan was too ill-thought and would leave too many people uninsured. GOP conservatives felt the bill did not go far enough, and dubbed it “Obamacare-Lite.” Those divides postponed the vote, which was supposed to take place yesterday. Ryan and other proponents of the bill did not want to go forward without the votes.

 

The new bill would defund Planned Parenthood. The rationale for this is restriction of abortions. However, Planned Parenthood puts no federal funding towards abortions. They do put federal funding towards reimbursement for services like birth control, contraception, and cancer screenings. Patients use public health programs, like Medicaid and Title X, go to places like Planned Parenthood that take that coverage. They use the programs, Planned Parenthood sends the claim to Medicaid (for example), which reimburses them, and then Medicaid sends the bill to the federal government. Abortions, which account for roughly 3 percent of all PP services, do not get reimbursed.

So when the GOP says that they will defund Planned Parenthood, they are doing it out of spite, because what they’re actually doing is stopping people from being able to use Medicaid for non-abortion services.

Vice President Mike Pence, formerly the Governor of Indiana, recently posted a photo of himself and the President meeting with the Freedom Caucus. The Freedom Caucus is made up of the GOP conservatives who are dragging their feet about the bill.

To get them on the side of voting yes, those in charge of the bill—House Speaker Paul Ryan, VP Pence, and even Trump—have struck a deal with the Freedom Caucus. If the Caucus agrees to the bill, the Essential Health Benefits list will be removed from the bill.

What’s the Essential Health Benefits?

It’s a holdover from the Affordable Care Act. It requires insurances to cover—at the bare minimum—the following 10 items:

  • Emergency Services
  • Hospitalization
  • Ambulatory patient services
  • Maternity and newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services

There has been no analysis on the future consequences on striking off the Essential Health Benefits because the CBO has not been given enough time to conduct research.

Trump has put pressure on the GOP to push this bill through. It would solidify his stance as a deal-maker—something he ran on during the campaign—and would show his control over the rapidly dividing Republican party. He has also threatened that the Republicans will lose their majority if the bill does not pass. That pressure has forced massive overhauls to the bill. House Republicans and Democrats are set to vote on a bill that they haven’t read in full, or had sufficient or significant research on.

But perhaps the scariest part of this whole thing is that photo that VP Pence Tweeted out. Him and the President meeting with the Freedom Caucus. With the strength of the Freedom Caucus, the American Health Care Act is that much closer to being passed.

A circle of wealthy, privileged, heterosexual cisgender white men, deciding the fate of women, minorities, cancer patients, those with mental illness, and the vulnerable. We might not have seen the finished bill, but we have seen enough of the consequences. The AHCA would mostly affect the elderly and sick—premiums would rise due to declining assistance—while the young, healthy and wealthy would see tax benefits. In addition, according to Forbes, over the next decade, the plan outlines an $880 billion tax cut, with $274 billion going directly to the richest 2%.

If the AHCA, the new healthcare plan, only benefits the young, healthy and wealthy, while leaving premiums rising, care decreasing, targeting the elderly and the sick, and ~24 million uninsured—then it’s possible that this isn’t the best plan.

But this is the world we live in—the decision of this small cluster of white men, for whom this healthcare plan will only benefit, will impact the rest of us.

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