Speaking for Millions Poised to Lose Healthcare, Doctor Confronts Trump in Tennessee
Advocating for a Medicare-for-All system, Dr. Carol Paris said the 'time is right' to do something that will make healthcare accessible for all people
by Lauren McCauley - Common Dreams
Giving a voice to the thousands who protested outside President Donald Trump's Wednesday evening appearance in Nashville—and the millions more poised to lose their healthcare—Dr. Carol Paris, head of a national organization of physicians dedicated to promoting healthcare for all, directly confronted the president and demanded he do better by the American people.
Cutting off Trump's speech as he lauded his administration's efforts to roll-back crucial health and environmental regulations, Paris, president of Physicians for a National Health Program (PNHP), held up a sign that read "Improved Medicare-for-All" while chanting: "Put your name on a plan that works: Medicare-for-All!"
In an interview with Common Dreams, Paris explained that she wanted to offer the president a chance to put his name on legislation that he could be proud of, "not this piece of doo-doo [House Speaker] Paul Ryan and [Health and Human Services Secretary] Tom Price are pitching"—referring to the American Healthcare Act (AHCA), which the Congressional Budget Office said would wipe out coverage for 24 million people by 2026.
Amid talks to replace the Affordable Care Act, or Obamacare, Paris said that the "time is right" to do so with something that will make healthcare accessible for all people, "not just the wealthy," as the AHCA is expected to do.
"People are dying," she said. "I'm a physician, I can't sit by and not speak up."
Paris explained how after Trump remarked last month that "nobody knew healthcare could be so complicated," she sent him a letter offering to meet with him about the simple single-payer solution. Receiving no response, Paris and other PNHP leaders penned an open letter explaining the benefits of such a plan. Again, no response.
"I have gone through the proper channels," Paris said, adding that her interruption was "just an attempt to be heard."
"I'm not doing this because it's fun," she continued. "I'm doing this because I want healthcare for everyone. Even people at the rally who booed me and probably think I'm crazy."
Indeed, Trump tried to brush off Paris' interruption Wednesday as just "one protester," saying: "One person and they will be the story tomorrow. Did you hear? There was a protester."
But that was not the case. Outside, an estimated 2,500 people were also demonstrating against the Republican plan to repeal and replace the Affordable Care Act (ACA), or Obamacare.
A coalition of organizations including Tennessee Citizen Action, Planned Parenthood, Tennessee Immigrant and Refugee Rights Coalition (TIRRC), the local Indivisible group, and the Tennessee Justice Center held a march and rally outside the city's Municipal Auditorium to register their opposition.
"Anyone who believed the GOP promises that people would still have health insurance under the Republican repeal plan now know that they were lied to; they are going to be left out in the cold," said LeeAnn Hall, co-director of People's Action.
Pointing to the $465 billion in tax cuts to the wealthiest tax payers as well as drug and other health corporations, Nashville resident Kathy Maxwell added: "This is a big tax cut for drug corporations, insurance companies, and the rich, paid for by taking health care away from 24 million people. None of us voted for that."
As Paris observed, the more that people learn about the Medicare-for-All or single payer healthcare plan, which would meet Trump's campaign promise of "insurance for everybody," the more they agree.
"There isn't anywhere I go that I'm not hearing...Medicare-for-All, that's what I really need," she said. "I literally cannot go into a grocery story line without hearing it. People may not understand it completely at first but as soon as I do my elevator pitch, they want it."
Even Trump supporters have expressed support for such a plan. Earlier this week, Sen. Bernie Sanders (I-Vt.) held a televised town hall with conservatives in rural McDowell County, West Virginia, who shared the sentiment that "healthcare is a human right."
And Jesus Said Unto Paul of Ryan ...
by Nicholas Kristof - NYT - March 16, 2017
A woman who had been bleeding for 12 years came up behind Jesus and touched his clothes in hope of a cure. Jesus turned to her and said: “Fear not. Because of your faith, you are now healed.”
Then spoke Pious Paul of Ryan: “But teacher, is that wise? When you cure her, she learns dependency. Then the poor won’t take care of themselves, knowing that you’ll always bail them out! You must teach them personal responsibility!”
They were interrupted by 10 lepers who stood at a distance and shouted, “Jesus, have pity on us.”
“NO!” shouted Pious Paul. “Jesus! You don’t have time. We have a cocktail party fund-raiser in the temple. And don’t worry about them — they’ve already got health care access.”
Jesus turned to Pious Paul, puzzled.
“Why, they can pray for a cure,” Pious Paul explained. “I call that universal health care access.”
Jesus turned to the 10 lepers. “Rise and go,” he told them. “Your faith has made you well.” Then he turned back to Pious Paul, saying, “Let me tell you the story of the good Samaritan.
“A man was attacked by robbers who stripped him of clothes, beat him and left him half dead. A minister passed down this same road, and when he saw the injured man, he crossed to the other side and hurried on. So did a rich man who claimed to serve God. But then a despised Samaritan came by and took pity on the injured man. He bandaged his wounds and put the man on his own donkey and paid an innkeeper to nurse him to health. So which of these three should we follow?”
“Those who had mercy on him,” Pious Paul said promptly.
Jesus nodded. “So go ——”
“I mean the first two,” Pious Paul interjected. “For the Samaritan’s work is unsustainable and sends the wrong message. It teaches travelers to take dangerous roads, knowing that others will rescue them from self-destructive behaviors. This Samaritan also seems to think it right to redistribute money from those who are successful and give it to losers. That’s socialism! Meanwhile, if the rich man keeps his money, he can invest it and create jobs. So it’s an act of mercy for the rich man to hurry on and ignore the robbery victim.”
“How hard it is for the rich to enter the kingdom of Heaven,” Jesus mused to himself. “It is easier for a camel to go through the eye of a needle than for a rich person to enter heaven.”
“Let me teach you about love, Jesus — tough love!” Pious Paul explained. “You need a sustainable pro-business model. And you need to give people freedom, Jesus, the freedom to suffer misery and poverty.”
“The Lord God has anointed me to bring good news to the poor,” Jesus replied, emphasizing the last two words. Then he turned to a paralyzed beggar at his feet. “Stand up!” Jesus told the man. “Pick up your mat and go home.” As the man danced about joyfully, Pious Paul rolled his eyes dismissively.
“Look, Jesus, you have rare talent, and it should be rewarded,” Pious Paul said. “I have a partner, The Donald, who would like to work with you: He’d set up a lovely hospital, and the rich would come and pay for you to heal them. You’d get a percentage, and it’d be a real money-spinner. Overhead would be minimal because every morning you could multiply some loaves and fishes. You could strike it rich!”
“Blessed are the poor, for theirs is the kingdom of God,” Jesus said. “But woe to you who are rich, for you have already received comfort.”
“Oh, come on, Jesus,” Pious Paul protested. “Don’t go socialist on me again. Please don’t encourage class warfare. The best way to help the needy is to give public money to the rich. That then inspires the poor to work harder, galvanizes the sick to become healthy, forces the lepers to solve their own problems rather than kick back and depend on others. That’s why any realistic health plan has to focus on providing less coverage for the poor, and big tax benefits for the rich. When millions of people lose health care, that’s when a country is great again!”
“From everyone who has been given much,” Jesus told him, “much will be required.”
“Well, sure, this hospital would have a foundation to do some charity work. Maybe commissioning portraits of The Donald to hang in the entrance. But let’s drop this bleeding heart nonsense about health care as a human right, and see it as a financial opportunity to reward investors. In this partnership, 62 percent of the benefits would go to the top 0.6 percent — perfect for a health care plan.”
Jesus turned to Pious Paul on his left and said: “Be gone! For I was hungry and you gave me no food; I was thirsty, and you gave me no drink; and I was sick, and you did not help me.”
“But, Lord,” protested Pious Paul of Ryan, “when did I see you hungry or thirsty or sick and refuse to help you? I drop your name everywhere. And I’m pro-life!”
“Truly, I say to you,” Jesus responded, “as you did not help the homeless, the sick — as you did not help the least of these, you did not help me.”
Democrats should offer solutions, not silence, on health care
by James Downie - Washington Post - March 16, 2017
In 2012, Barack Obama won Macomb County, Mich., by 16,000 votes. Four years later, Hillary Clinton lost the same county by three times that — a 64,000-vote swing in a state that Donald Trump won by only 10,000 votes overall. In February, Democracy Corps’s Stan Greenberg conducted a focus group in Macomb with Democrats and independents who shifted to Trump after voting at least once for Obama to see whether they might return to the Democrats in the future. What issue came up most? “The cost of health care dominated the discussion in these focus groups,” Greenberg writes. “They speak of the impossibly high costs and hope Trump will bring ‘affordable healthcare.’ ”
The GOP leadership’s disastrously designed replacement for Obamacare has only highlighted the fact that millions of Americans struggle with the rising costs of health care. Instead of offering their own plan to fix and build on Obamacare, though, Democrats have opted to simply let the Republicans fail. The strategy could cost them in the long run.
Even before the new president and Congress were sworn in, Democrats had settledon “stay quiet.” Politico reported in February that although Democrats will “publicly goad Trump on subjects he’s clearly sensitive about . . . on other issues, like Obamacare and tax reform, they’ll get out of the way and let Trump and House Republicans fall on their face.” With some exceptions, such as Sens. Chris Murphy (D-Conn.) and Bernie Sanders (I-Vt.), most of the Democratic caucus has stuck to that plan.
There is a certain logic to this approach. In a debate, you don’t interrupt while your opponent is floundering. Creating a Democratic alternative would give the GOP something to unite against. It could also alienate health-care-industry interests — doctors, hospitals, pharmaceutical lobbies and so on — that might otherwise rally to Democratic candidates.
But the cost of health care is not a news cycle to be won. It is a major, everyday problem that represents a key test for voters of whether a politician or party is serious about addressing their concerns. It’s not just Macomb voters who want answers: Two-thirds of Americans believe lowering health-care costs should be a “top priority” for lawmakers.
House Minority Leader Nancy Pelosi (D-Calif.) on March 13 said the House Republicans’ health-care plan “doesn’t achieve anything it sets out to do.” (Reuters)
The Affordable Care Act’s defenders will point out that the main goal of the law was to reduce the number of uninsured, that the law probably slowed the rise of premiums and that most people with plans purchased on the ACA exchanges are happy with their premiums and deductibles (though that majority has shrunk since the exchanges opened). All these arguments are true. They are also cold comfort to people facing still-rising costs, with premiums for employee plans climbing 50 percent in the past eight years. This is reflected in the fact that, even as the ACA’s approval rating ticks into positive territory for the first time, few believe the law is perfect. In a February NBC/Wall Street Journal poll, only 4 percent of respondents said they thought the law was “working well the way it is.” In poll after poll, most who support the law still say it needs fixing.
This is where Democrats will shout: “Clinton did have a health-care policy!” That’s true, but her campaign didn’t make much use of it. A recent study found that more than 60 percent of the ads Clinton and her allies ran were focused solely on the candidates’ personalities, rather than policy, “a huge difference from every other presidential campaign” since 2000. (Yes, that includes Trump — 70 percent of his side’s ads had at least some mention of policy.) It should not be surprising that Clinton’s health-care plans didn’t move most voters.
Even some conservatives recognize that the GOP rollout leaves an opening. On Tuesday, Trump ally Christopher Ruddy, chief executive of the conservative media company Newsmax, wrote that Trump “should be sticking to his guns on healthcare reform” — i.e., his repeated support for universal coverage — instead of following the House GOP’s plan. Ruddy goes so far as to suggest that Trump back a Medicaid-for-all plan. After all, Ruddy points out, that position helped “him win Democratic states like Wisconsin, Michigan and Pennsylvania.”
Rather than stay on the sidelines, Democrats in Congress should introduce and promote a new health-care plan. The outlines of such a plan are straightforward: expand Medicare and Medicaid, create a public option for everyone else that can use those programs’ pricing power, push regulatory reforms to lower drug prices, and give Medicare the power to negotiate prescription drug prices. Many progressives would prefer a Medicare-for-all system, but this plan would satisfy most of the party, and it has the political advantage of being closely tied to the extremely popular Medicare program.
The Make Inequality Worse Act of 2017
by E.J.Dionne, Jr. - Washington Post - March 15, 2017
“The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.”
Novelist Anatole France’s mischievous observation came to mind when the Congressional Budget Office released its analysis of the Republican cut-taxes/gut-Medicaid bill and its defenders went into a continuous loop talking about “freedom.” Conservatives are fond of saying that freedom isn’t free. This is entirely true, especially when it comes to health care.
Republicans speak of the wondrous things that will happen if they succeed in slaying the monster known as “Obamacare.”
House Speaker Paul Ryan (R-Wis.) offered this rush of animated words to conservative radio host Hugh Hewitt: “You need to have an individual market where people care about what things cost, where people have real freedom, where those providers of health-care services, be they insurers, doctors or hospitals and everybody in between, compete against each other for our business based on value, based on price, based on quality, based on outcome.”
Ryan spoke to Hewitt shortly before the CBO concluded that under his legislative contraption, 24 million fewer people would be insured over the next decade. Ryan dismissed the CBO in advance by accepting that the coverage numbers would, indeed, drop because people would be able to exercise a newfound right to be uninsured, much as they might be liberated to sleep under bridges or beg in the streets.
House Speaker Paul D. Ryan (R-Wis.) on March 15 said “necessary improvements” can be made to the House Republicans’ health-care plan now that the Congressional Budget Office has released its report on the proposed legislation. (Reuters)
“We’re going to have a free market, and you buy what you want to buy,” Ryan said. “They’re going to say not nearly as many people are going to do that.”
Left-wingers are often cast as dreamy utopians, but it’s Ryan and his allies who pretend they can create a capitalist paradise in health care — something that not one wealthy capitalist country has ever done, because the health-care market is not like any other.
Older people, for example, are not an ideal market for private insurance companies. That’s why we have Medicare. Lower-income people can’t afford to pay the full cost of a decent insurance policy. That’s why we have Medicaid, and why the Affordable Care Act subsidizes policies from private insurance companies.
Slash Medicaid and take away the subsidies and, presto, the ranks of the uninsured mushroom. There is thus something unseemly about Ryan declaring that he is “so excited” about eviscerating Medicaid. “We are de-federalizing an entitlement, block-granting it back to the states and capping its growth rate,” he told Hewitt. “That’s never been done before.”
Of course, maybe it’s “never been done before” because enough politicians stood up to resist the cruel idea of tossing so many people overboard.
Defenders of this proposal try to argue that health “care” is radically different from “coverage.” They must think the American people are dunderheads.
House Minority Leader Nancy Pelosi (D-Calif.) on March 13 said the House Republicans’ health-care plan “doesn’t achieve anything it sets out to do.” (Reuters)
House Speaker Paul D. Ryan (R-Wis.) on March 15 said “necessary improvements” can be made to the House Republicans’ health-care plan now that the Congressional Budget Office has released its report on the proposed legislation. (Reuters)
President Trump has introduced his budget plan, but that's just the beginning of the appropriations process. The Washington Post's White House economic policy reporter Damian Paletta explains what happens next. (Photo: Jabin Botsford/Video: Jenny Starrs/Photo: Jabin Botsford/The Washington Post)
Companies Behind Health Savings Accounts Could Bank On Big Profits Under GOP Plan
by Chad Terhune and Julie Appleby - Kaiser Health News - March 14, 2017
Health savings accounts are poised for a major expansion by Republicans in Washington, D.C., and that could mean millions more customers — and fees — flowing to a handful of companies.
Investors are betting on it, bidding up shares of HSA provider HealthEquity by about 35 percent since the November election. It’s one of the best performing stocks on Wall Street since Donald Trump won the White House.
Another big beneficiary might be Optum Bank, the industry leader, with more than 3 million of these accounts and about $7 billion in assets it manages for consumers. It’s owned by the nation’s largest health insurer, UnitedHealth Group.
For years, these companies and others have been lobbying lawmakers for changes that could become reality with a Republican-controlled Congress and Trump administration.
The GOP health law replacement plan introduced Monday in the House reflects the party’s broad consensus for giving more Americans access to HSAs, which allow people to put aside money tax-free for medical expenses.
“There is an excitement in the business now,” Dr. Steve Neeleman, founder of Utah-based HealthEquity and a former trauma surgeon. “There are definitely things Washington can do to make HSAs more enticing to a broader market.”
Health saving accounts were introduced in 2003 in legislation championed by President George W. Bush. Enrollment has grown steadily to nearly 21 million accounts with $41 billion in assets, according to the Devenir Group, a research and consulting firm that tracks the industry.
Still, that number is a small fraction of the 178 million people who have health insurance through their jobs or purchase it on their own.
Industry officials are eager to reach new markets, including baby boomers in Medicare and enrollees in the military’s Tricare system, for whom — under current law — HSAs are off-limits. They also want to manage larger accounts that generate more revenue. Republican proposals in Congress could help accomplish both.
Proponents say consumers with HSAs may be more judicious in using services and seeking lower prices because their own money is at stake. Backers also like the tax breaks: There’s no tax on the funds’ investment gains or on withdrawals if spent on medical care. But critics note this treatment favors the wealthy as those with lower incomes often struggle to afford health care and have little to set aside in savings accounts.
A 2015 study found that high-income households were considerably more likely than low-income to contribute to HSAs. The highest-income tax filers were also substantially more likely to fund their accounts fully.
Under current law, HSA accounts must be paired with a high-deductible health plan. Individuals can contribute as much as $3,400 annually, or $6,750 for families. Unused balances roll over to the following year, and consumers can take the account with them when they leave an employer, much like a 401(k) retirement account. Some employers contribute to HSAs on behalf of their employees.
It’s already a lucrative business. In a February investor presentation, HealthEquity touted a gross profit margin of 57 percent on its 2.7 million health savings accounts. And the company said the accounts become more profitable over time, reaching a 72 percent profit margin six years in as costs decrease and balances grow.
The House Republican plan proposes to nearly double the HSA contribution limits to $6,550 for individuals and $13,100 for families beginning in 2018. Meanwhile, in the Senate, other proposals — including one by Sen. Rand Paul (R-Ky.) and anotheradvanced by Sens. Bill Cassidy (R-La.) and Susan Collins (R-Maine) — lay out slightly different yet favorable treatment of HSAs.
The over-65 market in Medicare is a prime target for expansion.
“That is a great population that has the potential to save and really take more control over their health care,” said Eric Remjeske, president of the Devenir Group, the research and consulting firm.
Neeleman agreed and said it’s wrong to shut out thousands of baby boomers who are retiring every day. “It’s just not fair,” he said. Backers note that, even though Medicare is not a high-deductible health plan, there is cost sharing in Medicare, which leads many in Congress to think the prohibition should be abandoned.
The companies overseeing these accounts rake in money from a variety of fees, much like banks do.
Often consumers pay service fees that range from $2 to $5 per month for each account. The companies also earn interest on the customers’ money they manage in what’s known as “custodial” revenue. And HSA administrators collect fees from merchants when consumers use company-issued debit cards to pay for medical expenses out of their accounts.
At HealthEquity, the second-largest HSA provider, about half of its revenue comes from service fees and the rest derives from custodial revenue or debit fees, according to its annual report. Companies can also earn fees from mutual funds offered to customers as investment options. In the workplace, some employers cover some or all of the fees for workers.
Neeleman said that HealthEquity and other firms provide an important service and that they’re upfront about the fees they collect.
In addition to well-heeled retirees on Medicare, companies running these accounts also see opportunity among lower-income households.
Several states have experimented with adding savings accounts in Medicaid, the state-federal insurance program for the poor. Vice President Mike Pence embraced this idea while he was governor of Indiana. Medicaid members in Indiana can get additional benefits such as vision and dental coverage if they make small monthly contributions to accounts similar to HSAs. However, debate continues as to how effective the approach will be for this population.
Industry officials doubt they will get everything on their wish list from Congress. For instance, unlimited contributions to tax-free accounts could cost the federal government too much in revenue and invite more criticism that HSAs are a tax shelter for the rich.
Kevin Robertson, a senior vice president and director of sales for HSA Bank, the industry’s third-largest company, said some proposals are “more likely wishful thinking” but the overall direction is unmistakable as the GOP pushes a market-driven approach to health care.
“The political and economic winds are favorable and most definitely pushing HSAs,” he said.
While GOP Fumbles Obamacare ‘Replacement,’ Bernie Sanders’ Medicare-For-All Would Save $6 Trillion
by Tim M. Chambers - March 11, 2017
While Republicans fumble around with their “replacement” for Obamacare, Sen. Bernie Sanders (D-VT) has had the answer all along: Medicare-for-All.
The senator from Vermont released the details on his plan last year, just before the fourth Democratic presidential debate in Charleston, S.C. The Washington Post explains Sanders’ plan would provide health insurance to all of us through our Medicare program.
The Medicare-for-All plan would cost $1.38 trillion a year, but would save most of us thousands of dollars every year on healthcare costs. Gerald Friedman, an economist from U-Mass. Amherst, estimates a family earning $50,000 a year would save nearly $6,000 each year.
Furthermore, WaPo adds, a single-payer plan for universal healthcare would save us $6 trillion over the next 10 years:
Friedman estimated that Sanders’s Medicare-for-All plan would save $6 trillion over the next 10 years compared with the current system, in large part by eliminating what the Sanders campaign described as “expensive and wasteful private health insurance.”
That’s right. Having a single-payer healthcare system — like all the other advanced nations in the world do — would save us a whopping $6 trillion over the next 10 years.
Compare that to the GOP’s plan to repeal Obamacare. The non-partisan Committee for a Responsible Federal Budget (CRFB) crunched the numbers and found “a full repeal of Obamacare would cost $350 billion over the next decade.
In his statement on his Medicare-for-All plan, Bernie Sanders
“Universal healthcare is an idea that has been supported in the United States by Democratic presidents going back to Franklin Roosevelt and Harry Truman. It is time for our country to join every other major industrialized nation on earth and guarantee healthcare to all citizens as a right, not a privilege.”
So how would we pay for all this? The marginal tax rates for people making over $250,000 a year would go up a few points to 37 percent a year. The tax rates would then scale up over three additional tax brackets to 52 percent for those who make $10 million a year or more. The current top rate is a measly 39.6 percent.
Taxes on income we don’t work for — such as inheritances, capital gains, and dividends — would also go up. Employers would pay a new 6.2 percent payroll tax and the rest of us would pay a 2.2 percent healthcare tax based on our federal income taxes.
Of course, that’ll make a lot of us scream about paying higher taxes. But here’s the thing: When we pay inflated amounts to for-profit companies for what other countries provide as public services, that amounts to an invisible tax. Only instead of investing that money in our own well-being and that of our neighbors, we’re paying it to huge corporations.
Conservatives love to go on about how for-profit companies can provide goods and services more efficiently and cost-effectively than the government. But that’s utter nonsense. For starters, there’s no way the private sector can compete with the public sector on costs when they’re paying their CEOs millions of dollars each year.
Meanwhile, stingy old Uncle Sam only pays Patrick Conway, MD, MSc $170,000 a year. And he’s the top dog at the Centers for Medicare & Medicaid Services and a Level III executive on the U.S. government pay scale.
What can health insurance company CEOs possibly be doing that’s worth tens of millions of dollars?
Obamacare still has problems. In 2016, 29 million of us still lacked health insurance. We still pay more per per person for our healthcare than any other country and receive among the worst results. Plus, many of us still complain that our health plans cost too much, don’t cover enough, and that the healthcare exchanges are too hard to navigate.
These problems are a direct result of for-profit health insurance and drug companies jacking up prices. And who can blame them? They don’t exist to keep us healthy, they exist to churn out profits for their top brass and their shareholders.
Oh, and then we’ve got Republican governors who’d rather screw their own citizens than expand Medicare in their states. Our GOP-led Congress also refuses to let Medicare bargain down drug prices, refuses to increase subsidies, and refuses to allow a public option.
Forcing struggling Americans to bear the costs of a shifting economy in which many employers no longer provide steady, full-time jobs with benefits is cruel, unjust, and costly.
WATCH: Bernie Sanders’ Medicare-for-All plan explained.
The Medicare-for-All plan Bernie Sanders unveiled during the fourth Democratic debate with Hillary Clinton and Martin O’Malley is based on the American Health Security Act (S. 1782) bill he introduced back in 2013.
This article originally appeared on Samuel-warde.com
Trumpcare’s Lonely, and Seedy, Supporter
by David Leonhardt - NYT - March 17, 2017
The Republican health bill doesn’t have many outside supporters. Groups representing doctors, nurses, hospitals, retirees, patients of various diseases and even insurers have all criticized it. Some of the only outside praise has come from the chief executive of Anthem, the country’s second largest insurer.
And therein lies another tale of the Trump administration’s conflicts of interest.
It turns out that one of the bill’s few high-profile fans may not even support it on the merits. Instead, Anthem appears to be providing political cover to the administration at the same time that company officials are lobbying the administration for a favorable decision on another matter. It’s pretty brazen.
Here are the details: Anthem, which is based in Indiana, is already the largest insurer in California, Kentucky, Virginia and elsewhere. Two years ago, its chief executive, Joseph Swedish, made a big bet. He decided to put public pressure on Cigna, another major insurer, to accept a merger. Eventually, Swedish succeeded, and Anthem agreed to pay $48 billion to buy its rival.
But the Obama administration’s Justice Department filed suit against the merger, arguing that it would force consumers to pay higher prices. Last month, a federal judge agreed and blocked the merger. Cigna isn’t happy with the deal anymore either and has filed a $14 billion lawsuit against Anthem. None of it makes Swedish look good.
Anthem’s best remaining hope for the deal is probably to persuade the Trump administration to take a different view of the merger and unblock it.
Against this backdrop, Swedish wrote a carefully worded letter last week to Congress praising the Republican health bill. He stopped short of supporting the entire bill, as Jordan Weissmann of Slate has noted. Rather, Swedish lauded a few provisions (which would clearly help Anthem’s bottom line) and offered enough kind words that the White House could claim Anthem supported the bill.
“The time to act is now,” Swedish wrote. The bill, he added, “will ensure more affordable health plan choices for consumers in the short term.” More objective evaluators of the bill — like the Congressional Budget Office — are less sanguine.
Regardless of its accuracy, though, the letter seemed to make the White House happy. “Progress on repeal & replace: Major insurer supportive,” Kellyanne Conway tweeted, linking to Politico’s story about the letter.
More significantly, President Trump and Tom Price, the Health and Human Services secretary, granted Swedish a private meeting this week. At it, Swedish lobbied for changes to the bill that would benefit Anthem, according to reports in Bloombergand Modern Healthcare.
Anthem’s chief financial officer, John Gallina, all but bragged the next day at an industry conference about the meeting’s success: “We feel very good, very encouraged, by the fact that the president and his team are listening and actually making changes based on feedback that the industry is providing.”
It’s too early to know whether his self-interested optimism is warranted. The health care bill is in enough political danger that no version of it may pass, and the Anthem-Cigna merger may likewise be unable to come back from the dead.
But the episode is important because it shows both how big companies play political hardball and how unconcerned the Trump administration is with basic government ethics. That second point isn’t a partisan one. Top ethics advisers to both George W. Bush and Barack Obama have repeatedly expressed shock at Trump’s approach to ethics.
As it happens, recent history offers another insurance-industry tale that highlights the seediness of the Trump approach. Two years ago, around the same time that Anthem tried to buy Cigna, another insurer, Aetna, announced a plan to buy a rival, Humana.
That deal also ran into antitrust opposition from the Obama administration. Aetna responded with a bold attempt at quid pro quo. It threatened administration officials that it would withdraw from Obamacare insurance markets unless the merger was approved, even though withdrawal would cost the company money. Aetna executives tried to keep their conversations about the threats to phone calls rather than email “to avoid leaving a paper trail,” as a federal judge later found.
Yet the Obama administration didn’t buckle. It didn’t shower Aetna with private meetings and friendly tweets. Aetna did indeed withdraw from the markets last year, and the Trump campaign gleefully pointed to the decision as a sign that Obamacare was “imploding.”
Back then, Trump had it easier. He was a candidate, not the president, and he could pretend that he would magically fix the health market by offering coverage that was better, cheaper and universal.
Now that he is president, he has discovered how complicated health policy is. And one of the only people who likes his ideas is someone whose paycheck may depend on making the president happy.
Everyone loves Bernie Sanders. Except, it seems, the Democratic party
by Trevor Tim - The Guardian - March 17, 2017
If you look at the numbers, Bernie Sanders is the most popular politician in America - and it’s not even close. Yet bizarrely, the Democratic party - out of power across the country and increasingly irrelevant - still refuses to embrace him and his message. It’s increasingly clear they do so at their own peril.
A new Fox News poll out this week shows Sanders has a +28 net favorability rating among the US population, dwarfing all other elected politicians on both ends of the political spectrum. And he’s even more popular among the vaunted “independents,” where he is at a mind boggling +41.
This poll is not just an aberration. Look at this Huffington Post chart that has tracked Sanders’s favorability rating over time, ever since he gained national prominence in 2015 when he started running for the Democratic nomination. The more people got to know him, they more they liked him - the exact opposite of what his critics said would happen when he was running against Clinton.
One would think with numbers like that, Democratic politicians would be falling all over themselves to be associated with Sanders, especially considering the party as a whole is more unpopular than the Republicans and even Donald Trump right now. Yet instead of embracing his message, the establishment wing of the party continues to resist him at almost every turn, and they seem insistent that they don’t have to change their ways to gain back the support of huge swaths of the country.
Politico ran a story just this week featuring Democratic officials fretting over the fact that Sanders supporters may upend their efforts to retake governorships in Southern states by insisting those candidates adopt Sanders’ populist policies - seemingly oblivous to the fact that Sanders plays well in some of those states too.
Sanders’s effect on Trump voters can be seen in a gripping town hall this week that MSNBC’s Chris Hayes hosted with him in West Virginia - often referred to as “Trump Country” - where the crowd ended up giving him a rousing ovation after he talked about healthcare being a right of all people and that we are the only industrialized nation in the world who doesn’t provide health care as a right to all its people.
But hand wringing by Democratic officials over 2018 candidates it’s really just the latest example: the establishment wing of the party aggressively ran another opponent against Keith Ellison, Sanders’s choice to run the Democratic National Committee, seemingly with the primary motivation to keep the party away from Sanders’s influence.
They’ve steadfastly refused to take giant corporations head on in the public sphere and wouldn’t even return to an Obama-era rule that banned lobbyist money from funding the DNC that was rescinded last year. And despite the broad popularity of the government guaranteeing health care for everyone, they still have not made any push for a Medicare-for-all plan that Sanders has long called for as a rebuttal to the Republican’s attempt to dismantle Obamacare.
Democrats seem more than happy to put all the blame of the 2016 election on a combination of Russia and James Comey and have engaged in almost zero introspection on the root causes of the larger reality: they are also out of power in not the presidency, but both also houses of Congress, governorships and state houses across the country as well.
As Politico reported on the Democrats’ post-Trump strategy in February“Democratic aides say they will eventually shift to a positive economic message that Rust Belt Democrats can run on.” However: “for now, aides say, the focus is on slaying the giant and proving to the voters who sent Trump into the White House why his policies will fail.”
In other words, they’re doubling down on the exact same failing strategy that Clinton used in the final months of the campaign. Sanders himself put it this way in his usual blunt style in an interview with New York Magazine this week when asked about whether the Democrats can adapt to the political reality said “there are some people in the Democratic Party who want to maintain the status quo. They would rather go down with the Titanic so long as they have first-class seats.”
In the long term, change may be coming for Democrats whether they like it or not. Sanders loyalists are quietly attempting to take over many local Democratic party positions around the country. While Ellison lost the race for the DNC chair, it was incredibly close - closer than Sanders came to beating Clinton. And Sanders’s supporters are already organizing primary challenges to incumbent Democrats who aren’t sufficiently opposing Trump.
One thing’s for sure: Democrats who refuse to change do so at their peril.
ByThis may be the most brutal number in the CBO report
by Aaron Blake - Washington Post - March 14, 2017
The Congressional Budget Office released estimates, March 13, for how House Republicans’ proposal to revise the Affordable Care Act might affect Americans.(Sarah Parnass/The Washington Post)
Plenty has been made of the big Congressional Budget Office finding that 24 million people could lose their insurance under Republicans' Obamacare replacement over the next decade. That's higher than expected and poses a clear and massive hurdle for Republicans as they attempt to convince dozens of skeptical members.
But there's another number that paints a particularly dire picture for the GOP's alternative — especially in light of President Trump's populist rhetoric.
According to the CBO, 64-year olds making $26,500 per year would see their premiums increase by an estimated 750 percent by 2026. While they are on track to pay $1,700 under the current law, the CBO projects the American Health Care Act would force them to pay $14,600. Even if you grant that inflation will allow them to make slightly more money by 2026, that's still about half of their income going to health care.
Here's how that looks as a percentage of income (h/t Philip Bump):
As skeptics of the law noted, that suggests the reason premiums as a whole will eventually decline is because older, poorer people simply won't be able to afford it. The legislation reduces premiums substantially for younger people but increases them substantially for older people — and especially poorer, older people — according to the CBO.
The CBO's estimate of the premium increases for older, poorer Americans is actually worse than a previous one from AARP. Here's what AARP, which has announced its opposition to the bill, said last week:
… Our estimates find that, taken together, premiums for older adults could increase by as much as $3,600 for a 55-year old earning $25,000 a year, $7,000 for a 64-year old earning $25,000 a year and up to $8,400 for a 64-year old earning $15,000 a year.
If you're a Republican looking at these numbers, you have to be concerned — just from a self-preservation standpoint.
Republican leaders have made great pains to argue that the CBO's estimate of the millions who will lose insurance is faulty, or even that it's a necessary side effect of returning to a more free-market approach to health care. But the GOP's counter-argument is predicated on the idea that its alternative would at least allow people access to coverage. Paying such a substantial portion of one's income on health insurance doesn't meet that goal — if, in fact, the CBO's estimate is anywhere close to accurate.
It also affects a group of voters who are integral to the Trump Coalition. Less-formally educated and lower-income white Americans were the backbone of the electoral shift that allowed President Trump to be elected, and he has promised them the world: Coverage that is even more affordable than the Affordable Care Act and “insurance for everybody.”
On top of all that, older people are much more likely to vote than younger people, especially in a midterm election like 2018. So basically, Trump's win was built on older, poorer people, for whom this law appears to drive up premiums and drive down the insurance rate, while benefiting the younger and wealthier.
That's not something that will assure skeptical Republicans at all — even if they can get past that 24 million number.
Cholesterol-Slashing Drug Can Protect High-Risk Heart Patients, Study Finds
by Gina Kolata - NYT - March 17, 2017
The first rigorous test of an expensive new drug that radically lowers cholesterollevels found that it significantly reduced the chance that a high-risk patient would have a heart attack or stroke. These were men and women who had exhausted all other options.
The results of the study, which cost about $1 billion and was paid for by Amgen, maker of the drug, were published on Friday in The New England Journal of Medicine and presented at the annual meeting of the American College of Cardiology.
The drug, Repatha, is called a PCSK9 inhibitor and can make cholesterol tumble to levels almost never seen naturally in adults, or even in people taking cholesterol-lowering statins. The Amgen drug and a similar one, sold by Sanofi and Regeneron, were approved by the Food and Drug Administration in 2015 with the hope — and expectation — that they would lower the risk of heart attacks and strokes, and not just reduce levels of LDL cholesterol, the dangerous kind.
That hope has now been realized for the Amgen drug.
“This is like the era of the statins coming in,” said Dr. Eugene Braunwald, a cardiologist at Harvard Medical School who was not involved in the study. Like statins, which were introduced in the 1980s, the new class of drugs has the potential to improve the health and longevity of millions of Americans with heart disease, the nation’s leading killer, accounting for one in four deaths.
“It’s a new ballgame,” he said.
But cost will be an issue. Statins are available as cheap generics. The new drugs have a list price of $14,523 a year. “The next big challenge is financial: how to pay for it,” said Dr. David Maron, director of preventive cardiology at Stanford, who also was not involved in the study.
Insurance companies have been reluctant to pay for the drug without evidence it protected high-risk patients from heart attacks and strokes. Kristine Grow, a spokeswoman for the insurers’ organization America’s Health Insurance Plans, said insurers would consider the new data.
The study involved 27,564 men and women. About 80 percent had already had a heart attack, and the rest had had a stroke or had pain in their legs and feet from narrowed arteries. They were taking optimal doses of inexpensive, cholesterol-lowering statins, which gave them an average LDL of 92, well within the range — an LDL of under 100 — that has been advised for high-risk patients.
All continued with their statins, but half were assigned to inject themselves with Repatha, also known as evolocumab, and the rest were assigned a placebo. Those taking the new drug reached an average LDL of 30. A quarter of participants got to an LDL of 19 or lower.
Amgen estimates that about 11 million Americans are eligible to take the drug. They include people like those in the study and people who have a genetic condition, familial hypercholesterolemia, that results in intractably high LDL levels and a grave risk of a heart attack.
Amgen maintains that its drug is worth the price and that by preventing heart attacks and strokes, it will also prevent the costs associated with treating patients with worsening conditions. But the drug would need to be taken for life, and the bill for its widespread use could potentially be huge.
For cardiologists, the study was a crucial test of a long-held hypothesis: the lower the level of cholesterol in the blood, the better.
The results support that hypothesis. There seemed to be no floor to the benefits of cholesterol lowering, at least down to the stunningly low levels achieved in the study. The lower the LDL, the lower the risk, with no leveling off of the linear relationship.
Dr. Maron said the results were “incredibly important,” adding, “The future looks brighter for patients with established coronary disease.”
But Dr. Rita Redberg, a cardiologist at the University of California, San Francisco, tempered her enthusiasm, saying she would like to see what happens over a longer period of time.
Dr. Redberg also worried about the potential for bias because Amgen paid for the study, helped design it, collected the data and helped write the paper. The data analysis was done independently by a team of academic researchers, led by Dr. Marc S. Sabatine, chairman of a cardiovascular research group called TIMI at Brigham and Women’s Hospital, a teaching hospital for Harvard Medical School.
Participants in the study who used Amgen’s drug for 2.2 years were 20 percent less likely to die from heart disease, have a heart attack or have a stroke (816 patients taking evolocumab had one of those outcomes, compared with 1,013 taking the placebo).
There was a 15 percent reduction in the combined risk of having a heart attack or stroke or dying from cardiovascular disease, being hospitalized for worsening chest pain, or having a stent inserted to open a blocked artery (1,344 evolocumab patients versus 1,563 placebo patients).
The absolute reduction in the risk of a heart attack or stroke was 1.3 percent at two years, Amgen said, and 2 percent at three years.
That means that 74 high-risk patients would have to be treated for two years to prevent one heart attack or stroke or death from heart disease and that at three years 50 would have to be treated. Extrapolating, the authors predicted that after five years, just 17 high-risk patients would have to be treated.
“Reducing the risk of a heart attack or stroke by 20 percent is a pretty big reduction,” Dr. Sabatine said. He and others predicted that the risk would be reduced further as time went on, as it does in patients taking statins. He noted that that effect was already emerging, with a 25 percent reduction in the second year.
The only side effect seen during the study was a small incidence of redness or itchingat the injection site, with 2.1 percent of those taking the Amgen drug reporting such effects, compared with 1.6 percent of those taking the placebo injections. But patients in general did not stop using the drug for that reason.
There had been concerns that the drug might increase the risk of diabetes, or affect thinking and memory, but those effects were not seen.
Despite the positive results, about 10 percent taking the drug had a heart attack or stroke, or died of heart disease during the trial.
Many high-risk patients did not wait for the results and were already taking the Amgen drug outside the trial, betting it would help.
Robert Johnson, 51, of Glen Mills, Pa., had a father who died of a heart attack at age 42. He has familial hypercholesterolemia, and his LDL in 2011 was 377. He’s taking the Amgen drug and a statin. Now his LDL is about 80.
“I feel much safer, much better,” he said. “I always felt there was a ticking time bomb in my heart.”
Andrew Timmins, 65, of Boxford, Mass., had a heart attack 18 years ago and lived in constant fear of another. Despite taking the maximum dose of the most powerful statin, he never got his LDL below 180. Amgen’s drug brought it down to 42, he said.
He started taking it last summer at the suggestion of a doctor at Brigham and Women’s Hospital. When his general practitioner saw his blood work, he came bursting into the exam room. “He said, ‘I’ve never seen numbers like these. These are incredible,’” Mr. Timmins recalled.
“I have a new lease on life,” he said.
Kim Chaples, 55, of Lansdale, Pa., had an LDL of 200 even though she was taking maximum doses of a statin.
“I was scared,” she said.
Two years ago, her LDL soared to 450 for no apparent reason.
Dr. Daniel Soffer of the University of Pennsylvania changed her statin prescription to the maximum dose of the most powerful one, and then said, “There’s a drug out there I want you to try.”
She began taking evolocumab along with the statin. Two months later, her LDL was 50.
When she saw the lab report, she assumed there had been a mix-up. “I thought, ‘This cannot be mine,’” she said.
Hearing the results of the new study, she said, “makes me feel very good.”
Slower visa approval could worsen Maine’s doctor shortage
by Jen Lynds - Bangor Daily News - March 18, 2017
HOULTON, Maine — The Trump administration’s decision to suspend the fast-tracking of work visas for skilled foreign workers could worsen Maine’s shortage of physicians, particularly in rural areas, according to Dr. James Raczek, chief medical officer of Eastern Maine Medical Center in Bangor.
Eastern Maine Medical Center is “extremely concerned” about potential changes in immigration policies, Raczek said.
He estimated that 100 physicians “are currently at the hospital working in the U.S. on the broad spectrum of J-1, H-1B visas and green cards.
“It is critical to us that we have the ability to recruit and retain physicians from other countries,” he said. “They fill crucial roles at our hospitals and clinics and patient care functions because of them.”
The U.S. Citizenship and Immigration Services announced that as of April 3 it will process applications for H-1B visas — those for skilled foreign workers — at the same speed as other visa requests. That means that rather than getting a visa decision with 15 days, H-1B applicants might have to wait months.
Officials at CIS said that suspending “premium processing” will allow the agency to reduce a backlog of the specialized visa applications and in the end reduce overall processing times.
Trump has accused companies of abusing the H-1B program as a way to hire foreign workers at lower salaries, who take jobs away from Americans, according to CNN Money.
Racek said that EMMC is far from the only hospital relying on foreign doctors.
“Other medical centers have foreign-born physicians that they rely on to give patient care,” he said. “It is not like they are taking jobs from U.S. citizens. They are crucial to our healthcare system.”
Gordon H. Smith, executive vice president of the Maine Hospital Association, said that the suspension will “impact both hospitals and patients.”
He did not know how many foreign doctors are currently in Maine on specialty visas, and the state Department of Labor did not return calls.
While the proposed suspension would not impact the physicians who are currently practicing at The Aroostook Medical Center in Presque Isle, it would affect the arrival of new providers who are being recruited, according to Karen Gonya, TAMC’s communications manager.
“For TAMC, we are now expecting a delay in the addition of a new cardiologist to our team of specialty providers, with the possible delay of other new providers that we are in the process of recruiting,” she said.
Exchange visitors who came to the U.S. on a J-1 visa to complete graduate medical school or their training also had been able to apply to stay in the country under a waiver — provided they agreed to practice for at least three years in a medically underserved area.
But in order to be eligible for the so-called Conrad 30 waiver, the newly minted doctors also must be accepted under an H-1B visa or they have to leave the country for two years before they can apply to return, if they wish to practice in the U.S.
In a letter sent this week to acting CIS Director Lori Scialabba, U.S. Sens. Susan Collins, R-Maine, Amy Klobuchar, D-Minnesota, and Heidi Heitkamp, D-North Dakota, called on the agency to address its administrative needs without sacrificing support for the waiver program.
They noted that it “has brought more than 15,000 physicians to underserved communities over the last fifteen years.
“Healthcare facilities rely on premium processing to avoid delays in placing doctors in health care facilities where their services are desperately needed,” the senators wrote. “The suspension of premium processing will delay when these doctors can begin to serve patients in underserved areas across the country. That delay could harm patients and communities who rely on local health care facilities utilizing Conrad 30 doctors to fill critical needs.”
Tom Moakler, chief executive officer of Houlton Regional Hospital, said that there are three doctors working at the hospital under J-1 visas. He said he does not believe that the suspension will be permanent, but that if it lasts too long, it could have a significant impact on the hospital.
“It would have an impact on any hospital in The County, I imagine,” he said. “We all rely on doctors with J-1 Visas.”
http://bangordailynews.com/2017/03/18/business/slower-visa-approval-could-worsen-maines-doctor-shortage/
http://bangordailynews.com/2017/03/18/business/slower-visa-approval-could-worsen-maines-doctor-shortage/
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