- Jun 6, 2007
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In regards to the Presidential race Democrats are allowing themselves to be distracted they are unduly focusing on the pandemic and the major issues that stem from it. Democrats should also have as a top priority stopping the elimination of the Affordable Care Act they should be acting like they are vital fire fighters responding to a five alarm fire over this issue because if President Trump wins re-election the Republican power brokers have in their cross hairs the Affordable Care Act they are going to either get rid of it through the court system or through the Congress in their eyes it is way too expensive for the Federal Budget it creates too much of a need to increase taxes to pay for it taxes of course they abhor, the fact that it assures good health care for hundreds of millions of Americans they don't give a damn over! If you read between the lines at the last debate President Trump is very hungry to repeal the ACA and for me if you focus on the editorial pages of the Wall Street Journal you get an idea of the priorities of the wealthy and the big business executives that pour incredible amounts of money into America's elections and often are in firm control of this country and the WSJ editorial pages have been targeting and leveling illegitimate criticisms against the ACA and false claims about Republican alternatives to this law.
Democrats have to really get on the ball about this issue, they should be shining a titanic size spotlight on the Republicans alarming efforts to repeal and replace the ACA in Congress, Democrats should be focusing on the Republican Senate effort, the Health Care Freedom Act of 2017 (HCFA) colloquially called the "Skinny Repeal" bill that was just one vote short of becoming law but for the late Senator John McCain's extraordinary virtuous no vote on the bill on the Senate floor and the House of Representative effort called the American (should have used the word Martian) Health Care Act (AHCA) which passed the House with President Trump in a White House celebration ceremony calling a "great" plan and as time went by and the merits of the bill were evaluated President Trump joined in the widespread American public's condemnation of it reportedly calling the bill "mean".
The Democrats need to talk about the Republicans record on healthcare they need to talk about what was in the Republican House's (AHCA) bill. It would have eliminated the ACA's expansion of Medicaid which allowed people whose income was 138% of the poverty rate to get health care thru the Medicaid program, in effect, throwing the working poor in the gutter. It would have eliminated the ACA's reduction of out-of-pocket limits for low and middle Americans so for these struggling Americans making under four hundred percent of the poverty rate if they faced significant health problems requiring extensive health care services the ACA's extremely valuable help in dealing with insurance co-pays would not be there for them! It would have changed how the Federal government pays its portion of the funding for state Medicaid programs it would have changed the funding from a "percentage" to a" per capita (enrollee)" method. The per capita method worked in a manner where a base year would have been chosen and the federal government would have determined how much money they were going to give a state for each enrollee for that year then for subsequent years they would just increase the base rate by the inflation rate; prudence knows that the average rise in health care costs for Americans over many years rises more than the health care cost portion of the consumer price index this Republican move was to shift this funding challenge to the states many whose finances are such they could not handle the problem. A large portion of seniors on Medicare are also in the Medicaid program as well as many disabled people, this Republican move would have likely resulted in a reduction of services to these important groups! The AHCA also would allow the states to allow health insurance companies in the individual insurance market to charge older Americans more for their health insurance plan there was no numerical ratio restrictions on the states, the ACA had a three to one ratio where older Americans could only be charged three times the premium charge going to younger Americans; this could readily lead to older Americans not able to afford health insurance in the individual market. The AHCA allowed states to do away with the essential benefit mandate of the Affordable Care Act which involves the mandates for health insurance plans to cover: Emergency Department Services, Hospitalization, Mental Health and Substance Abuse Disorder services, prescription drugs, Rehabilitative services, laboratory services and chronic disease management services. The Congressional Budget Office did an analysis of the AHCA and determined one year after this bill was enacted into law the uninsured rolls in America would increase by fourteen million people and nine years from passage the uninsured rolls would increase by twenty-three million people!
The Republican Senate effort, the Health Care Freedom Act of 2017 (In the July 27th 2017 Congressional Record SA 667 to SA267 for HR 1628) although it was not a direct dismantling of the ACA it was an extreme threat to the ACA and its great protections for American consumers. The way the Republican "Skinny Repeal" bill worked is it weakened the safeguards in the ACA which allowed a State to get a waiver from various ACA mandates. Specifically. it took away the Secretary of Health and Human Services and the Secretary of the Treasury's discretion to grant waivers if the State's met the ACA criteria for a waiver the respective Secretary had to grant the waiver, instead of six months to consider a waiver application the Republican bill gave a Secretary only forty-five days to do the evaluation and the waiver period was lengthened from five years to eight years and also a critical factor was that the Republican bill took away the power of the Secretary to cancel the waiver during an eight year period; so if the state plan in practice didn't meet the promises the Secretary would be stuck! The nickname of the bill was an accurate description of the practical impact of the legislation it would have been a repeal of the ACA, repeal thru subterfuge, with no guaranteed health insurance protections for the American people!
One thing that Democrats should do is not let President Trump get away with his claims about "pre-existing conditions". He says Americans in that status should not worry if the ACA is found unconstitutional you have my Executive Order on pre-existing conditions and that will take care of you. His Executive Order on this is just a policy commitment that people with that status should get good and affordable health insurance; his Executive Order even on its face references problems it claims the Health Insurance Portability and Accountability Act protects these people, the language of the act allows a group insurance provider to not cover a pre-existing condition for a new enrollee for twelve months for a condition that the enrollee was treated for during the prior six months. Everyone should make no mistake if the ACA is repealed President Trump's Executive Order is completely worthless it won't compel one insurance company to provide a health insurance plan to even one person with a pre-existing condition. President Trump lacks knowledge about this whole issue before the ACA came into existence many Americans with serious pre-existing conditions did not have health insurance because the health insurance companies were going to charge them exorbitant yearly premiums for a plan because of their medical problems, some of these people were lucky enough to live in states which had a separate state run program for people with pre-existing conditions but even some of these states often had limited number of slots because the program had limited funds. Even if President Trump could through "Executive Order" order insurance companies operating in the individual health insurance market to offer health insurance to Americans with pre-existing conditions he does not have the authority to stop these insurance companies from underwriting the health insurance plans offered based on the applicants medical status and that is the crux of the problem, that is the eight hundred pound gorilla in the room, on the overall health care problem for America "How does America provide health insurance plans to these Americans with serious health problems which require a lot of health care services and so obviously cost a lot of money?". If America loses the "ACA", America will be thrown into a health care crisis over this because tens of millions of Americans with a serious pre-existing condition won't be able to purchase health insurance that will cover them for their health problems!
Democrats have to really get on the ball about this issue, they should be shining a titanic size spotlight on the Republicans alarming efforts to repeal and replace the ACA in Congress, Democrats should be focusing on the Republican Senate effort, the Health Care Freedom Act of 2017 (HCFA) colloquially called the "Skinny Repeal" bill that was just one vote short of becoming law but for the late Senator John McCain's extraordinary virtuous no vote on the bill on the Senate floor and the House of Representative effort called the American (should have used the word Martian) Health Care Act (AHCA) which passed the House with President Trump in a White House celebration ceremony calling a "great" plan and as time went by and the merits of the bill were evaluated President Trump joined in the widespread American public's condemnation of it reportedly calling the bill "mean".
The Democrats need to talk about the Republicans record on healthcare they need to talk about what was in the Republican House's (AHCA) bill. It would have eliminated the ACA's expansion of Medicaid which allowed people whose income was 138% of the poverty rate to get health care thru the Medicaid program, in effect, throwing the working poor in the gutter. It would have eliminated the ACA's reduction of out-of-pocket limits for low and middle Americans so for these struggling Americans making under four hundred percent of the poverty rate if they faced significant health problems requiring extensive health care services the ACA's extremely valuable help in dealing with insurance co-pays would not be there for them! It would have changed how the Federal government pays its portion of the funding for state Medicaid programs it would have changed the funding from a "percentage" to a" per capita (enrollee)" method. The per capita method worked in a manner where a base year would have been chosen and the federal government would have determined how much money they were going to give a state for each enrollee for that year then for subsequent years they would just increase the base rate by the inflation rate; prudence knows that the average rise in health care costs for Americans over many years rises more than the health care cost portion of the consumer price index this Republican move was to shift this funding challenge to the states many whose finances are such they could not handle the problem. A large portion of seniors on Medicare are also in the Medicaid program as well as many disabled people, this Republican move would have likely resulted in a reduction of services to these important groups! The AHCA also would allow the states to allow health insurance companies in the individual insurance market to charge older Americans more for their health insurance plan there was no numerical ratio restrictions on the states, the ACA had a three to one ratio where older Americans could only be charged three times the premium charge going to younger Americans; this could readily lead to older Americans not able to afford health insurance in the individual market. The AHCA allowed states to do away with the essential benefit mandate of the Affordable Care Act which involves the mandates for health insurance plans to cover: Emergency Department Services, Hospitalization, Mental Health and Substance Abuse Disorder services, prescription drugs, Rehabilitative services, laboratory services and chronic disease management services. The Congressional Budget Office did an analysis of the AHCA and determined one year after this bill was enacted into law the uninsured rolls in America would increase by fourteen million people and nine years from passage the uninsured rolls would increase by twenty-three million people!
The Republican Senate effort, the Health Care Freedom Act of 2017 (In the July 27th 2017 Congressional Record SA 667 to SA267 for HR 1628) although it was not a direct dismantling of the ACA it was an extreme threat to the ACA and its great protections for American consumers. The way the Republican "Skinny Repeal" bill worked is it weakened the safeguards in the ACA which allowed a State to get a waiver from various ACA mandates. Specifically. it took away the Secretary of Health and Human Services and the Secretary of the Treasury's discretion to grant waivers if the State's met the ACA criteria for a waiver the respective Secretary had to grant the waiver, instead of six months to consider a waiver application the Republican bill gave a Secretary only forty-five days to do the evaluation and the waiver period was lengthened from five years to eight years and also a critical factor was that the Republican bill took away the power of the Secretary to cancel the waiver during an eight year period; so if the state plan in practice didn't meet the promises the Secretary would be stuck! The nickname of the bill was an accurate description of the practical impact of the legislation it would have been a repeal of the ACA, repeal thru subterfuge, with no guaranteed health insurance protections for the American people!
One thing that Democrats should do is not let President Trump get away with his claims about "pre-existing conditions". He says Americans in that status should not worry if the ACA is found unconstitutional you have my Executive Order on pre-existing conditions and that will take care of you. His Executive Order on this is just a policy commitment that people with that status should get good and affordable health insurance; his Executive Order even on its face references problems it claims the Health Insurance Portability and Accountability Act protects these people, the language of the act allows a group insurance provider to not cover a pre-existing condition for a new enrollee for twelve months for a condition that the enrollee was treated for during the prior six months. Everyone should make no mistake if the ACA is repealed President Trump's Executive Order is completely worthless it won't compel one insurance company to provide a health insurance plan to even one person with a pre-existing condition. President Trump lacks knowledge about this whole issue before the ACA came into existence many Americans with serious pre-existing conditions did not have health insurance because the health insurance companies were going to charge them exorbitant yearly premiums for a plan because of their medical problems, some of these people were lucky enough to live in states which had a separate state run program for people with pre-existing conditions but even some of these states often had limited number of slots because the program had limited funds. Even if President Trump could through "Executive Order" order insurance companies operating in the individual health insurance market to offer health insurance to Americans with pre-existing conditions he does not have the authority to stop these insurance companies from underwriting the health insurance plans offered based on the applicants medical status and that is the crux of the problem, that is the eight hundred pound gorilla in the room, on the overall health care problem for America "How does America provide health insurance plans to these Americans with serious health problems which require a lot of health care services and so obviously cost a lot of money?". If America loses the "ACA", America will be thrown into a health care crisis over this because tens of millions of Americans with a serious pre-existing condition won't be able to purchase health insurance that will cover them for their health problems!
