Monday, September 18, 2017

My letter to Chris Christie on Graham-Cassidy

Graham-Cassidy's sponsors are relying in large part on support from Republican governors to win senators' votes for the bill. Today, Arizona Governor Doug Ducey came out in favor, notwithstanding that CBPP estimates that Arizona stands to lose $1.6 billion in federal funding in 2026 alone under the bill's redistribution formula.

At BlueWave New Jersey, we are calling on NJ Governor Chris Christie this week to defend the state's Medicaid expansion and coverage gains and come out against Graham-Cassidy. I have a letter in today's print Star-Ledger, but it's not online. Here is the text:
Behold the last and worst of the ACA repeal bills, introduced this week by four Republican U.S. senators.The bill ends the ACA Medicaid expansion, ultimately ends all ACA funding to help people gain health insurance, and guts federal spending on all Medicaid programs, which serve 75 million Americans. 

Saturday, September 16, 2017

How could Patty Murray "thread the needle" with Lamar Alexander?

Ever since the Cassidy-Collins bill was introduced in January, I've thought that Democrats should engage with Republicans in Congress who were willing to leave the ACA's taxes and core benefits intact. Cassidy-Collins didn't do that, but I thought it came close enough to be a basis for talks.

Triage was the byword. If a handful of the dozen-odd Republican senators who were then expressing qualms about repeal of the Medicaid expansion in particular could be engaged in compromise negotiations, I thought, that would lessen the chances of passage for a bill that would uninsure tens of millions -- as would the AHCA, the BCRA, and now Cassidy-Graham.

Events have almost proved me wrong. The prevailing Democratic strategy -- we'll talk about fixes when they give up on repeal -- has almost worked. Three repeal bills failed in the Senate. Lamar Alexander, HELP Committee chaired, has held hearings on a bipartisan bill to stabilize the individual market.  And on the other end of the equation, Cassidy -- who seemed like a possible partner since he wanted to preserve ACA taxes and so something like its scale of benefits -- is now a driving force behind a bill that would zero out ACA benefits and lay waste to Medicaid.

Still, ironically, we're at a point again where I'm tempted by similar logic: if Patty Murray and other Democrats engage with Alexander and come up with a compromise stabilization bill, that could blunt the drive toward Cassidy-Collins passage. Would co-sponsors of a stabilization bill, led by Alexander, turn around and vote for Graham-Cassidy?

Wednesday, September 13, 2017

Synthetic single payer

Here's a healthcare reform bill that fits on a postcard:

The Medicare-for-all Biosimilar Act of 2017

Title 1: Uniform Payment Rate
     Sect. 101. All payers for healthcare services shall pay providers at a rate equal to 120% of current Medicare payment rates. Price schedule will be maintained and updated by CMS, with existing alternative payment programs maintained at the 120% payment ratio. Medicare Advantage benchmarks will be adjusted accordingly.

Title II: Healthcare Budget
     Sect. 201. The Medicare tax will be increased to a level sufficient to fund the government's increased payments in Medicare and Medicaid.

Tuesday, September 12, 2017

Census: ACA cut uninsured rate in half in Medicaid expansion states by 2016

The Census Bureau released its report on health insurance coverage in the U.S. for 2016 today. One striking trend was flagged by Matt Broaddus at the Center for Budget and Policy Priorities: the gap between states that expanded Medicaid and those that refused continues to widen:

Uninsured Rate Gap Between Medicaid Expansion States and Others Widening

To this let me add a sidelight: in expansion states, the uninsured rate has been cut in half since the main ACA programs were implemented in 2014 -- from 12.9% in 2013 to 6.5% in 2016.

Monday, September 11, 2017

Elizabeth Warren is for single payer, sort of. And against healthcare profiteering...sort of.

Elizabeth Warren sent a letter to supporters last week announcing that she's co-sponsoring Bernie Sanders' Medicare for All bill and asking recipients to sign on as "citizen-co-sponsors."

That's interesting, as Warren herself does not sound exactly all-in.   My emphasis below:
I believe it’s time to take a step back and ask: what is the best way to deliver high quality, low cost health care to all Americans? Everything should be on the table – and that’s why I’m co-sponsoring Bernie Sanders’ Medicare for All bill that will be introduced later this month 
Warren is for putting Bernie's bill on the table -- not necessarily for passing it. There's more hedging near the bottom of the letter:

Friday, September 08, 2017

ACA innovation waivers: a need for speed? Not so fast, says Emma Sandoe

For all the relative comity of the Senate HELP Committee hearings on legislation to strengthen the individual market for health insurance (Sept. 6, Sept. 7), a potential battle line of sort was drawn on Tuesday in statements by the chair, Lamar Alexander, and ranking member, Patty Murray. As the Times' Robert Pear reported:
“To get a result,” Mr. Alexander said, “Democrats will have to agree to something — more flexibility for states — that some may be reluctant to support. And Republicans will have to agree to something, additional funding through the Affordable Care Act, that some may be reluctant to support. That is called a compromise.”

The senior Democrat on the panel, Senator Patty Murray of Washington, said: “Threading this needle won’t be easy. But I do believe an agreement that protects patients and families from higher costs and uncertainty, and maintains the guardrails in our current health care system, is possible.”

Sunday, September 03, 2017

How to hand the keys to an unfit successor

How do you hand the keys to the Oval Office to a man you've declared in no uncertain terms to be unfit for the presidency?

Obama's handwritten note to Trump, placed before Inauguration Day in the top drawer of the president's desk, is a carefully calibrated document -- a muted "don't be evil" plea on behalf of the nation, with goals distilled to the most basic: justice, security, democracy. Stark in its simplicity, it's generous without warmth, avoiding the hypocrisy of any hint of confidence in the recipient.

It begins with a depersonalized wish:

Share