Obamacare Question

[RoseWilder]

http://www.huffingtonpost.com/entry/gop-governors-obamacare_us_58792687e4b09281d0eab57d

Quote

As congressional Republicans move forward on plans to quickly repeal and ― less-quickly ― replace President Barack Obama’s health care law, a wide variety of industry and political influencers are trying to slow their progress. Among the most persuasive may be a set of Republican governors who are fearful about losing the substantial health and monetary benefits from the law that their states currently enjoy.

On Friday morning, Politico reported on five such GOP governors who have been publicly calling on lawmakers to consider keeping the portion of the Affordable Care Act that supports the expansion of Medicaid in states that choose to.

Behind the scenes, these same governors are also working to persuade lawmakers from their states and those who have purview over the repeal and replace strategy that it would be wise to keep some portion of the federal matching funds for states that have pursued Medicaid expansion.

 

[Howl]

On 1/9/2017 at 1:52 PM, GreyhoundFan said:

Interesting piece. Unfortunately, there are far too many words for Agent Orange to comprehend.

Here's my sense Trump -- he has no internal compass -- he's simply a random tweet generator.  He has no sense of public policy and governance, and I truly mean ZERO. He's consumed with his perceptions of petty insults and revenge, which takes up all of his time and energy.  That people's lives and well being are at stake here are not his concern; he's busy dealing with  important stuff like screwing with whoever is at the top of his current list.  Really, whatever he said while campaigning or during his time as PEOTUS is the past, as far as he's concerned.  He said it in the moment, and these remarks have no other portent than that he was using them to control whatever dynamic was happening in that moment.

Although I think the term narcissist is wildly overused to the point of non meaning, I'm afraid we'll have to flog it relentlessly over the next four years to understand the Trump dynamic. A quick google search of "what happens when a narcissist feels like he is losing control" brought up this handy web site:  The Narcissist Out of Control

Quote

The narcissist feels a compelling need to control people in his (or her) environment; his spouse or partner, work mates, friends and neighbors. That is because in his own mind he doesn’t feel in control; because he lacks feelings of internal control he has the strong urge to control whomever he can externally. He (or she) will seek to dominate every individual and every group with which he interacts. The narcissist’s obsessive desire for control is actually not about control for control’s sake; it is essentially a defense against the risk of receiving a “narcissistic injury” (a blow to the ego or self-esteem).

and then there is this

Quote

The connection between narcissism and control is strong and represents one of the diagnostic tools used by psychologists to define the personality disorder (Narcissistic Personality Disorder). People suffering from narcissism attempt to control others in order to enhance their own sense of power and entitlement. Narcissism and the need to control relate to their self image as does the tendency to devalue others to increase their own sense of self-worth. Controlling others also relates to a lack of empathy, a tell-tale trait seen in people with narcissism. Narcissists typically believe they deserve special recognition for their superior talent or intelligence, which they feel gives them the right to exploit, demean, and use others.

This last bolded sentence -- these characteristics were on full display for virtually every minute of the campaign. 

Full text  here: http://thenarcissisticlife.com/the-narcissist-out-of-control/

This brings us to the question -- what kind of personalities do the children of narcissists develop?  This is important because at least some of his children and spouses will be effectively running our country. 

In less than a week when he becomes POTUS, this personality will begin to have global implications and not in a good way. 

 

[RoseWilder]

 

[FakePigtails]

Is it safe to assume offices will be closed today for anyone making calls? I'm assuming if so that voicemail boxes will be full by now.

[GreyhoundFan]

2 hours ago, FakePigtails said:

Is it safe to assume offices will be closed today for anyone making calls? I'm assuming if so that voicemail boxes will be full by now.

I called a couple and they all went to voicemail. I left a message. I'll call the others in a few minutes.

[CTRLZero]

CNN published an article wherein the GOP did simultaneous facepalms as Trump promised "insurance for everyone" when he should have termed it "access" rather than "coverage."

Quote

Most conservatives have long opted to use the term "access" rather than "coverage" -- a major fault line dividing Democrats and Republicans on the healthcare debate.

It's an important distinction, and one I will be quick to point out when people who voted for Trump start losing their coverage.

Trump says coverage, GOP means access - facepalms ensue

[Childless]

There are going to be a lot of upset and scared people who voted GOP for both executive and legislative in a year.  I won't feel a damn bit sorry for them.  I'll reserve my empathy for people who were wise enough to vote in their own best interests.

[Audrey2]

During my insomnia last night, I saw this article and couldn't believe it. These Republican governors, who spent their time blasting "Obamacare" and refused to accept money so they could cover more people now suddenly want the money, now that Washington is all Republican. I have no words.

https://www.yahoo.com/news/gop-governors-turned-down-medicaid-091012213.html

Quote

Republican governors who turned down billions in federal dollars from an expansion of Medicaid under President Barack Obama's health care law now have their hands out in hopes the GOP-controlled Congress comes up with a new formula to provide insurance for low-income Americans.

The other GOP governors, such as Ohio Gov. John Kasich, who agreed to expand state-run services in exchange for federal help — more than a dozen out of the 31 states — are adamant that Congress maintain the financing that has allowed them to add millions of low-income people to the health insurance rolls.

These two groups of Republicans embody the difficulty the emboldened GOP congressional majorities face: Make good on their promises to repeal the 2010 health care law while preserving popular provisions.

With Congress starting to consider plans for annulling and reshaping Obama's overhaul, Republican governors and lieutenant governors from 10 states met privately for more than two hours Thursday with GOP members of the Senate Finance Committee and raised concerns about how lawmakers will reshape Medicaid.

"They're worried about how it all works out," Finance panel chairman Orrin Hatch, R-Utah, said after the session in a Senate office building.

GOP senators and governors stressed the need for giving states more flexibility to shape their Medicaid programs. That's a change that worries Democrats, who say some states would inevitably end up covering fewer people or offering skimpier benefits.

Arkansas Gov. Asa Hutchinson said governors could find savings by being allowed to impose "work incentives" for some beneficiaries. Kasich suggested shifting people who earn just above the poverty level from Medicaid to the online exchanges that Obama's law created for buying coverage.

"I think they understand this is not simple and I think they know they have to get it right," Kasich said.

A chief worry by governors was whether states that accepted extra federal money to expand Medicaid to more people would lose that extended coverage. Sen. John Cornyn, R-Texas, said afterward that "it ain't going to happen," though he did not detail how.

Now that these governors realize how big a pile of steaming poo they stepped in, the naysayers want coverage for their people, since they realize how big a mistake they made, and the governors who accepted the money are terrified it will go away and their people will lose coverage. The sad thing is, in many of these red states, I see them following up the Republican with a Republican, no matter what. 

[Childless]

3 hours ago, Audrey2 said:

During my insomnia last night, I saw this article and couldn't believe it. These Republican governors, who spent their time blasting "Obamacare" and refused to accept money so they could cover more people now suddenly want the money, now that Washington is all Republican. I have no words.

https://www.yahoo.com/news/gop-governors-turned-down-medicaid-091012213.html

Now that these governors realize how big a pile of steaming poo they stepped in, the naysayers want coverage for their people, since they realize how big a mistake they made, and the governors who accepted the money are terrified it will go away and their people will lose coverage. The sad thing is, in many of these red states, I see them following up the Republican with a Republican, no matter what. 

If I were a governor in a state that went red for both president and congressional members, I'd lay the blame where it belongs if money dries up: the citizens in the state.  They voted these yahoos in under the assumption that they would fulfill their promise to repeal the ACA.  They made their bed, now they have to lie in it.  No shifting blame to state legislators.  Votes matter and it's about time Americans realized it.  They have no one but themselves to blame for what's about to go down.

[Audrey2]

52 minutes ago, Childless said:

If I were a governor in a state that went red for both president and congressional members, I'd lay the blame where it belongs if money dries up: the citizens in the state.  They voted these yahoos in under the assumption that they would fulfill their promise to repeal the ACA.  They made their bed, now they have to lie in it.  No shifting blame to state legislators.  Votes matter and it's about time Americans realized it.  They have no one but themselves to blame for what's about to go down.

Sadly, owning up to the healthcare mistakes in reliably red states will never happen. They will always find a way to blame Democrats for everything, even when they had no voice in the decision. Reliably red states are reliable because, for many voters, they won't look at the candidate beyond the R after his or her name. They also are the ones who only vote anti abortion or for gun rights, or their other pet cause. If Bill Clinton has run with an R, he would have been the best president ever. If Reagan had run with a D, he would have been the worst president ever. Charles Manson could run as a Republican in some of these states and get elected to any office he desires.

[clueliss]

The Kansas City Star shared an article that outlines what those who do have employer healthcare might lose with the repeal of the ACA.

 

http://www.kansascity.com/news/nation-world/national/article127651149.html#fmp

Quote

Get health insurance at work? Here’s how ACA repeal could affect you

Obama: healthcare repeal 'huge disservice to the American people' 2:13

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1 of 2

President Obama on Friday defended the Affordable Care Act, also known as Obamacare, during a live interview with Vox’s Ezra Klein and Sarah Kliff. President-elect Donald Trump's team has said that repealing Obama's legislative achievement is their top priority.The White House

BY KAREN GARLOCH

kgarloch@charlotteobserver.com

 

Recent attention about the planned repeal of the Affordable Care Act has focused on the 20 million people who might lose their health insurance if President Barack Obama’s signature health care law is dismantled by Republicans in Congress.

But people who get insurance through their employers – an estimated 150 million Americans – may also lose consumer protections they have come to expect from their job-based plans.

1 of 2

Brendan Riley, a health policy analyst with the North Carolina Justice CenterNorth Carolina Justice Center

Most people associate the ACA with the online marketplace that offers health plans, with premium subsidies, to people who don’t get employer-sponsored insurance. Many are pleased with that coverage, but some individuals who earn too much to qualify for subsidies have complained bitterly about rising premiums and deductibles.

President-elect Donald Trump and congressional Republicans have called the ACA a “disaster” and pledged to repeal the law, which they refer to pejoratively as “Obamacare.” But their zeal for repeal hasn’t been matched by a consensus about what should replace it.

[READ MORE: Large employer health plans could see impact]

[READ MORE: ACA repeal could affect job-based plans]

Trump and others have said they’d like to keep some of the ACA benefits while getting rid of taxes that have helped pay for them. But several analyses suggest this would disrupt the insurance market and result in even higher premiums and deductibles.

It’s not clear when repeal measures would take effect. Because most people have already signed up for 2017 coverage, it’s possible that changes wouldn’t occur before 2018.

[READ MORE: Consumers worry about what will happen with ACA repeal]

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Mike Pence: 'The first order of business is to repeal and replace Obamacare'

Vice President-elect Mike Pence on Wednesday discussed plans to dismantle the Affordable Care Act, President Obama's controversial health care law. Pence was on Capitol Hill to meet with Republican congressional leaders to discuss strategy.

C-SPAN

Depending on the outcome of the debate, some provisions that affect the health care for nearly every American – not just those who bought insurance through the marketplace – could be in jeopardy. Here are some examples:

Preventive services

The ACA requires all new health plans, including those sponsored by employers, to cover recommended preventive services with no out-of-pocket payments. This means people can get screenings, such as mammograms and colonoscopies, without having to first meet a costly deductible or co-payment. (Patients may be responsible for part of the cost of a colonoscopy if it’s performed for “diagnostic” reasons instead of screening.)

It also requires that plans cover all forms of Food and Drug Administration-approved contraception without cost-sharing. (There are limited exceptions for religious employers). This requirement brought new benefits to 71 million Americans.

Pre-existing conditions

Prior to the ACA, employees hired by large companies sometimes had to wait up to a year for the health plan to cover a pre-existing health condition. Smaller companies were allowed to refuse coverage or charge more for employees with pre-existing conditions. The ACA prohibits discrimination against employees with pre-existing conditions. Trump has said he’d like to keep this provision.

“You don’t have to suffer from what we call job-lock anymore,” said Brendan Riley, a health policy analyst with the North Carolina Justice Center. “You don’t have to stay in a job just to keep health insurance.”

Waiting periods

Employers used to be able to make new employees wait indefinitely before becoming eligible for coverage under the company plan. Now the waiting time can be no more than 90 days.

Annual and lifetime limits

The ACA prohibits employer-based plans from setting annual or lifetime limits on what insurance will pay for “essential health benefits” outlined in the law. Before the ACA, even the most generous plans often had caps on benefits.

“A lot of insurers had a $1 million cap,” said Michael Matthews, assistant professor of health care management at Winthrop University. “You’d be amazed in health care how fast you can go through $1 million. If you have a baby born premature in a hospital, you will hit that cap fast.”

Estimates are that 70 million people in large employer plans, 25 million in small employer plans, and 10 million with individual plans had lifetime limits on benefits before the ACA, according to the U.S. Department of Health and Human Services.

Out-of-pocket limits

The ACA sets limits on how much individuals will pay out-of-pocket each year. (”Grandfathered” plans that existed before the ACA are not subject to this provision.)

In 2017, the limit for individuals is $7,105, and the limit for families is $14,300. “It’s a safeguard to ensure that you aren’t going broke from health care costs,” Riley said.

Minimum value

The ACA doesn’t require large employer plans to include the same 10 “essential health benefits” that individual and small-group plans must include. But it does require large companies to offer plans that meet a “minimum value” standard.

“This prevents employers from offering really skimpy plans that don’t cover anything,” Riley said. “There’s a minimum value that plans have to meet so that people aren’t on the hook for huge medical bills when they go to use their insurance coverage.”

Dependent coverage to age 26

The ACA requires all plans, including those sponsored by large employers, to cover dependents up to age 26, even if they’re married, financially independent and live in another state. Before the ACA, one of the fastest growing groups of uninsured was young adults. Since the ACA, there has been a dramatic increase in the number of insured young adults, particularly among those with job-based coverage. Republicans have said they’d like to keep this provision.

Standard summary of benefits

The ACA requires all plans to provide a “summary of benefits and coverage” in a standard form that allows consumers to understand their coverage and make apples-to-apples comparisons. Summaries can be found on HealthCare.gov, and “because of the ACA, employer plans are supposed to provide that same thing,” Riley said.

Mental health parity

Before the ACA, small-group health plans did not have to cover mental health and substance use disorder services. Under the law, these small employers (50 employees and under) not only have to include these services, they must offer coverage that is comparable to that for general medical and surgical care. More than 23 million people in new small-group plans gained access to these benefits with the ACA, according to the federal government. An earlier federal law already required large employers’ plans to offer behavioral health coverage at parity with medical coverage .

Limits on ER costs

If you land in an emergency room that is not part of your insurance plan’s network, the ACA requires all health plans to charge patients the same co-payments or co-insurance for out-of-network emergency care as for hospitals that are in-network. The hospital may still “balance bill” the patients for costs that exceed what the insurer reimburses. Non-profit hospitals are required to post online financial assistance policies that outline eligibility requirements for free or discounted care.

Other provisions

Other provisions of the ACA, unrelated to job-based health plans, that have become familiar to consumers could go away, depending on the extent of “repeal and replace” efforts.

▪ Black lung: Two amendments were meant to make it easier for longtime coal miners with black lung disease to get disability benefits. They are referred to as the “Byrd amendments,” for late Sen. Robert C. Byrd (D-W.Va.), who wrote them.

One allows widows of coal miners who received federal black lung benefits to continue receiving them after their husbands die. The other says a worker with at least 15 years in the mines and disabling breathing problems is presumed to have black lung. That shifted the burden of proving that the disability was directly caused by working in the mines away from the victim to the company.

▪ Menu calorie counts: Most restaurants and fast food chains with at least 20 stores are required to post calorie counts of their menu items.

▪ Breastfeeding benefits: Employers are required to provide a place and time for women to pump breast milk for up to a year after giving birth. The place must be private, other than a bathroom. In addition, most plans must offer breast-feeding support and equipment without a co-pay.

KAISER HEALTH NEWS CONTRIBUTED

Read more here: http://www.kansascity.com/news/nation-world/national/article127651149.html#fmp#storylink=cpy

6

 

[Ali]

If they get rid of the exclusion for preexisting conditions, pregnancy could be considered a preexisting condition. So, women changing insurance while pregnant would be faced with the of paying high medical bills or avoiding prenatal care and hoping everything works out well. Without prenatal care, I am not sure my daughter would of survived. The "pro-life" party really cares about the safety of the unborn.

[GreyhoundFan]

And so it begins: "Trump signs executive order that could effectively gut Affordable Care Act’s individual mandate"

Spoiler

President Trump signed an executive order late Friday giving federal agencies broad powers to unwind regulations created under the Affordable Care Act, which might include enforcement of the penalty for people who fail to carry the health insurance that the law requires of most Americans.

The executive order, signed in the Oval Office as one of the new president’s first actions, directs agencies to grant relief to all constituencies affected by the sprawling 2010 health-care law: consumers, insurers, hospitals, doctors, pharmaceutical companies, states and others. It does not describe specific federal rules to be softened or lifted, but it appears to give room for agencies to eliminate an array of ACA taxes and requirements.

However, some of these are embedded in the law, so it is unclear what latitude the executive branch will have.

Though the new administration’s specific intentions are not yet clear, the order’s breadth and early timing carry symbolic value for a president who made repealing the ACA — his predecessor’s signature domestic achievement — a leading campaign promise.

Additionally, the order’s language about easing economic and regulatory burdens aligns with long-standing Republican orthodoxy that the government exerts too heavy a hand on the U.S. health-care system.

“Potentially the biggest effect of this order could be widespread waivers from the individual mandate, which would likely create chaos in the individual insurance market,” said Larry Levitt, senior vice president at the Kaiser Family Foundation. In addition, he said, the order suggests that insurers may have new flexibility on the benefits they must provide.

“This doesn’t grant any new powers to federal agencies, but it sends a clear signal that they should use whatever authority they have to scale back regulations and penalties. The Trump Administration is looking to unwind the ACA, not necessarily waiting for Congress,” Levitt said.

The order, several paragraphs long, does not identify which of the many federal rules that exist under the ACA the new administration intends to rewrite or eliminate. In general, federal rules cannot be undone with a pen stroke but require a new ­rulemaking process to replace or delete them.

But in giving agencies permission to “waive, defer, grant ­exemptions from or delay” ACA rules, the order appears to create room for the Department of Health and Human Services to narrow or gut a set of medical benefits that the ACA compels insurers to include in health plans that they sell to individuals and small businesses.

The order does not mention Medicaid, but it says one of its goals is to “provide greater flexibility to States,” raising the question of whether the Trump HHS might try to loosen rules for states that have expanded the program for lower-income Americans, as the law allows.

The order directs all federal agencies “to minimize the unwarranted economic and regulatory burdens” of the Affordable Care Act — the first step of Trump’s central campaign promise to repeal and replace former president Barack Obama’s health-care plan.

Trump’s action drew swift protests from ACA proponents who have coalesced to try to preserve the law. “While President Trump may have promised a smooth transition” from the current law to a replacement, said Leslie Dach, director of the fledging Protect Our Care Coalition, “the executive order does the opposite, threatening disruption for health providers and patients.”

Also late Friday, Reince Priebus, Trump’s chief of staff, issued an executive memorandum ordering a freeze on regulations for all government agencies.

The memo could freeze several new Energy Department efficiency standards, such as those affecting portable air conditioners, commercial boilers and uninterruptable power supplies, which were issued Dec. 28 but not yet published in the Federal Register. The regulations were part of the Obama administration’s broader effort to cut greenhouse gas emissions linked to climate change.

The move echoes a missive that then-White House Chief of Staff Rahm Emanuel sent the heads of every federal agency on Jan. 20, 2009, asking them to freeze any rules that had not yet been published in the Federal Register, and to consider a 60-day extension of the effective date of rules that had not yet gone into effect.

Also Friday, Trump signed the official paperwork installing Defense Secretary James Mattis and Homeland Security Secretary John F. Kelly, two of his Cabinet picks the Senate voted to confirm earlier in the day.

Trump’s health-care order came at the end of what had otherwise been a largely ceremonial day. The White House did not immediately return requests for comment. 

During his campaign and afterward, Trump pledged that fundamental changes to the health-care system would be a first priority. In a speech outside Philadelphia six days before the November election, Trump vowed to abolish the Affordable Care Act before he was sworn in. “Have to do it,” he said. “I will ask Congress to convene a special session so we can repeal and replace.”

Last week, both chambers of Congress approved a budget resolution that was the first legislative step toward repealing the 2010 law, which was the centerpiece of the Obama administration’s health policies. But health care was not among a half-dozen issue areas listed on the new WhiteHouse.gov website that debuted shortly after noon on Friday.

Earlier Friday, in the Capitol, the new president took several more perfunctory executive actions shortly after he was sworn in at noon, the most notable being to overturn a recent mortgage-fee reduction — geared at helping first-time and low-income home buyers — that Obama announced last week and that called for the Federal Housing Administration to cut its annual borrowing fee by a quarter of a percentage point.

Trump also signed a waiver for Mattis to lead the Defense Department, despite having only been retired for three years. Without the waiver, federal law would have prohibited Mattis from serving as defense secretary until he had been retired from military service for at least seven years.

And just moments after Trump took the oath of office, he began implementing his general vision, transforming the official White House website with a new set of policy pledges that offered the broad contours of the Trump administration’s top priorities. They included fierce support for law enforcement and gun owners’ rights to defend themselves. There were also some notable absences, such as the omission of a policy page on climate change.

The issues page of Trump’s White House offered no new plans or policies but rather a rehash of many of his most prominent campaign promises — a signal to the nation that Trump, more pragmatic than ideological, plans to implement at least the key guideposts of his campaign vision.

The policies laid out on the website included plans to both withdraw from and renegotiate major trade deals, grow the nation’s military and increase cybersecurity capabilities, build a wall at the nation’s southern border and deport undocumented immigrants who have committed violent crimes.

“Our job is not to make life more comfortable for the rioter, the looter, or the violent disrupter,” read the law and order section, which calls for “more law enforcement” and “more effective policing.” “Our job is to make life more comfortable for parents who want their kids to be able to walk the streets safely. Or the senior citizen waiting for a bus. Or the young child walking home from school.”

The climate change Web page that existed under Obama was not replaced on the Trump site, with scant mention of climate change under the new president’s energy plan. Also gone or not immediately replaced were the Web pages the previous administration had devoted to the rights of lesbian, gay, bisexual and transgender individuals; people with disabilities; and civil rights more generally.

Trump’s entire campaign was largely a repudiation of Obama, and a new Republican administration is unlikely to have the same set of issues and priorities as an outgoing Democratic one. But the missing issue pages were particularly alarming to Democrats and activists, especially after a vitriolic campaign in which Trump drew criticism for seeming to mock a disabled reporter and being insensitive to the needs and rights of minority communities.

On energy, Trump vowed to eliminate “harmful and unnecessary policies” such as the Climate Action Plan and the Waters of the United States rule. The first represents a variety of efforts Obama had pursued to reduce U.S. greenhouse gas emissions while the second is a rule issued by the Environmental Protection Agency to protect not only the largest waterways but also smaller tributaries that others believe should fall under the jurisdiction of states rather than the federal government.

The initial Trump website also did not devote a separate section to immigration, another central tenet of his candidacy, though it mentioned immigration under the law enforcement section. Despite rumors within the immigration advocacy community that one of Trump’s initial executive actions could be to revoke Obama’s protections for “dreamers” — undocumented immigrants brought to the country as young children — his website so far focused only on big-picture enforcement and security goals.

“He is dedicated to enforcing our border laws, ending sanctuary cities, and stemming the tide of lawlessness associated with illegal immigration,” read part of the immigration section.

The new administration’s language echoed Trump’s tough rhetoric on the campaign trail, including his promises to strengthen the law enforcement community, crack down on what he views as a broad range of trade violations and potentially forge alliances with countries long considered dangerous rivals, such as Russia.

“Finally, in pursuing a foreign policy based on American interests, we will embrace diplomacy,” read part of Trump’s policy vision. “The world must know that we do not go abroad in search of enemies, that we are always happy when old enemies become friends, and when old friends become allies.”

Melania Trump, the first lady, also received a biographical overhaul. Her web page featured a black and white glamour shot of her, and touted her jewelry line and modeling career, describing the many high fashion photographers with whom she has worked and the glossy magazines for which she has posed (Vogue and the Sports Illustrated swimsuit edition, among others).

The first lady’s biography also correctly stated that she began college at the University of Ljubljana in Slovenia, her home country, but never graduated — a fact that was misstated during the campaign.

Only at the very end of her page did Melania offer a glimpse of the sort of first lady she might be: “Mrs. Trump cares deeply about issues impacting women and children,” read the biography, “and she has focused her platform as First Lady on the problem of cyber bullying among our youth.”

 

[Childless]

19 hours ago, GreyhoundFan said:

And so it begins: "Trump signs executive order that could effectively gut Affordable Care Act’s individual mandate"

  Reveal hidden contents

President Trump signed an executive order late Friday giving federal agencies broad powers to unwind regulations created under the Affordable Care Act, which might include enforcement of the penalty for people who fail to carry the health insurance that the law requires of most Americans.

The executive order, signed in the Oval Office as one of the new president’s first actions, directs agencies to grant relief to all constituencies affected by the sprawling 2010 health-care law: consumers, insurers, hospitals, doctors, pharmaceutical companies, states and others. It does not describe specific federal rules to be softened or lifted, but it appears to give room for agencies to eliminate an array of ACA taxes and requirements.

However, some of these are embedded in the law, so it is unclear what latitude the executive branch will have.

Though the new administration’s specific intentions are not yet clear, the order’s breadth and early timing carry symbolic value for a president who made repealing the ACA — his predecessor’s signature domestic achievement — a leading campaign promise.

Additionally, the order’s language about easing economic and regulatory burdens aligns with long-standing Republican orthodoxy that the government exerts too heavy a hand on the U.S. health-care system.

“Potentially the biggest effect of this order could be widespread waivers from the individual mandate, which would likely create chaos in the individual insurance market,” said Larry Levitt, senior vice president at the Kaiser Family Foundation. In addition, he said, the order suggests that insurers may have new flexibility on the benefits they must provide.

“This doesn’t grant any new powers to federal agencies, but it sends a clear signal that they should use whatever authority they have to scale back regulations and penalties. The Trump Administration is looking to unwind the ACA, not necessarily waiting for Congress,” Levitt said.

The order, several paragraphs long, does not identify which of the many federal rules that exist under the ACA the new administration intends to rewrite or eliminate. In general, federal rules cannot be undone with a pen stroke but require a new ­rulemaking process to replace or delete them.

But in giving agencies permission to “waive, defer, grant ­exemptions from or delay” ACA rules, the order appears to create room for the Department of Health and Human Services to narrow or gut a set of medical benefits that the ACA compels insurers to include in health plans that they sell to individuals and small businesses.

The order does not mention Medicaid, but it says one of its goals is to “provide greater flexibility to States,” raising the question of whether the Trump HHS might try to loosen rules for states that have expanded the program for lower-income Americans, as the law allows.

The order directs all federal agencies “to minimize the unwarranted economic and regulatory burdens” of the Affordable Care Act — the first step of Trump’s central campaign promise to repeal and replace former president Barack Obama’s health-care plan.

Trump’s action drew swift protests from ACA proponents who have coalesced to try to preserve the law. “While President Trump may have promised a smooth transition” from the current law to a replacement, said Leslie Dach, director of the fledging Protect Our Care Coalition, “the executive order does the opposite, threatening disruption for health providers and patients.”

Also late Friday, Reince Priebus, Trump’s chief of staff, issued an executive memorandum ordering a freeze on regulations for all government agencies.

The memo could freeze several new Energy Department efficiency standards, such as those affecting portable air conditioners, commercial boilers and uninterruptable power supplies, which were issued Dec. 28 but not yet published in the Federal Register. The regulations were part of the Obama administration’s broader effort to cut greenhouse gas emissions linked to climate change.

The move echoes a missive that then-White House Chief of Staff Rahm Emanuel sent the heads of every federal agency on Jan. 20, 2009, asking them to freeze any rules that had not yet been published in the Federal Register, and to consider a 60-day extension of the effective date of rules that had not yet gone into effect.

Also Friday, Trump signed the official paperwork installing Defense Secretary James Mattis and Homeland Security Secretary John F. Kelly, two of his Cabinet picks the Senate voted to confirm earlier in the day.

Trump’s health-care order came at the end of what had otherwise been a largely ceremonial day. The White House did not immediately return requests for comment. 

During his campaign and afterward, Trump pledged that fundamental changes to the health-care system would be a first priority. In a speech outside Philadelphia six days before the November election, Trump vowed to abolish the Affordable Care Act before he was sworn in. “Have to do it,” he said. “I will ask Congress to convene a special session so we can repeal and replace.”

Last week, both chambers of Congress approved a budget resolution that was the first legislative step toward repealing the 2010 law, which was the centerpiece of the Obama administration’s health policies. But health care was not among a half-dozen issue areas listed on the new WhiteHouse.gov website that debuted shortly after noon on Friday.

Earlier Friday, in the Capitol, the new president took several more perfunctory executive actions shortly after he was sworn in at noon, the most notable being to overturn a recent mortgage-fee reduction — geared at helping first-time and low-income home buyers — that Obama announced last week and that called for the Federal Housing Administration to cut its annual borrowing fee by a quarter of a percentage point.

Trump also signed a waiver for Mattis to lead the Defense Department, despite having only been retired for three years. Without the waiver, federal law would have prohibited Mattis from serving as defense secretary until he had been retired from military service for at least seven years.

And just moments after Trump took the oath of office, he began implementing his general vision, transforming the official White House website with a new set of policy pledges that offered the broad contours of the Trump administration’s top priorities. They included fierce support for law enforcement and gun owners’ rights to defend themselves. There were also some notable absences, such as the omission of a policy page on climate change.

The issues page of Trump’s White House offered no new plans or policies but rather a rehash of many of his most prominent campaign promises — a signal to the nation that Trump, more pragmatic than ideological, plans to implement at least the key guideposts of his campaign vision.

The policies laid out on the website included plans to both withdraw from and renegotiate major trade deals, grow the nation’s military and increase cybersecurity capabilities, build a wall at the nation’s southern border and deport undocumented immigrants who have committed violent crimes.

“Our job is not to make life more comfortable for the rioter, the looter, or the violent disrupter,” read the law and order section, which calls for “more law enforcement” and “more effective policing.” “Our job is to make life more comfortable for parents who want their kids to be able to walk the streets safely. Or the senior citizen waiting for a bus. Or the young child walking home from school.”

The climate change Web page that existed under Obama was not replaced on the Trump site, with scant mention of climate change under the new president’s energy plan. Also gone or not immediately replaced were the Web pages the previous administration had devoted to the rights of lesbian, gay, bisexual and transgender individuals; people with disabilities; and civil rights more generally.

Trump’s entire campaign was largely a repudiation of Obama, and a new Republican administration is unlikely to have the same set of issues and priorities as an outgoing Democratic one. But the missing issue pages were particularly alarming to Democrats and activists, especially after a vitriolic campaign in which Trump drew criticism for seeming to mock a disabled reporter and being insensitive to the needs and rights of minority communities.

On energy, Trump vowed to eliminate “harmful and unnecessary policies” such as the Climate Action Plan and the Waters of the United States rule. The first represents a variety of efforts Obama had pursued to reduce U.S. greenhouse gas emissions while the second is a rule issued by the Environmental Protection Agency to protect not only the largest waterways but also smaller tributaries that others believe should fall under the jurisdiction of states rather than the federal government.

The initial Trump website also did not devote a separate section to immigration, another central tenet of his candidacy, though it mentioned immigration under the law enforcement section. Despite rumors within the immigration advocacy community that one of Trump’s initial executive actions could be to revoke Obama’s protections for “dreamers” — undocumented immigrants brought to the country as young children — his website so far focused only on big-picture enforcement and security goals.

“He is dedicated to enforcing our border laws, ending sanctuary cities, and stemming the tide of lawlessness associated with illegal immigration,” read part of the immigration section.

The new administration’s language echoed Trump’s tough rhetoric on the campaign trail, including his promises to strengthen the law enforcement community, crack down on what he views as a broad range of trade violations and potentially forge alliances with countries long considered dangerous rivals, such as Russia.

“Finally, in pursuing a foreign policy based on American interests, we will embrace diplomacy,” read part of Trump’s policy vision. “The world must know that we do not go abroad in search of enemies, that we are always happy when old enemies become friends, and when old friends become allies.”

Melania Trump, the first lady, also received a biographical overhaul. Her web page featured a black and white glamour shot of her, and touted her jewelry line and modeling career, describing the many high fashion photographers with whom she has worked and the glossy magazines for which she has posed (Vogue and the Sports Illustrated swimsuit edition, among others).

The first lady’s biography also correctly stated that she began college at the University of Ljubljana in Slovenia, her home country, but never graduated — a fact that was misstated during the campaign.

Only at the very end of her page did Melania offer a glimpse of the sort of first lady she might be: “Mrs. Trump cares deeply about issues impacting women and children,” read the biography, “and she has focused her platform as First Lady on the problem of cyber bullying among our youth.”

 

And when they start loosing benefits and can't afford healthcare, then maybe the Trump voters will recognize what they have done to themselves.  

[VixenToast]

My friend took her toddler to ER today. She has him on Medicaid. She said the check in ladies laughed at her and said they are refusing Medicaid and she has to pay out of her own pocket. Or that is what's she said on Facebook. She is in a small Nebraskan city, not huge, not tiny.

what could be going on? Or did something happen?

[clueliss]

Remember that Medicaid is administrated by state.  (things I know because of my mother and dementia - I've spent time bickering with the brokeass state of Kansas on getting her approved)

[QuiverDance]

On 1/13/2017 at 4:19 PM, apple1 said:

You and I must be close to the same age. My personal experience was nearly identical.

Mine was similar.

[HarryPotterFan]

On January 5, 2017 at 1:42 PM, candygirl200413 said:

 

Also as a Public Health major, I remember taking my first class of my major and it was about healthcare, and I always knew America could improve in that aspect, but I didn't know how bad of a system we truly had, especially for being a developed country but having the worst health insurance ever.You would think if trump among others really wanted to "make america great again" that they would look into bringing us back to number one, but alas they won't.

I wish some of my public health classes covered that topic...that would have been useful.

On January 13, 2017 at 7:36 PM, formergothardite said:

Oh, but Paul Ryan swore that she could get insurance through a high risk insurance pool. I wish someone would have asked him to say exactly how much the premiums on those are, because from what I've read, they are very high. He was going on like it was something very affordable. 

http://www.commonwealthfund.org/publications/blog/2015/feb/why-high-risk-pools-still-will-not-work

I wanted to slap Paul Ryan's smug face when he was going on about those. 

Fuck him. I have multiple preexisting conditions and fuck that little shit hole. All I did to have this health crap was be born.

On January 21, 2017 at 10:46 PM, VixenToast said:

My friend took her toddler to ER today. She has him on Medicaid. She said the check in ladies laughed at her and said they are refusing Medicaid and she has to pay out of her own pocket. Or that is what's she said on Facebook. She is in a small Nebraskan city, not huge, not tiny.

what could be going on? Or did something happen?

They fucking LAUGHED? What assholes. This situation makes no sense to me. I've heard of private practices deciding not to accept medicaid/care since they're slow with reimbursement, but not a hospital! And ERs are supposed to treat you, regardless of ability to pay.

[GreyhoundFan]

"Repealing the Affordable Care Act will kill more than 43,000 people annually"

Quote

Now that President Trump is in the Oval Office, thousands of American lives that were previously protected by provisions of the Affordable Care Act are in danger. For more than 30 years, we have studied how death rates are affected by changes in health-care coverage, and we’re convinced that an ACA repeal could cause tens of thousands of deaths annually.

The story is in the data: The biggest and most definitive study of what happens to death rates when Medicaid coverage is expanded, published in the New England Journal of Medicine, found that for every 455 people who gained coverage across several states, one life was saved per year. Applying that figure to even a conservative estimate of 20 million losing coverage in the event of an ACA repeal yields an estimate of 43,956 deaths annually.

With Republicans’ efforts to destroy the ACA now underway, several commentators have expressed something akin to cautious optimism about the effect of a potential repeal. The Washington Post’s Glenn Kessler awarded Sen. Bernie Sanders (I-Vt.) four Pinocchios for claiming that 36,000 people a year will die if the ACA is repealed; Brookings Institution fellow Henry Aaron, meanwhile, predicted that Republicans probably will salvage much of the ACA’s gains, and conservative writer Grover Norquist argued that the tax cuts associated with repeal would be a massive boon for the middle class.

But such optimism is overblown.

The first problem is that Republicans don’t have a clear replacement plan. Kessler, for instance, chides Sanders for assuming that repeal would leave many millions uninsured, because Kessler presumes that the Republicans would replace the ACA with reforms that preserve coverage. But while repeal seems highly likely (indeed, it’s already underway using a legislative vehicle that requires only 50 Senate votes), replacement (which would require 60 votes) is much less certain.

Moreover, even if a Republican replacement plan comes together, it’s likely to take a big backward step from the gains made by the ACA, covering fewer people with much skimpier plans.

Although Aaron has a rosy view of a likely Republican plan, much of what they — notably House Speaker Paul D. Ryan (R-Wis.) and Rep. Tom Price (R-Ga.), who is Trump’s nominee to head the Department of Heath and Human Services, which will be in charge of dismantling the ACA — have advocated in place of the ACA would hollow out the coverage of many who were unaffected by the law, harming them and probably raising their death rates. Abolishing minimum coverage standards for insurance policies would leave insurers and employers free to cut coverage for preventive and reproduction-related care. Allowing interstate insurance sales probably would cause a race to the bottom, with skimpy plans that emanate from lightly regulated states becoming the norm. Block granting Medicaid would leave poor patients at the mercy of state officials, many of whom have shown little concern for the health of the poor. A Medicare voucher program (with the value of the voucher tied to overall inflation rather than more rapid medical inflation) would worsen the coverage of millions of seniors, a problem that would be exacerbated by the proposed ban on full coverage under Medicare supplement policies. In other words, even if Republicans replace the ACA, the plans they’ve put on the table would have devastating consequences.

The frightening fact is that Sanders’s estimate that about 36,000 people will die if the ACA is repealed is consistent with well-respected studies. The Urban Institute’s estimate, for instance, predicts that 29.8 million (not just 20 million) will lose coverage if Republicans repeal the law using the budget reconciliation process. And that’s exactly what they’ve already begun to do, with no replacement plan in sight.

No one knows with any certainty what the Republicans will do, or how many will die as a result. But Sanders’s suggestion that 36,000 would die is certainly well within the ballpark of scientific consensus on the likely impact of repeal of the ACA, and the notion of certain replacement — and the hope that a GOP replacement would be a serviceable remedy — are each far from certain, and looking worse every day.

a race to the bottom...that describes the Republicans perfectly.

[Childless]

The only faint silver lining is that maybe the clusterfuck the GOP is about to rain down on our heads will cause an uprising that will usher in a single payer system.  Of course, that rests on the hope that Americans support policies that are in their best interests and from what I've seen thus far, most Americans are not that bright.

[apple1]

18 hours ago, HarryPotterFan said:

I wish some of my public health classes covered that topic...that would have been useful.

Fuck him. I have multiple preexisting conditions and fuck that little shit hole. All I did to have this health crap was be born.

They fucking LAUGHED? What assholes. This situation makes no sense to me. I've heard of private practices deciding not to accept medicaid/care since they're slow with reimbursement, but not a hospital! And ERs are supposed to treat you, regardless of ability to pay.

ERs are only required by law to respond to an care for immediate life-threatening issues. As awful as it is, they can refuse to see people if they come in for anything that is not deemed immediately life-threatening.

[RoseWilder]

Republicans held a meeting to discuss repealing the ACA and someone anonymously emailed a recording of the meeting to Washington Post: 

https://www.washingtonpost.com/politics/behind-closed-doors-republican-lawmakers-fret-about-how-to-repeal-obamacare/2017/01/27/deabdafa-e491-11e6-a547-5fb9411d332c_story.html?utm_campaign=pubexchange&utm_medium=referral&utm_source=huffingtonpost.com&utm_term=.dde58c50c39c

Quote

Republican lawmakers aired sharp concerns about their party’s quick push to repeal the Affordable Care Act inside a closed-door meeting Thursday, according to a recording of the session obtained by The Washington Post.

The recording reveals a GOP that appears to be filled with doubts about how to make good on a long-standing promise to get rid of Obamacare without explicit guidance from President Trump or his administration.

Senators and House members expressed a range of concerns about the task ahead: how to prepare a replacement plan that can be ready to launch at the time of repeal; how to avoid deep damage to the health insurance market; how to keep premiums affordable for middle-class families; even how to avoid the political consequences of defunding Planned Parenthood, the women’s health-care organization, as many Republicans hope to do with the repeal of the ACA.

“We’d better be sure that we’re prepared to live with the market we’ve created” with repeal, said Rep. Tom McClintock (R-Calif.). “That’s going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.”

In short: they're trying to figure out a way to do something simply to spite President Obama without pissing off so many voters that they get voted out in 2018, and they can't figure out how to do it.

Here's a crazy thought, maybe they should just work on improving the parts of the ACA that aren't working instead of throwing a spiteful, toddler temper tantrum aimed at punishing President Obama. 

[Childless]

30 minutes ago, RoseWilder said:

Republicans held a meeting to discuss repealing the ACA and someone anonymously emailed a recording of the meeting to Washington Post: 

https://www.washingtonpost.com/politics/behind-closed-doors-republican-lawmakers-fret-about-how-to-repeal-obamacare/2017/01/27/deabdafa-e491-11e6-a547-5fb9411d332c_story.html?utm_campaign=pubexchange&utm_medium=referral&utm_source=huffingtonpost.com&utm_term=.dde58c50c39c

In short: they're trying to figure out a way to do something simply to spite President Obama without pissing off so many voters that they get voted out in 2018, and they can't figure out how to do it.

Here's a crazy thought, maybe they should just work on improving the parts of the ACA that aren't working instead of throwing a spiteful, toddler temper tantrum aimed at punishing President Obama. 

That would require they be mature adults.  Don't hold your breath.

[AmericanRose]

28 minutes ago, RoseWilder said:

The recording reveals a GOP that appears to be filled with doubts about how to make good on a long-standing promise to get rid of Obamacare without explicit guidance from President Trump or his administration.

They were expecting any guidance from Trump...? As far as I can tell, his method of 'guidance' is "I want this. Figure out a way to make it so." Plus, dude is still hung up on the election.

But if they can't just fix the parts of the ACA that need fixing, I'd rather them spend time quibbling about how to replace it. Though the only better option I see is single-payer, which I know Republicans would never go for. Someone who makes less than I do would pay less for the same healthcare!!!!

[Penny]

These people are idiots. Saying they are going to do something and not knowing how to do it. They should all be voted out of office.