People Who Want To Torpedo Medicare-For-All Are Endorsing... Status Quo Joe

A couple of weeks ago, Bernie enumerated a dozen or so prominent people who he would rather not get endorsements from. I don't think he really needed to worry about that. He was speaking about people who are likely already committed to either Status Quo Joe-- Pete when Biden self-destructs-- or Trump. I suppose there might be a couple of Kamala backers in the mix too. But no Bernie backers; no Warren backers. Basically, it was the "anybody but Bernie" crowd.

Yesterday, Mike Duggan, mayor of Detroit, endorsed Biden. He's Detroit's first white mayor in around 4 decades. Duggan made his millions when, as CEO of non-profit Detroit Medical Center, he sold it to all-about-profit Vanguard Health Systems. So I imagine he actually really knows how much help Medicare-For-All would be for his Detroit constituents. So why did he endorse Status Quo Joe?

Politicians who are endorsing Biden don't want to help anyone... but themselves. Am I saying that someone who endorses Biden deserves opprobrium and disdain? Unless today is the first time you've been over to DWT and have never heard me on Nicole Sandler's show or on David Feldman's show, you know that's just a rhetorical question. Of course, they deserve opprobrium and disdain-- and worse.

For example, these are the members of the Senate-- each of whom sporting an "F" grade from ProgressivePunch-- who have endorsed Biden so far (not counting former senators like slime ball Sickness Industry lobbyist Tom Daschle). All oppose Medicare-For-All and each has his or her net worth next to their name:

• Sen. Doug Jones (AL)- $12 million
• Sen. Dianne Feinstein (CA)- $79 million
• Sen. Tom Carper (DE)- $5.2 million
• Sen. Chris Coons (DE)- $8.8 million
• Sen. Bob Casey (PA)- $0.7 million

Last week Kaiser Health News reported that the system backed by Status Quo Joe, Mike Duggan, Tom Daschle Doug Jones, Dianne Feinstein, Tom Carper Chris Coons and Bob Casey-- and everyone else who endorses Biden-- has been bilking taxpayers for tens of billions of dollars. "Health insurers," they wrote, "that treat millions of seniors have overcharged Medicare by nearly $30 billion the past three years alone.

Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have.

Getting refunds from the health plans has proved daunting, however. Officials with the Centers for Medicare & Medicaid Services repeatedly have postponed, or backed off, efforts to crack down on billing abuses and mistakes by the increasingly popular Medicare Advantage health plans offered by private health insurers under contract with Medicare. Today, such plans treat over 22 million seniors, more than 1 in 3 people on Medicare.

Now CMS is trying again, proposing a series of enhanced audits tailored to claw back $1 billion in Medicare Advantage overpayments by 2020-- just a tenth of what it estimates the plans overcharge the government in a given year.

At the same time, the Department of Health and Human Services Inspector General’s Office has launched a separate nationwide round of Medicare Advantage audits.

As in past years, such scrutiny faces an onslaught of criticism from the insurance industry, which argues the CMS audits especially are technically unsound and unfair and could jeopardize medical services for seniors.
America’s Health Insurance Plans, an industry trade group, blasted the CMS audit design when details emerged last fall, calling it “fatally flawed.”

Insurer Cigna Corp. warned in a May financial filing: “If adopted in its current form, [the audits] could have a detrimental impact” on all Medicare Advantage plans and “affect the ability of plans to deliver high quality care.”
But former Sen. Claire McCaskill, a Missouri Democrat who now works as a political analyst, said officials must move past powerful lobbying efforts to hold health insurers accountable and demand refunds for “inappropriate” billings.

“There’s a lot of things that could cause Medicare to go broke. This would be one of the contributing factors,” she said. “Ten billion dollars a year is real money.”

Catching Overbilling With A Wider Net

In the overpayment dispute, health plans want CMS to scale back-- if not kill off-- an enhanced audit tool that, for the first time, could force insurers to cough up millions in improper payments they’ve received.

For over a decade, audits have been little more than an irritant to insurers because most plans go years without being chosen for review and often pay only a few hundred thousand dollars in refunds as a consequence. When auditors uncover errors in the medical records of patients they paid the companies to treat, CMS has simply required a rebate for those patients for just the year audited-- relatively small sums for plans with thousands of members.

The latest CMS proposal would raise those stakes enormously by extrapolating error rates found in a random sample of 200 patients to the plan’s full membership-- a technique expected to trigger many multimillion-dollar penalties. Though controversial, extrapolation is common in medical fraud investigations-- except for investigations into Medicare Advantage. Since 2007, the industry has successfully challenged the extrapolation method and, as a result, largely avoided accountability for pervasive billing errors.

“The public has a substantial interest in the recoupment of millions of dollars of public money improperly paid to health insurers,” CMS wrote in a Federal Register notice late last year announcing its renewed attempt at using extrapolation.

Penalties In Limbo

In a written response to questions posed by Kaiser Health News, CMS officials said the agency has already conducted 90 of those enhanced audits for payments made in 2011, 2012 and 2013-- and expects to collect $650 million in extrapolated penalties as a result.

Though that figure reflects only a minute percentage of actual losses to taxpayers from overpayments, it would be a huge escalation for CMS. Previous Medicare Advantage audits have recouped a total of about $14 million, far less than it cost to conduct them, federal records show.

Though CMS has disclosed the names of the health plans in the crossfire, it has not yet told them how much each owes, officials said. CMS declined to say when, or if, they would make the results public.

This year, CMS is starting audits for 2014 and 2015, 30 per year, targeting about 5% of the 600 plans annually.

This spring, CMS announced it would extend until the end of August the audit proposal’s public comment period, which was supposed to end in April. That could be a signal the agency might be looking more closely at industry objections.

I Still Contend That Trump Is Worse Than Biden

Establishment vs Bernie by Nancy Ohanian

Judging by the polls, the roll-out for Status Quo Joe went well-- especially (and ironically) with black women. According the new poll released yesterday by Morning Consult, Biden is the top choice among all men, all women, white men, white women and black men and black women... But the black women were most likely to have fallen for the Biden bullshit (also least likely to have fallen for the McKinsey Pete bullshit; that honor goes to white men). So the question is... do black women just not know that Biden built his entire career on racism and anti-families/anti-progressive values... or they just not care about that? I suspect it's the former and that when they look into his record more thoroughly, his support will sink back down to reasonable levels. The idea of a fraud and hollow establishment hack like Biden beating Kamala Harris, Elizabeth Warren and Bernie among black women is bizarre and probably-- or at least hopefully-- temporary.

Change Research is a more credible polling firm and they also released a new survey yesterday, showing, among other things a 15 point decline for Biden since March, exactly in line with a 15 point rise for a virtual Bider The Younger (McKinsey Pete). Among likely Democratic primary voters nationwide, their poll shows this lay of the land among candidates polling 5% or more:

• Biden- 21%
• Bernie- 20%
• McKinsey Pete- 17%
• Beto- 9%
• Elizabeth Warren- 8%
• Kamala Harris- 7%

The survey also found that the "plurality of Democratic voters (22%) select health care as the most important issue to them in the upcoming election. However, their concern about health care is not driven by dissatisfaction with their own insurance plans. 82% rate theirs as at least acceptable, and 54% rate it as excellent or good. Just 15% say their coverage is poor. 70% say they have been continuously covered the last five years. Despite these acceptable insurance conditions, 62% say that they or someone in their household has struggled to cover the costs of health care. Solid majorities support a “Medicare for All” or single-payer system." Bottom line support Medicare for All and 92% believe the government should regulate the prices of life-saving medicine, Bernie's programs, opposed by Biden and the GOP. "71% of Democratic voters are more likely to vote for a candidate if the candidate supports Medicare for All. 69% would be less likely to vote for a candidate who opposes Medicare for All and a public option... Democratic voters rate Bernie Sanders as their preferred candidate on health care issues (66%), followed by Elizabeth Warren (54%), Joe Biden (49%), Kamala Harris (37%), Beto O’Rourke (36%), and Pete Buttigieg (34%)."

A couple of days earlier, Vox published a piece by Dylan Scott-- The Health Care Industry Is Betting On Joe Biden In Its War Against Medicare-for-all-- that demonstrates why Biden has to hope Democratic primary voters continue to be hoodwinked by a campaign that shows his strategy to be to lie as much and as deeply as Trump. Biden's healthcare agenda is all about preserving the status quo, strengthening and improving a very inadequate Obamacare. And the health care industry is jumping for joy-- as happy as Wall Street that he's in the race.

Industry lobbyists aren’t certain Biden will win. One Democratic health care lobbyist grimly predicted to me Sanders would take the Democratic nomination. A trade association leader brought up Biden’s two previous failed presidential bids. But they finally have a candidate in their corner with the profile to battle Sanders and single-payer.

The health care industry-- doctors, hospitals, insurers, pharmaceuticals-- has united in the Partnership for America’s Health Care Future, a lobbying coalition, to stop Medicare-for-all. That organization aggressively denounces single-payer at every opportunity, and has condemned proposals like a public option or letting people 55 and older buy into Medicare.

“Let’s do Alexander-Murray,” a top trade association president told me, referring to the bipartisan Obamacare stabilization plan from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) that fizzled out after Obamacare repeal failed. “Make the individual market better, which we clearly could do; it wouldn’t cost that much money.”

Industry insiders expect Biden to, at most, support a public option that allows some or all people under 65 to buy into Medicare. The Biden campaign did not respond to requests for comment on the candidate’s health care plans.

“The industry would just like to see a candidate who would be responsible and be pragmatic,” this person said. “From the industry standpoint, it’s like, what was all the energy about 2010? Biden would be more sympathetic toward that.”

Sanders has made Medicare-for-all something of a primary litmus test, and several of his opponents-- Sens. Elizabeth Warren, Kamala Harris, Cory Booker, and Kirsten Gillibrand-- have signed on to his bill. Not every 2020 Democrat is backing single-payer, of course. Pete Buttigieg, Beto O’Rourke, and Amy Klobuchar talk about alternative plans that don’t go as far as the single-payer system envisioned by the Vermont senator.

But it’s Biden who’s leading the polls, edging out Sanders for the most part, while the other lesser-known candidates still trail behind. He’ll position himself as the most viable center-left alternative to Sanders, the best bet to beat Trump in the general election. The primary will be Biden versus Sanders until proven otherwise, and the industry obviously views the vice president as the guy on their side.

“This encapsulates a liberal versus a moderate in people’s minds. People want to beat Trump. They know a socialist can’t. The government isn’t going to fix everything,” a Democratic health care lobbyist said. “To that extent, people are waiting for” a candidate like Biden who wants more incremental improvements.

We shouldn’t understate the success single-payer supporters have had in bringing the idea into the mainstream political debate. Sanders has gone from being the lone sponsor of a single-payer bill in the Senate to having a bill with 17 co-sponsors, including Warren, Harris, Booker, and Gillibrand. A full 80 percent of Democratic voters said they supported the plan in the most recent poll from the Kaiser Family Foundation.

...The health care industry does generally seem to see Biden as their best chance to stop Sanders, or Warren or any of the other Medicare-for-all supporters. At least one high-profile guest at the vice president’s first big fundraiser is reported to be a health care executive.

“He’s the only bet,” the Democratic lobbyist said. “He’s the only person that’s anyone.”

I don't know... Twitter found Status Quo Joe tied with Trumpanzee as the least politician who can be expected to perform like Arya. So there's that. Elizabeth Warren was seen as the most Arya-like-- and she has a grudge against Biden, when Biden's plans to help the credit card companies that financed his vile political career screw over working people.

In the 1990s, the increasing number of US consumer bankruptcies led to a push by the financial sector to make it harder for people to seek relief from the courts. Lenders argued that deadbeats who had been borrowing to fund lavish lifestyles would then use bankruptcies to erase their debt. It was called the Bankruptcy Abuse Prevention Consumer Protection Act (BAPCPA).

Warren, a nationally recognized expert on the topic, used her research to argue that the real problem could be found in lax lending practices, like credit-card companies opening accounts for teenagers with no incomes, or the impact of sudden, enormous medical bills on family finance.

Nonetheless, the legislation was enacted, but president Bill Clinton refused to sign it, in part thanks to Warren’s lobbying of first lady Hillary Clinton. With George W. Bush in the White House following the 2000 election, the legislation was reintroduced, and eventually became law. Its top champion among Senate Democrats was  Biden of Delaware, a state called home by several major lenders whose employees contributed generously to his campaigns.

BAPCPA proponents note that bankruptcies have fallen since it became law in 2005. But researchers say its main effect has been that financially strapped consumers simply delay filing for bankruptcy, piling up more debts they can’t afford.

One of the decisive moments came in a February 2005 hearing, when Warren testified before the committee on which Biden sat as the senior Democrat. The collapse of Enron was fresh economic trauma. Warren criticized an aspect of the bill that allowed the Houston-based energy company to conduct its bankruptcy proceedings in Delaware, a jurisdiction where its employees found it difficult to challenge decisions that included the future of their pension fund.

Delaware’s economy is founded on cozy relationships of its courts with corporations, and Biden took umbrage in a series of testy questions for Warren:

Biden then launched into a critique of Warren’s views, suggesting that she was thrusting the responsibilities of the government on innocent businesses.

...Warren has said that the experience of seeing the bankruptcy bill pass was a wakeup call. Being right was not enough; the political power of entrenched interests made traditional remedies for consumers obsolete. Two years later, she would publish an article calling for the creation of a federal Consumer Financial Protection Agency as a new, direct solution for the problem of unsafe financial products.

She would also lose patience with members of her own Democratic party who made compromises with the financial sector. When she found herself an adviser in the Obama White House, with Biden as vice president, she clashed with treasury secretary Tim Geithner over the powers that should be given to the new agency when it was created by the Dodd-Frank financial reform law. Ultimately, Obama gave the job of running the new agency to Ohio attorney general Richard Cordray, and Warren ran for a Massachusetts senate seat in 2012.

Warren was one of the first candidates to throw her hat in the 2020 Democratic presidential ring, running on a platform of policy ideas that can be traced to the views of the American economy she developed in her research into bankruptcy. When Biden, a frontrunner in the polls, finally got in the race last week, Warren didn’t waste any words.

“Our disagreement is a matter of public record,” she said. “When the biggest financial institutions in this country were trying to put the squeeze on millions of hardworking families who were in bankruptcy because of medical problems, job losses, divorce and death in the family, there was nobody to stand up for them. I got in that fight because they just didn’t have anyone, and Joe Biden was on the side of credit-card companies.”

In the 2016 primaries, Hillary Clinton’s support for the same bankruptcy law proved a potent critique for Bernie Sanders, who’s also in the Democratic race this time around. On a future debate stage, Biden will have a difficult time changing the subject when Warren lays into him about his links to the financial industry.

Biden is a TOTAL piece of shit-- almost on a Trumpian level (not quite, but along the worst of lines). Don't fool yourself and further wreck the country.

Midnight Meme Of The Day!

by Noah

As we hit the end of March 2019, I think this brief Tom Tomorrow summary of lowlights of the month (minus the Mueller Report and any of its ongoing fallout) is sadly appropriate. Any one of the people depicted is, of course, deserving of special recognition as Douchebag Of The Month, and so much more, but let's be fair and go with the everyone gets a trophy approach.

But wait! There's more!

Trump, Believing His Own P.R., Over-Reaches

Collusion by Nancy Ohanian

Tuesday night it leaked out that Attorney General Bill Barr and Alex Azar, Secretary of Health and Human Services both opposed Trump's decision to invalidate the Affordable Care Act, kicking over 20 million Americans off healthcare and shit-canning popular provisions like protections for people with preexisting conditions.

Right-wing ideologue Mick Mulvaney and two deputies-- Trump's domestic policy chief, Joe Grogan, and the acting director of the Office of Management and Budget, Russ Vought were the ones who engineered the move. Eliana Johnson and Burgess Everett made clear in their Politico write-up that many Republicans are miserable over the decision "because they see it as bringing high political risk for a party that has failed to unite behind an Obamacare alternative and which lost House seats in the 2018 midterms when Democrats made health care a focus of their attacks.

Although Trump babbled some typical gaslighting bushiest about how "the Republican Party will soon be known as the party of health care," he handed the Democrats a winning issue for 2020-- exactly the kind of issue that will strengthen the anti-red wave that swept over 40 Republicans out of their House seats. The imbecile-in-chief continued: "I mean it 100 percent, I understand healthcare now, especially very well. A lot of people don’t understand it, we are going to be, the Republicans, the party of great healthcare. The Democrats have, they’ve let you down, they came up with Obamacare, it’s terrible."

At a lunch Tuesday with Senate Republicans, Trump was boasting while some Senate Republicans were sitting silently in dread. Susan Collins (R-ME), one of the most vulnerable senators up for reelection next year: "I was extraordinarily disappointed in the position the Justice Department has taken. I thought it was bad enough when they didn’t want to defend parts of the law, the parts protecting people with pre-existing conditions. This goes far beyond that and I think this was a huge mistake."

This is part of Trump's feeling that he was empowered by a p.r. victory in the way the GOP has been able to spin the still closely-held Mueller-report. The Regime succeeded in stampeding imbeciles in the media to repeat bogus claims that the report exonerated him, which it didn't. It was an empowering couple of days for an illegitimate "president" who isn't used to-- but always craves-- good press coverage. He thinks Barr's press release has vindicated him. Sen. Johnny Isakson (R-GA): "He's doing a victory lap, no doubt about it."

Burgess Everett and John Bresnahan reported that "Trump’s decision to jump headlong into another divisive health care effort-- with Democrats in control of the House no less-- shows that he isn’t shying away from conflicts, even those that could hurt vulnerable GOP lawmakers. In fact, Republicans had no real plans to pass or even necessarily plan for sweeping health care legislation as of 24 hours ago. And most in the party have been eager to put the disastrous effort to repeal Obamacare behind them." Trump urged senators to block aid to Puerto Rico, to investigate Hillary Clinton and Obama, to pass his new NAFTA deal and to help him wreck NATO. He also "told Republicans he wants to protect intellectual property produced by 'nerds' in Silicon Valley from China, angling for a new pact with the country by driving a hard bargain. 'Very good deal. Not a good deal. Not an OK deal it has to be a great deal,' Trump said, according to Sen. Marco Rubio.'"

So far at least, Trump got no bounce with voters after Barr claimed he was cleared of collusion. "A new Morning Consult/Politico survey conducted after Attorney General William Barr released his summary of Mueller’s findings shows a negligible immediate effect on how the public views the president. The March 25-26 survey found 42 percent of voters approve of the president and 55 percent disapprove-- a net approval rating 13 percentage points underwater and virtually identical to the poll conducted the week before."

Asked directly, 39 percent of voters said they had a more favorable view of the president after answering previous questions regarding the Mueller report, compared with 43 percent who said they had a less favorable view. Democrats and Republicans mirrored each other, while independents were 9 points more likely to express unfavorable views about the president, 41 percent to 32 percent.

Regardless of whether voters correctly identified Mueller’s conclusion on whether the president committed obstruction of justice, the determination itself did little to move public opinion: Forty-seven percent of registered voters said they believed Trump tried to impede or obstruct the investigation, compared with 44 percent who said the same in a February poll.

Similarly, most voters (52 percent) still believe it is likely that Russia has compromising information on Trump, compared with 51 percent last month.

...[T]he public is fully on board with efforts by lawmakers to make Mueller’s report public, with 82 percent of voters-- including 3 in 4 Republicans and 88 percent of Democrats-- saying the report should be disclosed.

A new poll by Ipsos for Reuters this morning shows that about half the country doesn't believe Barr's p.r. stunt and that they're more aware than the elite media hacks are that Trump colluded with the Russians to steal the election and enrich himself. The survey found that 48% of respondents believe "Trump or someone from his campaign worked with Russia to influence the 2016 election" and 53% believe "Trump tried to stop investigations into Russian influence on his administration." Among independents 43% approve of the way Trump is doing his job and 56% disapprove.

David Leonhardt called it in his column this morning: William Barr, Media Handler. His point is that "Barr did a skillful job of managing the news media this weekend. He released a four-page letter summarizing Robert Mueller’s investigation, which rightly received blanket coverage, since it was the only official description of the investigation. But I think much of the media was too credulous about Barr’s letter, producing banner headlines and chyrons that treated it as an objective summary of Mueller’s work rather than as a political document meant to make President Trump look good. And it was very much a political document. Barr, the attorney general, works for Trump. Before he joined the administration, he made clear that he felt some disdain for the Mueller investigation-- especially about whether Trump obstructed justice. That disdain surely increased his chances of being appointed attorney general. Trump fired the previous holder of the job, after all, for not doing more to control the Russia investigation. It’s still possible that Barr’s summary of Mueller’s report is fair. But the longer that Barr waits to release a fuller version of the report, the more suspicious we should be. Barr has been around Washington a long time. He understands that an initial story line can matter more than the details that emerge later. Barr has to be very happy with the media coverage he has received over the past two days."

“The Barr summary did its job: control the narrative and turn ‘not enough to charge on this’ into ‘no issues with Russia ever,’” as Tom Nichols, a national security expert, wrote.

Susan Hennessey of Lawfare put it this way: “It is possible that the report really does say that there is no evidence. It’s also possible there’s a mountain of evidence just short of the criminal standard. Or something in between. Any of that would be consistent with Barr’s summary.”

Leonhardt, like most of us, still has as many unanswered questions as before Barr's press release, first and foremost "Did Robert Mueller find evidence that the Trump campaign colluded with Russia, but that the collusion was not criminal? And a couple of corollaries: "Why did Trump and his associates repeatedly lie about their contacts with Russians? [and] "Did Mueller find evidence that the activities of Trump or his aides have compromised national security?"

Democrats And Republicans About To Clash Majorly-- On Health Care For Americans

But we can't afford to expand health care

Trump is celebrating his possible victory-- we'll see what's true and what's not when the whole Mueller Report is released instead of just a GOP press release from Barr's office-- by kicking millions of poor people off healthcare. Again, through Barr, Trump had told a reactionary Texas appeals court (the 5th Circuit), he wants the whole Affordable Care Act shit-canned. CNN reported that that is "a major shift for the Justice Department from when Jeff Sessions was attorney general. At the time, the administration argued that the community rating rule and the guaranteed issue requirement-- protections for people with pre-existing conditions-- could not be defended but the rest of the law could stand."

Note: protection for people with pre-existing conditions is the single most popular part of the ACA and if Trump has it struck down, it will be another nail in his political coffin. Last night, Robert Pear reported for the NY Times that Pelosi is on the verge of unveiling a plan ro expand health coverage-- far from Medicare-for-All, but far better than what Trump is offering America. Pear pointed out that "Democrats won control of the House in large part on the strength of their argument that Congress needs to protect people with pre-existing medical conditions and to lower the cost of health care and that today she's "putting aside, at least for now, the liberal quest for a government-run Medicare for all single-payer system and unveil a more incremental approach toward fulfilling those campaign promises. Building on the Affordable Care Act, they would offer more generous subsidies for the purchase of private health insurance offered through the health law’s insurance exchanges while financing new efforts to increase enrollment."

Did Pelosi stab the CPC in the back over Medicare-For-All? 

She and her lieutenants will offer legislation that also reverses actions by Trump that "allow insurance companies to circumvent protections in the Affordable Care Act for people with pre-existing conditions. Insurers could no longer sell short-term health plans with skimpy benefits or higher premiums for people with chronic illnesses. She says the legislation will 'strengthen protections for pre-existing conditions, reverse the G.O.P.’s health care sabotage and lower Americans’ health costs.'"

The legislative package, put together by Ms. Pelosi and several House committee chairmen, builds on the health law that the speaker was instrumental in passing-- and that was signed by President Barack Obama almost exactly nine years ago. And it seems to answer a question facing Democrats since they took control of the House: How would they balance the expansive demands of their most liberal members with the needs of more pragmatic Democrats elected in seats that were held by Republicans?

Ms. Pelosi, the committee chairmen and many other House Democrats see the new legislative package as a more efficient way of achieving universal coverage, a goal shared by champions of “Medicare for all,” led by Representatives Pramila Jayapal of Washington and Debbie Dingell of Michigan.

Democrats said they would probably try to pass the legislative package piece by piece, with the first votes on the House floor expected in May. Some elements could win support from Republican House members and from the Republican-controlled Senate.

With their new proposal, House Democratic leaders hope to finesse the disagreements within their caucus and to focus public attention instead on the gulf that separates Democrats of all stripes from President Trump on health care.

In his latest budget request, Mr. Trump urged Congress again to repeal the expansion of Medicaid under the Affordable Care Act, which has provided coverage to at least 12 million people newly eligible for the program. Mr. Trump attacked Senator John McCain last week, seven months after his death, for casting a decisive vote against repeal of the 2010 health law.

And in the economic report of the president, the White House boasted last week about how Mr. Trump had allowed small businesses and individual consumers to buy insurance plans that skirt many requirements of the Affordable Care Act, offering lower costs but fewer benefits.

Under a rule issued in August, Mr. Trump greatly expanded the market for sales of short-term insurance plans that do not have to cover prescription drugs, maternity care, drug abuse treatment or pre-existing conditions.

The House Democrats’ bill would turn back the president’s action by stipulating that short-term plans are included in the definition of “individual health insurance coverage” under the Affordable Care Act and therefore must comply with coverage requirements of the health law.

“These junk plans discriminate against people with pre-existing conditions,” said Representative Frank Pallone Jr., Democrat of New Jersey and an architect of the new legislation. “They deny access to basic benefits. They set arbitrary dollar limits for health care services, leading to huge surprise bills for consumers.”

“We passed the Affordable Care Act to rein in exactly these types of abuses,” said Mr. Pallone, who is investigating the short-term plan as chairman of the Energy and Commerce Committee.

The Affordable Care Act provides two main types of financial assistance to people of modest means buying private insurance: tax credits to help them pay premiums, and cost-sharing reductions to lower their deductibles, co-payments and other out-of-pocket costs.

The House Democrats’ bill would revise the law to provide more of both types of assistance.

In addition, the bill would make subsidies available to some working families who are now ineligible. The law, as interpreted by the Internal Revenue Service, bars subsidies to workers who have access to affordable employer-sponsored coverage for themselves-- even if the cost of coverage for the entire family is unaffordable. The House Democrats’ bill would eliminate this quirk in the law, sometimes called the family glitch.

...The package will also include a bipartisan bill offered by Representative Andy Kim, a freshman Democrat from New Jersey, that would provide federal money to states that want to set up their own insurance marketplaces but have yet to do so.

“With skyrocketing premiums in the federal marketplace, state-based exchanges have proven to be more effective at increasing the rate of coverage and lowering costs,” said Representative Brian Fitzpatrick, Republican of Pennsylvania, who helped write this proposal with Mr. Kim.

Karoli Kun is an editor at Crooks and Liars and a friend and colleague. She is just coming out on the other side of a serious health issue, which she details at C&L. "After six days in the hospital," she wrote last night, "doctors finally narrowed the cause to a carotid artery stenosis, a blockage likely caused by years of smoking and (also undiagnosed) high cholesterol. Last Monday, an excellent vascular surgeon performed surgery to place a stent in my carotid artery, opening it up and getting rid of the debris still left in that artery. The description of the procedure is terrifying, but it went without a hitch and is successful. I'm told I may have come out of the anesthetic growling 'Fck Trump' since he really is to blame for every bad thing. Going forward, I just have a lovely zipper on my neck now, but it’s a small price to pay to have the artery open and working properly.

In the aftermath, I am wearing a continuous heart monitor for the next 2 weeks to rule out atrial fibrillation as a cause. The doctors doubt it, but recommend it out of an abundance of caution.

I will likely be on medication for high blood pressure and blood thinners for the rest of my life. The side effects are a challenge but in the end it’s a small price to pay. Thursday I start physical and speech therapy to fix the remaining speech and fine motor skills issues, which are improving every day but still linger when I’m tired or talking too fast. I’m seeing a neurologist and cardiologist for follow-ups, and an ophthalmologist to evaluate vision changes and fix my glasses prescription.

The way I have been treated is the way everyone’s health care should be handled. From the moment I arrived at the ER through my surgery last week, Kaiser has been in charge of my healthcare needs. Not their bottom line: my needs. If I needed surgery, I got surgery. No fighting, no initial denials. If I needed a test, I got a test. If I needed a specialist, I got a specialist. This is how medicine should work: Doctors healing, health professionals and support staff healing, while the patient does not worry.

In all of my conversations with the health professionals treating me over the past 4 weeks, I realized that one of the reasons for my superior treatment is mainly because Kaiser really knows how to deliver health care, but also because California in particular has higher standards for health care professionals. Nurses, for example, cannot be responsible for more than 4 patients in a hospital. That means they’re available, less stressed, more attuned to their patients’ needs. Several of the nurses caring for me told me they moved here from other states where the standards are far lower in order to feel like they were able to do their best work. That suggests there should be national standards for health care delivery rather than letting some states race to the bottom and cheap it up. (Yes, the states they left were red states. Deep red states.)

Health care needs to be that way for everyone, not just lucky ones with good insurance in blue states. At this point, I don’t care how we get there but we have to get there. Soon.

Well, Trump sure isn't offering it-- and neither are Pelosi and her lieutenants. And Trump is also proposing cutting billions of dollars from Medicare and Medicaid (and Social Security). You know who is offering real healthcare to Americans, though, right?

Chicken/Egg-- Why Are People In Blue States Healthy And People In Red States Sickly, Unhealthy, Diseased And Dying Off?

In short, are people in red states sick because of the Republican policies that are created by the politicians they vote for or is the fact they're sick make them vote for politicians who create those policies? A new report from the United Health Foundation ranked every state in the union, as it has been doing for almost 3 decades. Here's the ranking )along with what percentage of the vote Trump won in each state):

1- Hawaii- 30.03%
2- Massachusetts- 32.81%
3- Connecticut- 40.93%
4- Vermont- 30.27%
5- Utah- 45.54%
6- New Hampshire- 46.61%
7- Minnesota- 44.92%
8- Colorado- 43.25%
9- Washington- 36.83%
10- New York- 36.52%
11- New Jersey- 41.00%
12- California- 31.62%%
13- North Dakota- 62.96%
14- Rhode Island- 38.90%
15- Nebraska- 58.75%
16- Idaho- 59.25%
17- Maine- 44.87%
18- Iowa- 51.15%
19- Maryland- 33.91%
20- Virginia- 44.41%
21- Montana- 56.17%
22- Oregon- 39.09%
23- Wisconsin- 47.22%
24- Wyoming- 67.40%
25- South Dakota- 61.53%
26- Illinois- 38.76%
27- Kansas- 56.65%
28- Pennsylvania- 48.18%
29- Florida- 49.02%
30- Arizona- 48.67%
31- Delaware- 41.72%
32- Alaska- 51.28%
33- North Carolina- 49.83%
34- Michigan- 47.50%
35- New Mexico- 40.04%
36- Nevada- 45.50%
37- Texas- 52.23%
38- Missouri- 56.77%
39- Georgia- 50.77%
40- Ohio- 51.69%
41- Indiana- 56.82%
42- Tennessee- 60.72%
43- South Carolina- 54.94%
44- West Virginia- 68.50%
45- Kentucky- 62.52%
46- Arkansas- 60.57%
47- Oklahoma- 65.32%
48- Alabama- 62.8%
49- Mississippi- 57.94%
50- Louisiana- 58.09%

The creators of the survey explained that to create the rankings, the report takes into account 35 health factors which fall into categories-- "the behaviors that we are choosing in our lifestyle; the community and environment where we live; the public policy that happens at a state level; and the clinical care that we receive when we go to the doctor and the hospital ultimately influence the outcomes around our health"-- and examines them by state.

"Starting with the thing that concerned us the most, obesity has hit an all-time high. The obesity rate in America for the adult population, for the first time in the history of producing this report, is up 5% in the past year. It hit 31.3% for 2018," Randall said.

In other words, nearly one in three US adults is obese.

Obesity rates also appeared to be high in many of the states ranked as least healthy. For instance, the prevalence of obesity in West Virginia is 38.1%, nearly double the prevalence in Colorado, where it is 22.6%, according to the report.

"Another thing that concerns us that we found in this report was that premature death increased 3% in the past year. That means years of life lost before people are reaching the age of 75," Randall said.

"That often has correlation with a number of factors-- things like our lifestyle choices, living with more chronic diseases," she said. "We also know that the suicide rate has increased as well, and that would contribute to the increase in premature death rate, along with other causes."

The report measured the suicide rate as the number of deaths due to intentional self-harm per 100,000 deaths recorded on death certificates, and the data showed that America's suicide rate has increased 16% since 2012.

..."If you think about the things that cause premature death-- heart disease, perinatal deaths, tobacco-related diseases-- in many ways, those are spurred by social determinants," Benjamin said.

For instance, "Mississippi, Alabama, Louisiana continue to be at the bottom, and that kind of carries up to the Arkansas and Tennessee region. When you look at some of the challenges they have, it's still around tobacco use and poverty and, to some degree, physical inactivity," he said. "Those are the things that we know result in fundamentally poor health outcomes. What we would like to see is all states improving."

Mississippi is only the second least healthy state and this morning we learned from Paul Demko at Politico that Gov. Bryant (R) wants to give his long-suffering, sickly people the benefits of ObamaCare by expanding Medicare. "The behind-the-scenes move", wrote Demko, "comes as a surprisingly viable Democratic gubernatorial candidate is planning to make Medicaid expansion a central issue in the 2019 election. But in an even more unlikely scenario, Republicans could beat him to it and undercut a key Democratic message. Until now, Medicaid expansion has largely been ignored in the Republican-dominated state, one of the sickest and the poorest in the country. Even Mississippi Democrats have largely dismissed it as politically unviable since a 2012 Supreme Court decision made the program optional for states."

Half dozen patriotic states all got much healthier

The First 6 Freshmen/The First 7 Freshmen

The first 6 freshmen to sign onto the #GreenNewDeal, which is seeking to establish a new House committee to deal with Climate Change, are Alexandria Ocasio Cortez (D-NY), Rashida Tlaib (D-MI), Deb Haaland (D-NM), Ilhan Omar (D-MN), Joe Neguse (D-CO) and Ayanna Pressley (D-MA). Hey, California! What's up with that? Signing onto an aggressive initiative like that is a much-welcomed signal about expected congressional activism of the best sort.

The exact opposite are the 7 Democrap freshmen who were inducted into the Blue Dog Caucus, all shitbags we warned you about all cycle: Jeff Van Drew (NJ), Mikie Sherrill (NJ), Anthony Brindisi (NY), Max Rose (NY), Xochitl Small (NM), Ben McAdams (UT) and Abigail Spanberger (VA), most of whom were not just heavily supported by the DCCC, but actively recruited by them to run. Joining the Blue Dogs is also a signal; these will surely be among the worst member of Congress, constantly crossing the aisle to vote with the Republicans and Trump, always working to water down any progressive legislation on anything important to the American people. Just watch.

A new poll from the Kaiser Family Foundation, the week after the midterms, asked voters what they want from the new Congress. Predictably, a majority want the 2 parties to work together "to address the major problems facing the country as well as conduct oversight of the Trump administration’s actions on policies such as health care. Yet, few Americans are “very confident” (6 percent) that Republicans and Democrats in Congress will be able to work on bipartisan legislation to address the health care issues facing the country.

About half of the public (53 percent) say oversight of the Trump administration’s actions on policies such as health care, education, and the environment should be a “top priority” for House Democrats in the coming year. This is similar to the share (55 percent) who say that working to enact new laws to address the major problems facing the country should be a “top priority” for House Democrats in the coming year and substantially larger than the share who say investigating corruption within President Trump’s administration should be a “top priority” (36 percent).

When asked which health care issue they would most like to see the next Congress act on in 2019, more Americans offer issues around health care affordability and cost (19 percent) than other health care issues including the 2010 Affordable Care Act (ACA) (10 percent) or Medicare (6 percent). Health care affordability and cost are also the most frequently mentioned health care issues by Democrats (14 percent), independents (25 percent), and Republicans (17 percent). The ACA is the second most frequently mentioned health care issue among partisans, with Democrats saying they want to see Congress “protecting or improving the ACA” while Republicans say they want to see the next Congress “repealing the ACA.” Independents are divided on this issue, with similar shares saying they want to see Congress repealing and protecting the 2010 health care law.

While there appears to be consensus among the public on what health care issue they want to see Congress work on next year, not quite one-third are confident that Democrats and Republicans in Congress will be able to work together on bipartisan legislation to address the health care issues facing the country. In fact, seven in ten say they are either “not very confident” (34 percent) or “not at all confident” (35 percent) that Congress will be able to work on such bipartisan legislation, while fewer are confident, either “very confident” (six percent) or “somewhat confident” (24 percent), in Congress being able to work together.

...The majority of the public say it is “very important” to them that the ACA’s provisions protecting those with pre-existing conditions remain law even after hearing that these protections may have led to increased insurance costs for some healthy people. Sixty-five percent of the public say it is “very important” to them that the provision that prohibits health insurance companies from denying coverage because of a person’s medical history remains law. An additional fifth (22 percent) say it is “somewhat important” this provision remains law. Similarly, about six in ten say it is “very important” that the provision that prohibits health insurance companies from charging sick people more remains law, while an additional one in five (22 percent) say it is “somewhat important.”

If the judge ruling on Texas v. United States decides the ACA’s protections for people with pre-existing conditions are unconstitutional, a majority of the public-- including 87 percent of Democrats, 67 percent of independents, and about half of Republicans-- say they would want their state to establish protections for people with pre-existing health conditions, even if this means some healthy people may pay more for coverage.

Expect the Blue Dogs to side with the Republicans on any push to expand healthcare in any meaningful way to more Americans. Let's watch... and think about primary opponents for those who betray Democratic values and their constituents.

Will Their Opposition To Healthcare Kill The GOP November 6th?

One of the funniest moments in the election debate this cycle-- at least for me-- came when Arizona congresswoman, Martha McSally, a garden variety Trump rubber-stamp who had voted to repeal protections for pre-existing conditions several times, was cornered by a reporter asking her to square her consistent record against healthcare with her promise now-- as she runs for U.S. Senate-- to protect people with pre-existing conditions from the greed of insurance companies. After lying for a few minutes to a reporter who kept pointing out her votes, she finally said something to the effect of "Can't you ask me about something voters are interested in, like the Caravan?" True, Fox News and hate talk radio hosts are interested in the Caravan... but voters? Not so much. They're more interested in Republicans trying to take away their healthcare.

In TX-10, Mike Siegel is campaign for Congress on a platform that includes Medicare for All. His opponent, Michael McCaul is a Trump enabler who has voted to destroy Medicare and to strip away protections for pre-existing conditions. "I have friends and family who would not be alive, and would not have healthcare, but for the Affordable Care Act's protections for pre-existing conditions," Mike told us. "My cousin received a liver transplant that his private insurance refused to pay for, thanks to the ACA. My opponent Michael McCaul voted repeatedly to repeal the ACA without having any replacement in place. The differences between us could not be more stark, and the choice for voters is clear." This is the ad Mike has been running on social media in his district:



In Omaha, progressive Democrat Kara Eastman has had to confront this bullshit head-on, as her opponent, anti-healthcare fanatic and desperate, compulsive liar Don Bacon (R-NE), has tried to pose as a protector of preexisting conditions-- even though he voted against protecting them every single time he could. "My opponent," she told us, "voted 'Hell Yes' for the AHCA. He claims this would have protected people with pre-existing conditions. However, the Washington Post gave this claim 3 PINOCCHIOS as the law would have allowed states the option to seek waivers that would nullify this promise."



The new Ipsos poll released by Reuters yesterday shows that 58% of likely voters want to keep ObamaCare in place and "eight in 10 likely voters from each major party want to protect coverage for people with existing conditions, such as heart disease, diabetes or cancer." I wonder how long before Trump and his sycophants start claiming they support it too. And have always supported it.

With the Nov. 6 elections looming, Democrats are reminding voters of Republicans’ often-repeated promises to repeal the 2010 law. Many Republican candidates are softening their tone or removing website references decrying what they long derided as “Obamacare,” according to candidates, analysts and healthcare experts in both parties.

As Democrats seek to take control of Congress, they see Republicans as having a particularly weak spot on healthcare. Sixty-seven of the 73 most vulnerable Republican incumbents in the House of Representatives voted at least once to eliminate the ACA and its protections for pre-existing conditions, according to the Center for American Progress Action Fund.



Some of those votes date back to the Obama administration, though his successor, Republican President Donald Trump, also campaigned on a promise to undo the law. A repeal attempt after Trump took office last year failed.

Opinion polls show Democrats as having a chance to achieve the net gain of 23 seats they would need to take a majority in the House, but facing a longer shot at picking up the two seats they need to take control of the Senate.

Democratic activists said the repeated Republican attempts to repeal the ACA provide a powerful tool to motivate voters.

“Healthcare has an ability to move people into action,” said Ben Wikler, Washington director of liberal activist group MoveOn. “It is turning people out in town hall meetings ... getting people to make hundreds of thousands of phone calls and getting voters to the polls.”

One sign of Democratic focus: 54.5 percent of Democrats’ federal election ads from Sept. 18 to Oct. 15 mentioned healthcare, far more than the 8.7 percent that did so at the same time in 2010, according to the Wesleyan Media Project.

Some 33.9 percent of Republican federal election ads mentioned healthcare during this period and 31.5 percent in 2010. Republicans took control of the House in the 2010 midterm elections, boosted in part by opposition to the ACA, which had become law earlier that year.

While the aim of the ACA was to expand healthcare insurance to reach millions of Americans who did not have any coverage, Republicans campaigned for years against it as government overreach, especially its requirement that people buy health insurance or pay a financial penalty.

U.S. Senator Claire McCaskill has made healthcare the focus of her campaign in Missouri against Republican challenger Josh Hawley. The state’s attorney general, Hawley has faced criticism from individuals and healthcare groups for saying he supports covering pre-existing conditions even after suing to end the ACA.

“Everyone is feeling anxious and worried about the future of healthcare,” McCaskill said in a telephone interview. “It’s beginning to dawn on people that the Republicans didn’t have a replacement (for the ACA), and that they have no ideas on how they could do it better.”

Hawley ran for state attorney general by emphasizing his role in a lawsuit against the ACA that went to the U.S. Supreme Court, and also worked on a team that successfully challenged the ACA’s requirement to provide contraceptives coverage.

Despite Republican opposition, eight years after its passage many Americans have seen some benefits from the law.

“By the time Republicans last year tried to repeal the law, it had become real, people had benefited,” said Brad Woodhouse, executive director of Protect Our Care. He said at least 20 Republican incumbents have “scrubbed” their websites to appear more supportive of the law.

In Kentucky, Representative Andy Barr has called his vote to repeal the ACA “a great day for freedom in America” but now plays up his support of programs to prevent and treat opioid addiction. In Maine, Representative Bruce Poliquin dropped a promise to “end Obamacare” and now talks about protecting hospitals.



Ted Cruz, a U.S. senator from Texas, said during a debate this month against Democratic challenger Beto O’Rourke that he would protect pre-existing illnesses, despite having once forced a shutdown of the federal government over ACA repeal efforts.

In a hotly contested upstate New York congressional race, Democratic challenger Antonio Delgado has hammered his opponent, first-term Republican John Faso, over his vote to repeal the ACA.

“John Faso, despite voting to take away protections, is running TV ads saying the exact opposite,” he said during a recent town hall meeting. “How can you look someone in the face and say, ‘No, I didn’t do that.’ After a while, you’re just lying to our faces blatantly. This is too real to lie about.”

Faso defended his vote in an interview, saying New York state law already ensures patients with pre-existing conditions are protected, regardless of federal legislation.

Despite support for specific elements of the law, 52 percent of likely voters told Reuters/Ipsos they view the U.S. healthcare system as “poor” or “terrible.”