Tag Archives: obamacare

Tensions rise between the Trump administration and Alaska.

Trump’s ire fell on Alaska Republican Lisa Murkowski, who on Tuesday voted “no” to moving a health care repeal bill to the Senate floor for debate. After the vote, Trump tweeted (of course) that Murkowski had let the country and her party down. Then, Interior Secretary Ryan Zinke reportedly called Murkowski and the state’s other Republican senator, Dan Sullivan, to inform them Murkowski’s move would not be forgotten.

According to the Alaska Dispatch News, Sullivan said the call sent a “troubling message.” Murkowski didn’t comment, but Sullivan appeared unnerved by the conversation. “I fear that the strong economic growth, pro-energy, pro-mining, pro-jobs and personnel from Alaska who are part of those policies are going to stop,” Sullivan said.

At a rally on Tuesday night, Trump implied there would be repercussions: “Any senator who votes against repeal and replace is telling America that they are fine with the Obamacare nightmare, and I predict they’ll have a lot of problems.”

The Interior Department has input over several issues important to Sullivan and Murkowski, like energy exploration and drilling in parts of Alaska. Murkowski, as chair of two committees related to the Interior, has say in several issues important to the department, like its budget.

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Tensions rise between the Trump administration and Alaska.

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Brandi Is Terrified That She’ll Fall Back Into Addiction if Obamacare Is Repealed

Mother Jones

Brandi, 30, depends on Medicaid expansion for opioid addiction medication. Courtesty of Brandi

For much of her twenties, Brandi was in a bad place: staying up all night to sniff OxyContin and dealing marijuana from her apartment in a dingy Rochester, New York, housing project to feed her insatiable painkiller addiction. Drug users were always coming in and out of her place, a nearly empty one-bedroom that smelled of cat pee. Dinners consisted of instant noodles or McDonald’s, where a friend would trade chicken nuggets for a gram of marijuana. “Any money would go directly into buying pills,” said Brandi, who requested to go by her first name.

A 30-year-old with piercing green eyes, Brandi hasn’t used drugs since January of 2015, when she started taking buprenorphine, a medication that treats opioid addiction. She lives in a townhouse with her fiancé, also a former drug user, and their cats. Thanks to the medications, she says, “both of our lives are a total 180 from what they used to be.” She works the night shift at the supermarket during the week, visits family on Sundays, occasionally splurges at Bonefish Grill or TGI Friday’s. Each day, the couple takes their medications: buprenorphine for her, methadone for him. She’s been reading the news about the potential repeal of Obamacare and Trump’s budget proposals, and she finds it “all terrifying”—because if Obamacare is repealed and Medicaid expansion is cut, she, like hundreds of thousands of Americans, could lose her ability to pay for buprenorphine. Without the medication, she worries, she’ll fall back into the cycle of drug abuse.

She’s been there before. Brandi first got her life back on track when she went on buprenorphine as a 22-year-old straight out of rehab. She did well for a few years: She got a job as a cashier, moved into a nicer place, started buying groceries and brushing her hair. But when she was 26, just before New York expanded Medicaid, she was kicked off her mom’s health insurance. Knowing she didn’t make nearly enough to be able to pay for her own coverage, she stretched out her buprenorphine supply as long as she could, stockpiling what she had in the months before her 26th birthday and weaning her dose down. But eventually there was none left, and within two weeks, she says, “I found pills and it was just done and over with.” She used for nearly two years before going back to rehab and realizing that, with Medicaid expansion, she could pay for the medication once again.

On the campaign trail, President Donald Trump promised to “spend the money” to tackle the nation’s opioid epidemic. Yet drug policy experts fear that passage of the American Health Care Act, also known as Trumpcare, would cut off former drug users from their addiction medications, making an already devastating epidemic even worse. That’s largely because the AHCA would dramatically cut funding for Medicaid—the federal program that provides health insurance to poor Americans and the largest federal funder of addiction services. It would also phase out Medicaid expansion, which expanded the eligibility requirements of the publicly-funded insurance program to include those who earn up to 138 percent of the federal poverty level in the 31 states that opted to expand it. Cuts to Medicaid would hurt most in many of the states that helped vote Trump in: in places like Ohio, West Virginia, and Kentucky, Medicaid pays for at least forty percent of buprenorphine prescriptions.

“People talk about being committed to doing something about drugs,” says Keith Humphreys, a Stanford University psychiatry professor who advised the Obama administration on drug policy. But “their Medicaid cuts would swamp anything else they could do.”

Nearly three million Americans with a substance use disorder, including more than 200,000 who were addicted to opioids, would lose some or all of their insurance coverage if Obamacare is repealed, according to an analysis by researchers Richard Frank of Harvard Medical School and Sherry Glied of New York University. In a report released last week, the Congressional Budget Office found that if the AHCA passes, addiction treatment services “could increase by thousands of dollars in a given year” for those who aren’t covered by insurance through their employers.

Both Humphreys and Frank worry that many politicians don’t understand just how critical addiction medications can be. Indeed, last month, Health and Human Services Secretary Tom Price said addiction medications were “substituting one opioid for another,” contradicting years of research by the agency he now runs. Buprenorphine and methadone, the two most common such medications, work by binding to the brain’s opioid receptors and decreasing craving for more harmful opioids like painkillers or heroin—without inducing the high. They come with some side effects: It’s still possible to abuse the medications, and coming off of them too quickly can result in a painful process similar to withdrawing from other opioids.

But a wealth of research has found that addiction medications like buprenorphine help curb opioid addiction and prevent relapse and overdose. Organizations from the Centers for Disease Control to the Substance Abuse and Mental Health Administration to the World Health Organization support access to the medications for opioid users. “I don’t think that there are any areas where the data is shaky,” said Dr. Nora Volkow, the head of the National Institutes on Drug Abuse, part of the National Institutes of Health, to STAT news. “It clearly shows better outcomes with medication-assisted therapy than without it.”

Brandi may be lucky: If the AHCA does pass, there’s still a chance that her home state of New York would find a way to fund treatment for people in her position. But many Americans may not be so fortunate. As Humphreys told me this spring, without Obamacare, “We’re back where we were before: bad access, low quality of care, and a lot of patients being turned away.”

For now, Brandi plans to keep taking the medication for as long as she can. “People I work with right now would never in a bajillion years picture me as a drug addict—ever.” The impact of the medication is “like night and day,” she said—and going back to the days without coverage would amount to “a nightmare.”

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Brandi Is Terrified That She’ll Fall Back Into Addiction if Obamacare Is Repealed

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Democrats Don’t Brag Enough About the Stuff They Do

Mother Jones

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A couple of days ago Paul Krugman wrote about the Trump double-cross:

Let’s talk about West Virginia, which went Trump by more than 40 percentage points, topped only by Wyoming. What did West Virginians think they were voting for?

They are, after all, residents of a poor state that benefits immensely from federal programs: 29 percent of the population is on Medicaid, almost 19 percent on food stamps. The expansion of Medicaid under Obamacare is the main reason the percentage of West Virginians without health insurance has halved since 2013.

….Trumpcare, the budget office tells us, would cause 23 million people to lose health insurance, largely through cuts to Medicaid….Then we need to add in the Trump budget, which calls for further drastic cuts in Medicaid, plus large cuts in food stamps and in disability payments. What would happen to West Virginia if all these Trump policies went into effect? Basically, it would be apocalyptic.

….So many of the people who voted for Donald Trump were the victims of an epic scam by a man who has built his life around scamming. In the case of West Virginians, this scam could end up pretty much destroying their state. Will they ever realize this, and admit it to themselves? More important, will they be prepared to punish him the only way they can — by voting for Democrats?

Since I happened to be chatting about this yesterday, I want to offer an alternative explanation for what’s going on here. More accurately, I guess, it’s a supplementary explanation, since there’s not much question that Donald Trump has indeed pulled a very long con on voters like the ones in West Virginia.

Basically it’s this: what do you expect if Democrats don’t support their own policies? For the past five years, Republicans have battered Obamacare as the most horrific policy ever enacted. Democrats have—what? Hidden under rocks, mostly. Moderates looked at the polls and decided to avoid even talking about Obamacare. Progressives mostly scorned it as a piece of crap and spent their energy explaining why we should all support single-payer instead. So what’s the result? Lots of people think Obamacare is horrific. After all, that’s what one side says, and the other side hardly even fights back.

West Virginians on Medicaid probably have no idea they’re getting it via Obamacare. West Virginians who buy insurance from Healthcare.gov probably have no idea they’re insured via Obamacare. West Virginians who got a payroll tax break early in the Obama years probably have no idea they even got it, let alone that it came from Democrats. West Virginians who got new roads or schools from the stimulus program probably have no idea it came from Democrats. West Virginians who got an increase in the minimum wage in 2007-09 probably have no idea it was passed by Democrats.

On the other hand, they certainly do know that Obamacare is destroying the nation; that Democrats want to take away their guns; that Mexicans took away all their jobs; that Obama wanted to let a flood of ISIS terrorists into the country; and that fanatical leftists want to allow men into their daughters’ bathrooms.

Republicans are going to say what they’re going to say. There’s not much you can do to stop them from lying. What you can do is to loudly and proudly demand credit for the stuff you’ve done. If no one really knows that you subsidized their insurance or provided them with Medicaid or raised their wages or built them new schools, you can hardly expect them to vote for you.

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Democrats Don’t Brag Enough About the Stuff They Do

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Obamacare Is Pretty Stable — Unless Republicans Cripple It

Mother Jones

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The CSR subsidies that President Trump keeps threatening to kill are pretty important:

Here in California, our insurance commissioner has asked all health insurers for two sets of rate hike requests: one that assumes the CSR subsidies continue and one that assumes they don’t. We won’t get the rate requests for several weeks, but I expect that we’ll see the same kind of difference. At a guess, average rate increase requests will be around 6 percent with CSR and 15 percent without.

Just to be crystal clear about this: What this means is that if Republicans stop screwing around with CSR, rate hikes nationwide would probably be in the 5-10 percent range, which is fairly normal. It also shows that the market has started to stabilize after last year’s big increases. The only reason we’re likely to see another year of big increases is because of a deliberate campaign to undermine the Obamacare market by Republicans.

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Obamacare Is Pretty Stable — Unless Republicans Cripple It

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Donald Trump Just Released a Plan to Destroy Medicaid

Mother Jones

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When President Donald Trump released his first full budget Tuesday, he directly contradicted one of his most explicit promises from the presidential campaign. “I’m not going to cut Medicare or Medicaid,” Trump unequivocally promised back in 2015.

Trump’s 2018 budget, if approved by Congress, would do just that. It calls for more than $1.4 trillion in cuts to Medicaid—the federal program that provides health insurance to low-income Americans—spread out over the next decade. Rather than simply adopting the Medicaid cuts that House Republicans passed earlier this month as part of their bill repealing of Obamacare, the president’s budget actually goes even further.

It’s hard to overstate how dramatic these Medicaid cuts would be. The House bill not only rolls back Obamacare’s expansion of Medicaid, it also imposes a cap on how much money the federal government sends to state governments. The Congressional Budget Office expects that Medicaid spending would drop by $880 billion over the next 10 years under the GOP’s plan, compared with current law. The cuts compound over time. By 2026, yearly Medicaid spending would have dropped by 25 percent, with 14 million fewer people enrolled in the government insurance program.

But Trump’s budget doesn’t end there. It calls for an additional $610 billion drop in Medicaid funding over the next decade. How, exactly, it achieves that isn’t entirely spelled out, but the budget outline emphasizes spending caps and block grants that would lower the amount of Medicaid dollars that the federal government gives to states. If both the House’s Obamacare repeal and Trump’s budget were put into effect, in 2027 federal Medicaid spending would be nearly 50 percent lower than it would be under current law.

Trump’s embrace of Medicaid reductions could put a group of Republican senators in a tricky position. Before their colleagues in the House had even unveiled their plan to dismantle the Affordable Care Act, four senators wrote a letter to their House counterparts warning them against dramatic cuts to Medicaid funding. Those four senators—Rob Portman (R-Ohio), Shelley Moore Capito (R-W.Va), Cory Gardner (R-Colo.), and Lisa Murkowski (R-Alaska)—have good reason to be wary. All four represent states that adopted Obamacare’s Medicaid expansion, which offers insurance for people earning up to 138 percent of the federal poverty level. So far 19 states have resisted taking federal funds for the program, but it’s popular with the public, and politicians might face a backlash if they suddenly take those benefits away from their constituents.

“I am seriously interested in reforms to Medicaid and better ways to make the money go further, but I’ve seen a lot of benefits to the Medicaid expansion in our state, particularly in the mental health and opioid and drug abuse areas,” Capito said earlier this month after the House bill passed.

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Donald Trump Just Released a Plan to Destroy Medicaid

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Does Donald Trump Know the Difference Between Health Insurance and Life Insurance?

Mother Jones

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I say this with no snark whatsoever: can someone tell me WTF Donald Trump is talking about here?

You’re going to have absolute guaranteed coverage. You’re going to have it if you’re a person going in…don’t forget, this was not supposed to be the way insurance works. Insurance is, you’re 20 years old, you just graduated from college, and you start paying $15 a month for the rest of your life and by the time you’re 70, and you really need it, you’re still paying the same amount and that’s really insurance.

But I believe it’s very important to have this. Because one thing Obamacare did, is it gave that and it was a concept that people hadn’t heard of. And now I don’t want to end it. I don’t want to end it for somebody that…first of all I don’t want to end it for the people that already have it. And I don’t want to end it for somebody that hasn’t been buying insurance for all of his life where he has a guarantee that for all of his life he’s been buying the insurance and he can buy it inexpensively when he turns 65 or 70 years old. So we put in a tremendous amount and we’re…you know, for the pre-existing conditions. We are going to have a great pool for pre-existing conditions.

What exactly is it that’s “really insurance”? What is “very important to have”? What is the “concept that people hadn’t heard of”? What is it that Trump doesn’t “want to end”? Why does Trump think people need the ability to “buy it inexpensively” after they turn 65?

The only thing I can think of is that Trump is talking about life insurance, not health insurance. That doesn’t fit entirely, but it fits enough that the rest of it could be chalked up to Trump’s usual simplemindedness along with his 50s-era understanding of pretty much everything. Any other ideas?

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Does Donald Trump Know the Difference Between Health Insurance and Life Insurance?

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Health Care Vote Likely to Happen on Thursday

Mother Jones

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It’s been literally hours since I last updated you on the Republican health care bill, so let’s catch up. Twitter is our friend:

What’s the rush?

Roger that. TrumpCare 1.0 arguably failed because of that hideous CBO score saying that 24 million people would lose coverage—a truly remarkable achievement since Obamacare only covers 20 million people in the first place. TrumpCare 3.0 is even worse, so God only knows what the CBO would say about it. Anyway, how bad can it be? I mean really?

Urk. Pretty bad. Even the AMA gets it:

Good for them. What’s remarkable, though, is how lonely their position is:

I don’t really get this either. Maybe they’ve just given up? Maybe they figure that as part of the hated establishment, their opposition is just more likely to make Republicans vote yes? Beats me.

This bill needs to be decisively put out of its misery. Yes, I suppose Democrats might benefit by forcing vulnerable House members to vote for it, and then killing it in the Senate, but that’s not worth the risk that, somehow, it might actually pass if it gets through the House. You never know. Best to make it crystal clear that there’s simply no needle Republicans can thread on this subject.

Then we get to wait and see if President Trump kills Obamacare anyway in a fit of pique by cutting off the CSR subsidies. This is really shaping up to be a great year.

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Health Care Vote Likely to Happen on Thursday

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Jimmy Kimmel Makes Impassioned Plea to Save Obamacare After Son’s Heart Surgery

Mother Jones

In an emotional plea to protect the Affordable Care Act, Jimmy Kimmel opened his show on Monday by sharing the news of his newborn baby’s open-heart surgery just 10 days before. The late-night host prefaced the monologue by saying the story had a “happy ending”—both the baby and mother were now home and in good health—but revealed that the heart-wrenching experience had moved him to speak out against President Donald Trump’s desire to repeal his predecessor’s signature health care law.

“We were brought up to believe that we live in the greatest country in the world, but until a few years ago, millions and millions of us had no access to health insurance at all,” Kimmel said visibly shaken. “You know, before 2014, if you were born with congenital heart disease, like my son was, there’s a good chance you’d never be able to get health insurance, because you had a preexisting condition.”

“If your baby is going to die and it doesn’t have to, it shouldn’t matter how much money you make.”

The impassioned monologue was roundly praised by audience members and Democratic officials online. Barack Obama even weighed in to thank Kimmel for sharing his personal story:

Kimmel’s powerful address comes amid the Trump administration’s second harried attempt to dismantle Obamacare, after Republicans pulled their repeal bill in March.

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Jimmy Kimmel Makes Impassioned Plea to Save Obamacare After Son’s Heart Surgery

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Chart of the Day: Obamacare’s Triumph—Except in the South

Mother Jones

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The CDC has a new report out on the chronically uninsured. Here’s the good news:

Starting in 2014, when Obamacare went into effect, the number of chronically uninsured plummeted by more than half, from 15.7 percent to 7.6 percent. That’s a huge public policy victory.

Now here’s the bad news—at least for some people:

States that resisted Obamacare in general, and refused the Medicaid expansion in particular, were largely in the South. In 2013 those states already accounted for 46.1 percent of the uninsured even though they have only 35 percent of the US population. By 2016, as other states were making progress, their share of the chronically uninsured skyrocketed to 54.7 percent.

Put another way: by 2016, the per capita rate of chronically uninsured in the South was more than twice what it was in the rest of the country even though southern states could have reduced their uninsured rate practically for free. This is the triumph of Republican bitterness over human decency.

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Chart of the Day: Obamacare’s Triumph—Except in the South

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Obamacare Is Doing Fine Unless Trump Kills It

Mother Jones

The Congressional Budget Office says that Obamacare is in good shape:

Under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference. The subsidies to purchase coverage combined with the penalties paid by uninsured people stemming from the individual mandate are anticipated to cause sufficient demand for insurance by people with low health care expenditures for the market to be stable.

Insurance companies are starting to make money on Obamacare. Nearly 20 million people have health insurance because of Obamacare. Premiums will probably go up next year, but not by a huge amount. And even if they do go up, federal subsidies will shield most people from having to pay any more than this year. Because of all this, CBO believes that Obamacare will stay stable and strong:

President Trump tweeted the opposite today, saying once again that Obamacare was on the verge of failing. This is a lie, one that he’s repeated over and over. Obamacare will fail only if he cuts off its funding.

The reason for this post isn’t so much to mention that Trump lied again today. The sun also rose in the east, and I didn’t write about that. It’s to remind everyone—including me—to stop writing tweets and blog posts that say something like this:

Trump says Obamacare is in a death spiral. He’s wrong.

When we repeat the lie, we just give it more exposure. The end result is that people vaguely know something about Obamacare and death spiral and controversial, and that’s it. They don’t really know who’s right, they just know that they keep seeing stuff about Obamacare being in trouble.

So don’t do it. Instead, just write the truth and then mention that Trump has lied about it.

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Obamacare Is Doing Fine Unless Trump Kills It

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