Tag Archives: obamacare

Brandi Is Terrified That She’ll Fall Back Into Addiction if Obamacare Is Repealed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potential repeal of Obamacare and Trump’s budget proposals, and she finds it “all terrifying”—because if Obamacare is repealed and Medicaid expansion is cut, she, like hundreds of thousands of Americans, could lose her ability to pay for buprenorphine.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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