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My reaction on health care right now.

Once more dear friends

The BCRA is getting pulled but the healthcare fight is not over. Senate Majority Leader McConnell wants the Senate to vote on a Find and Replace version of the reconciliation bill that President Obama vetoed in 2016. That bill would repeal every funded element of the ACA on 12/31/19 and cut taxes effective immediately.

As a reminder this is the bill that the Congressional Budget Office (CBO) scored as leading to 32 million more people without insurance by the end of 2026 with 18 million not having insurance in the first year. Premiums on the individual market would increase by 50% over baseline by 2026.

Unless McConnell thinks that he can get his vulnerable in 2018 and 2020 members to fall in line with the barely veiled threat of a massive right wing primary challenge, I am having a hard time seeing the logic of bringing up this bill unless it is to show the House a body and move onto something else.

So you know what to do — call your Senator this morning.

No’s are piling up

The BCRA draft v2 was released just as I was heading out to lunch with a colleague so I have not read the bill yet although I did look through Health Wonk Twitter as I waited for my colleague to get back to the table with a drink. Most are bewildered at the mechanical changes.

However something quite important has happened in the past couple of minutes:

I am reading Portman as a time holding “No.” If there are no other Senators declaring “No” on the motion to proceed, I think he can be arm twisted to say he read the bill over the weekend and it is good to go. However it only took two hours to get a temporary blocking coalition in place.

So you know what to do:


Call Portman and reward good behavior!
Call Collins and reward good behabior!

Call Moran, Capito, Murkowski and ask for good behavior.
Call Heller and remind him that this is a chain saw attacking Medicaid.

Call Paul and ask him to laugh at Ted Cruz for us.

If you are a resident of a state of any of those Senators, call

Everyone keep on calling anyways!

I like the way you walk, I like the way you talk

Gonna be tough for Collins to vote for Trumpcare after this:

For the 15th year, Sen. Susan Collins (R-Maine) spent July 4 marching through this town of 1,331, a short boat ride away from Canada. She walked and waved, next to marching bands and Shriner-driven lobster boats. Her constituents cheered — and then asked whether she would vote against repealing the Affordable Care Act.

“There was only one issue. That’s unusual. It’s usually a wide range of issues,” Collins said in an interview after the parade. “I heard, over and over again, encouragement for my stand against the current version of the Senate and House health-care bills. People were thanking me, over and over again. ‘Thank you, Susan!’ ‘Stay strong, Susan!’ ”

But never underestimate the ability of “Republican moderates” to cave.

Keep up the pressure

Local media is covering the impact of the Senate Bill. Here in North Carolina is an extraordinarily detailed and humane look at the care that medically frail kids needs. It is a lot.

Among those who could be deprived of medical services are nearly 2,400 “medically fragile” children in North Carolina whose ventilators, oxygen tanks, feeding tubes, catheters and round-the-clock nurses are covered by a little-known Medicaid program available to middle-class families with private health insurance.

The program pays for services that private insurance doesn’t cover, allowing parents to work and the children to attend school….
Caring for one seriously ill child in the program costs an average of $80,000 a year in North Carolina, compared with $4,700 for a typical Medicaid beneficiary in the state. That could make the program an easy target for cost reductions, parents fear, because the amount of money required to treat one “medically fragile” child can be used to provide health care for 17 kids on Medicaid.

“Our kids aren’t cheap,” said Jenny Hobbs, a Pfafftown mom near Winston-Salem who works as an HR manager. Three of her four children are “medically fragile.”

Madison, 7, Meredith, 12, and Michael, 14, all have mitochondrial disease, a progressive disorder that can cause muscle weakness and pain, seizures, vision loss and hearing loss, learning disabilities and organ failure, among other complications. The condition has no cure. Last year, Madison was also diagnosed with melanoma. All three use feeding tubes for medications and supplemental feedings. Meredith and Michael need ventilators to help them breathe, while Madison requires an oxygen tank. All three have their own designated private duty nurse who accompanies them to school and cares for them overnight.

A block grant program creates a very strong incentive for states to minimize the amount of money that they spend on the highest cost cases. That means providing minimal or inadequate care to the kids who need the most help.

The local press is doing a good job of highlighting locally relevant stories.

Use these stories when you call your Senator this week.

I can still hear you saying you would never break the chain

The massive human chain protest in DC at 5 pm today sounds cool.

Here’s the FB page for it.

What other protests are people hearing about? Now’s the time to throw the Republicans an anvil on health care.

In Re: Calls

Following up Doug’s post, and Doug’s post, and David’s post, and…you get the idea…

Keep calling, and don’t restrict yourself to your senators’ DC offices.  Each and every senator has several in-state offices. They’re populated mostly by actual staffers, not interns.  Real people answer the phones — and if the one nearest you doesn’t pick up, you can call on down the line till you find someone at home.  They’re often less crazed and more ready to listen, even to opposing views.

My own experience:  my wife’s family has a place in the Bath-Boothbay stretch of the Maine coast, and several family members who live up around the Penobscot Bay area.  So I used that as the base from which I called Senator Collins’ Portland office, the one she lists as serving the county in which my in-laws hang.  I told the nice lady who answered that I was grateful to the senator for coming out in opposition to the bill, that I agreed with her that it was bad for Maine, and that I was calling both to thank her and to emphasize that cosmetic changes to the bill won’t alter its underlying effects, which will still be bad for Maine.  We talked about this for five or ten minutes and it was an actual conversation.

How much effect will it have? Not that much. She knew I was only partly attached to Maine, so that’s a discount right there.  But at least it lets that office and perhaps the senator know that we’re paying attention, and that we will continue to do so.  And the fact that this was a conversation, an actual accumulation of reasons to worry about the bill matters quite a bit, I think.

So the moral of the story:  you don’t have to bash down the front door to reach someone who can reach closer to power.  There are back doors, listed (with phone numbers) on every senators’ web page.

Use them.

Image:  Gerrit Beneker Telephone Operator (A Weaver of Public Thought), 1921.