Thursday Morning Open Thread: Keep Going After the Bastids

Per Crooks & Liars:

A frustrated Senator Warren asked Rep. Price direct questions about his own policy prescriptions, but he refused to give a definitive answer, even about the cuts he has repeatedly called for.

Sen. Warren discussed his calls to cut funding and asked, “You recently authored as chair of the House Budget Committee would have cut spending on Medicare by $449 billion dollars over the next decade, is that right?

Rep. Price replied, “I don’t have the numbers in front of me.”

She replied, “I have the numbers.”

He said, “I assume you’re correct.”…

Sen. Warren then brought up Trump’s positions on both health care plans, in which he states there will be no cuts to the programs, funding-wise. She asked if Trump was telling the truth and he replied, “yes.”…

Warren said, “Can you guarantee to this committee that you will safeguard president-elect Trump’s promise and while you are HHS secretary, you will not use your authority to carry out a single dollar of cuts to Medicare or Medicaid eligibility or benefits?”

Price said, “What the question presumes is that money is the metric. In my belief from a scientific standpoint, if patients aren’t receiving care even though we’re providing the resources, it doesn’t work for patients.”

Warren said, “We’re very limited on time. The metric IS money. The President-elect…said he would not cut dollars from this program. So that’s the question I’m asking you. Can you assure this committee you will not cut one dollar from Medicare or Medicaid should you be confirmed to this position?

Price replied, “I believe that the metric ought to be the care that the patients are receiving.”

Warren said, “I’ll take that as a no.”…

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Apart from applauding Women Who Take No Shit, what’s on the agenda for the day?
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Open Thread: Repeal and…. Uhhh…

(Jack Ohman via GoComics.com)
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It’s all fun and games, until your constituents realize they’ll be losing their insurance…

Of course, the GOP’s own President-Asterisk has been running his mouth without bothering to check on the Party Line — it’s HIS party now…


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Tuesday Morning Open Thread: Encourage Dissent


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A note from commentor Lizzy L:

For those worried about ACA coverage for themselves and their families…. After hearing about the midnight repeal of the pre-existing conditions clause, a friend of mine called Senator Warren’s office. The woman she spoke to said they are being flooded with calls, as are the offices of Speakers Ryan and McConnell.

Senator Warren’s staff member told her that what would help the most would be to call the five Republican senators who have broken away from the GOP to demand a slow down of the repeal. Tell them how much you appreciate their efforts to stop this train wreck! If this issue affects you or someone you love, share your story with the staffer who answers the phone. (Remember the time difference when you call.)

The senators are:
Senator Bob Corker – (202) 224-3344
Senator Lisa Murkowski – (202) 224-6665
Senator Rob Portman – (202) 224-3353
Senator Susan Collins – (202) 224-2523
Senator Bill Cassidy – (202) 224-5824

if you call the number and get VM, one approach would be to leave an appreciative and encouraging message. I know people who prefer to do that, since calling a Representative’s office often means waiting on hold for a loooong time.

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Apart from encouragement — and resistance — what’s on the agenda for the day?
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Is the ACA (But Not ‘Obamacare’) Achieving Third-Rail Status?

Meanwhile, far from the Village of Media Idiots…

Republicans are debating how long to delay implementing the repeal. Aides involved in the deliberations said some parts of the law may be ended quickly, such as its regulations affecting insurer health plans and businesses. Other pieces may be maintained for up to three or four years, such as insurance subsidies and the Medicaid expansion. Some parts of the law may never be repealed, such as the provision letting people under age 26 remain on a parent’s plan…

To cushion the political blow of upending the system, party leaders are putting out a stream of statements portraying Obamacare as collapsing on its own.

But the Department of Health and Human Services reported that signups reached 6.4 million by the Dec. 19 deadline, an increase of 400,000 over the previous year’s number at this time. Earlier, President Barack Obama said that more than 670,000 Americans signed up for coverage on Dec. 15, “the biggest day ever for Healthcare.gov.”

“The overarching challenge is that the Affordable Care Act is the status quo, and disrupting the status quo in health care is always controversial,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation and former adviser to President Bill Clinton’s health-care efforts. “There are so many moving pieces to this effort involving lots of money and lots of interest groups. So piecing together the votes is daunting.”…

Some Republican aides say they may pursue a replacement through a series of small bills as opposed to one big measure. Leading Republicans such as Senate Majority Whip John Cornyn of Texas have said they want Democratic buy-in on a replacement plan. Breaking a filibuster would require the support of at least eight Democrats.

Obamacare continues to be viewed unfavorably by Americans, but the politics of undoing the law are complicated. A Kaiser Family Foundation poll after the election showed 26 percent want to repeal it, while 17 percent want to scale it back. Nineteen percent want to move forward with implementation and 30 percent want to expand it…
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Thursday Evening Open Thread: Tim’s Right About Medicare

From the article:

… “We say to our Republicans that want to privatize Medicare, go try it, make our day,” said Senator Chuck Schumer of New York, the incoming Democratic leader, mustering his best Clint Eastwood/Ronald Reagan impersonation.

Since 1995 — when the newly installed speaker, Newt Gingrich, famously proposed $270 billion in cuts to Medicare and declared the program would “wither on the vine” because of the appeal of Republican-crafted free-market options — Democrats have seen the exceedingly popular but financially strained program as a winning wedge issue…

Now Democrats intend to capitalize on it again, beginning with their approach to the nomination of Representative Tom Price, Republican of Georgia, to lead the Department of Health and Human Services.

Mr. Price is not only a leading proponent of repealing the Obama-era health care law, but he has embraced Republican efforts to move future Medicare users into private insurance programs and raise the eligibility age. He told reporters shortly after the Nov. 8 election that he anticipated Republicans would embark on a substantial Medicare overhaul within the first six to eight months of Donald J. Trump’s presidency.

Senate Democrats intend to press Mr. Price on this subject during his confirmation hearings. They see a wide opening for political gain, given the 57 million older Americans who rely on Medicare — including many white Midwesterners with financial worries who voted for Mr. Trump.

“Good luck to selling that to the voters in Indiana and Ohio that were Democrats and voted for Trump this time,” Senator Sherrod Brown, Democrat of Ohio, said about a Medicare revamp. “They’re going to be fleeing quickly, right?”

A Medicare fight is also a potential political lifeline for Democrats in red states who could be in very tough contests in 2018. Ten Senate Democrats face re-election in states carried by Mr. Trump. One of them, Joe Donnelly of Indiana, has already made it clear that he will brook no overhaul of Medicare and that he intends to vote against Mr. Price’s nomination to the health care agency…

Democrats also noted that Mr. Trump did not campaign on the idea of tinkering with Medicare or its companion entitlement program, Social Security. In fact, his statements about those two cornerstones of American retirement security were that he would not cut them. That difference raises the prospect of a clash with congressional Republicans — particularly House Republicans led by Speaker Paul D. Ryan — who have long pushed for Medicare changes and championed them in House budgets…

So, with a little luck & a lot of skill, we can protect Medicare, scare a bunch of venal Repubs, ding up a particularly bad cabinet member wannabe, drive a wedge between the upcoming President-with-an-asterisk and his GOP ‘partners’, and keep voters’ attention focused for the 2018 elections. Sounds worth some phone calls to me!
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Apart from fighting the good fight, what’s on the agenda for the evening?



Not the bumper sticker but the core of the fight

Actuarial value and subsidy level is the core element of the coming fight on Medicare. The delivery mechanism through which that value is transferred is window dressing.

Andrew Sprung outlines what is at stake for Medicare:

what precisely is the Medicare guarantee?

At present, there’s a pretty specific answer: for 95% of seniors, the federal government will pay about 85% of the premiums for insurance that covers a bit more than 80% of the average user’s medical costs. That’s what traditional Medicare does right now, via Parts A, B and D, for those whose incomes are below $85,000 for a single person or $170,000 for a couple.

Put another way, the federal government pays a bit more than two thirds of the average senior’s total medical costs. Low income beneficiaries have all or part of their premiums and out-of-pocket costs paid by Medicaid, though a variety of programs. High income seniors pay higher shares of their premiums, with the percentage stepped up through several income brackets. …..

And here is he is on the ACA:

For 8.8 million current enrollees in the ACA marketplace (as of June 31 30), subsidies cover an average of 73% of the premium for plans with a weighted average actuarial value of 80% (surprise!– thanks to Cost Sharing Reduction (CSR) subsidies, the average AV of plans sold in the marketplace is really that high). On average, then, the ACA marketplace covers about 58% of enrollees’ costs — though that average is very uneven, ranging from over 90% for the lowest-income enrollees to close to zero for the barely subsidy-eligible (and zero for the subsidy-ineligible)*. For another 12 million people whom the ACA rendered eligible for Medicaid, federal and state government cover close to 100% of costs….

Under the charitable assumptions that a typical EPFA(HR2300) subsidy would cover 59% of the premium for a plan with a 60% actuarial value, the premium subsidy would cover 35% of the average enrollee’s medical costs — regardless of whether her income were $17,000 or $17 million.

That is the the essence of the upcoming healthcare fights. Everything else is window dressing or mechanics to shift blame for large benefit cuts.



Network information

Loren is a healthcare wonk. He knows this shit cold and he is right, no one in their right mind would think to call the in-network hospital to see if the anesthesiologist would be in-network if a laboring mother to be needed/wanted an epidural.

As other wonks in the tweet stream noted, the best that he could hope for is the hospital to give him a non-binding informational advisory that their anesthesiologists were or were not in network. And even here, the information is incomplete. Many carriers will offer a number of different networks in the employer and individual markets. Some carriers will tell providers that they are in seven of the twelve networks offered. In those cases, the office manager or the billing clerk might be able to tell an interested patient who is trying to effectively shop for planned care whether or not Dr. Smith is in-network for them. Here the system may not be working but it is not flailing around completely in a fireball of fail.

However not all carriers will do this. Instead they’ll send Dr. Smith seven contract amendments for the seven current networks that they want Dr. Smith in. They will never send him the other five narrow network amendments to sign or reject. So when a patient is trying to conform to the system that we impose on them, the billing manager will honestly say “Yep, we take all plans from Mayhew Insurance….” and three months later as the claim is submitted and everyone expects an in-network charge, the patient gets whacked with an out of network bill.

Our provider information systems are designed to fail in a Kafka-Goldberg-Dilbert menage a trois.