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The Rude Pundit


      There are many, many analyses out on the effects of Trumpcare--and the various versions (House, Senate, proposed variations, etc.) thereof. People like Iconoclast will, of course, consider all such analyses unworthy of being read (since the all-wise Senators haven't yet settled on exactly what crap they want to promulgate). The most enlightening of these, IMNHO, is also the most scatological, crude, obscene, vulgar--in short, the rudest--it comes from the always-funny, always-adults-only, Rude Pundit:


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      Trumpcare/RyanCare/McConnellCare: Each One A Disaster For My Mo. Neighbors


          5 ways the House GOP Obamacare Repeal and Replacement would affect Missourians

          Republicans say their proposal would "rescue" Americans from the failures of the Affordable Care Act, which they have blasted as a one-size-fits-all law that forced consumers to purchase expensive insurance plans they didn't necessarily need and often could not afford. Democrats say the GOP's efforts to repeal-and-replace the ACA, or Obamacare, would strip health insurance from millions of Americans and shred the current safety net for the poor.

          The Congressional Budget Office clearly agrees with the Democratic Interpretation. In its two reviews of bills from House and the Senate the CBO has pointed to how hard the GOP will be on the very poor, the working poor, the chronically ill, the old and women.

          I worked as a Navigator for the Affordable Care Act in 2010 and 2011 in a rural Missouri County. I live in a farming community composed of mostly small family farms where the wage earners usually have to have jobs to supplement farming income. It was not at all unusual for most to have little or no insurance for the adults in the family relying on insufficiently staffed and provisioned clinics. Children were covered by the CHIP program.

          I am proud to say that several dozen of my neighbors got health insurance they could afford that covered them very well thanks to the ACA. Sadly ost of them voted for Trump and the GOP believing his promises to lower their premiums, expand coverage, and improve accessibility and now nearly all of them face an end to the kind of care they have gotten used to and most of them do not realize what is coming their way.

          Here is what I have been sharing with them based on a number of state based research findings:

          A) The state’s uninsured rate would rise.

          More than 200,000 Missourians have gained insurance since the Affordable Care Act took effect, with the uninsured rate dropping from 13.2 percent in 2010 to 9.8 percent in 2015.

          Forecasts show that nearly 80 percent of those Missourians would no longer be covered. 160,000 Missourians will no longer be insured.

          Some people would choose to drop their coverage, because the GOP repeals the individual mandate that requires most Americans to purchase insurance. Others would no longer be able to afford health insurance under the Republican plan.

          B) The mandates on individuals and businesses would be nixed.

          Under the Affordable Care Act, people who failed to buy insurance faced a tax of as much as $2,676 in 2016. The penalty would go away under the GOP plan.

          However, if an individual or family dropped coverage and then decided to re-enroll, the House GOP plan would allow insurers to charge them 30 percent more for premiums for one year.

          The ACA also requires businesses with at least 50 full-time employees to provide its workers with “affordable” insurance — essentially, a plan that cost less than 10 percent of a worker’s household income. Failure to do that currently costs business owners up to $2,260 per employee annually. The GOP plan would nix that tax, so those business owners could stop offering insurance.

          C) Insurances rates would vary wildly (as would coverage benefits) and costs would increase significantly for older, low-income consumers.

          Much of the criticism of Obamacare has centered on the rising cost of private insurance plans, especially for individuals buying insurance on the health care exchanges with no federal help to offset the costs.

          In Missouri estimates are that premiums would rise for most of the insured by 15 to 20 percent over the next three years. Of course, many would be forced to drop insurance since their ages and medical conditions would permit far higher premiums for those who most benefit from having insurance. Additionally, since GOP plans allow states to eliminate many of the guaranteed coverage benefits, a number of insurance plans will be economical but will provide few benefits.

          In general, the cost of buying insurance on the individual market would go up for low-income, older Americans, and it would go down for younger, wealthier Americans. Both plans (although with each using different formulas) offer far less in the way of tax credits to those who qualify. They actually increase the number of those who will get no credits at all because the "working poor" will be excluded. The "working poor" are those who make less than 138% of the Federal Poverty Guideline. The assumption was that those individuals would qualify for expanded Medicaid. Missouri chose to "take advantage" of the Supreme Court ruling that said states could opt out of the expansion.

          In addition, the House GOP bill would ease limits on how much insurers could charge older consumers, who tend to have more health problems than younger ones. The GOP change is aimed at drawing younger people into the market, but it could mean higher premiums for seniors.

          D) Missouri hospitals could take a financial hit.

          With more Missourians uninsured, hospital officials fear they would have to provide more uncompensated care. Hospitals are required to serve patients who have no ability to pay their bills, but those costs have diminished under Obamacare, as fewer uninsured patients arrived at their doorstep. The GOP bills will leave those hospitals with much more uncompensated care.

          The Missouri Hospital Association estimates that the Republican plan could cost the state’s hospitals $5.5 billion over the next decade. The MHA also estimates that 30 public clinics and 9 hospitals will be forced to close their doors. Hospitals would be paying for a significant portion of the new law, at the same time as uncompensated care costs explode and Medicaid comes a less reliable source of care for the poor.

          When the hospitals take a hit so does the local economy. In many of the counties in my state the hospitals are one of the top employers. Closing hospitals hits the local economy and makes the poor poorer.

          E) Missouri would lose federal funding for Medicaid even the state chose not to participate in the expansion option.

          Missouri never took advantage of the Obamacare provision that allowed states to expand Medicaid, the joint federal-state health insurance program for the poor and disabled. So in some ways, the GOP plan — which phases out the Medicaid expansion — will be less painful here than in other states that have come to rely on a generous federal match to expand coverage for low-income residents.

          But Missouri — like every other state — would still lose federal funding under the GOP bills because of other changes the measures would make to Medicaid.

          Right now, the federal government pays about 65 percent of the health-care costs for Missourians who are on Medicaid, and the state pays the other 35 percent. Under the GOP bills, that formula would be nixed, and states would instead get a capped amount of money for each Medicaid enrollee.

          The capped federal contributions would not increase as much as the projected cost of treating Medicaid patients, so states would face a growing tab for the program. In other words the GOP programs pass the expanding costs on to the states such that they become responsible for more and more of the costs of Medicaid.

          Critics say that would blow a hole in state budgets, prompting governors and state legislators to cut benefits and restrict eligibility for low-income residents. Supporters of the bill say Medicaid’s costs are unsustainable and the GOP bill puts the program on a more fiscally responsible course.

          In Missouri the largest single bloc of Medicaid holders are the elderly with more than half of these in nursing homes. If Medicaid is reduced what happens to them. Medicaid in Missouri is generally for the very poorest who can barely hold on now. What happens to them?

          I am a member of two Indivisible Groups that are focusing on the Health Insurance Bills. In meeting after meeting with GOP staff and members of Congress.....all they have is generalizations and platitudes.....they cannot respond substantively to concerns and questions. In my opinion they know how terrible their bills are.

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          Pundit Post

          'Pharma Bro' Martin Shkreli Goes On Trial On Securities Fraud Charges


              Let's just see if Pharma Bro will sit in court with that smirk on his face like he did during the Congressional Hearings when he sat there taking the fifth to all questions asked of him. I really don't like to wish ill will on anyone but this guy has it coming and I truly hope they throw the book at him and he ends up sitting in jail for a good portion of the rest of his life smirking at four concrete walls.


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              Mitch's Dependency On Socialized Medicine--


                  As we calmly contemplate--oh, OK, *not* calmly--the health insurance industry protection measures now being proposed (not "healthcare"--time to stop pretending that's the goal), let us reflect on whether socialized, taxpayer-funded healthcare is a good thing. I'd warn Iconoclast not to read this, but it's likely safe to say he wouldn't read anything from the Daily Beast--just comment on it without reading it, as is his wont.

                  Say for Mitch McConnell:

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                  Under Sessions, Who Will Keep Tabs On The Cops?


                      ______________________________________________________________________'Despite the torrential rain outside, Newark residents filed into St. Stephen’s Church, in the heart of the city’s multiethnic Ironbound neighborhood, last Monday night for a meeting with Peter Harvey, the federal monitor assigned to oversee the implementation of court-ordered reforms by the Newark Police Department.

                      'Newark was one of 14 police departments to enter into consent decrees with the Department of Justice during the Obama administration as a result of investigations into unconstitutional practices by police in cities across the country. Now, that department is led by an outspoken opponent of police oversight: Attorney General Jeff Sessions. Law-enforcement agencies, local judicial systems and civil-rights advocates are all looking for signs of how the change in leadership will play out in cities under consent decrees — and in those without them as well.

                      'In late March, Sessions issued a memo ordering a broad review of all the department’s existing investigations, training, compliance reviews and other engagements with local law enforcement agencies — including “existing or contemplated consent decrees” — to ensure that they do not undermine the Trump administration’s law and order agenda.

                      'Harvey had been slated to discuss the findings of his first quarterly report on the Newark department’s progress. But he was met with repeated accounts of abuses at the hands of the department he was monitoring — including threats, harassment and physical assault against civilians.

                      '“He kicked the door in, as if he was my personal enemy,” said Julio Sancho, describing an encounter with a Newark police officer who’d become aggressive after Sancho, an Ecuadorian immigrant who has lived in Newark for 17 years, questioned the officer about why he was ticketing cars across the street. With the help of an English translator, Sancho described in Spanish how the officer proceeded to physically assault him, pepper-spraying his children—the youngest of whom is 4 years old—as they yelled for him to stop.

                      '“My children are traumatized,” said Sancho’s wife, Gloria Solano, becoming choked up as she corroborated her husband’s account.'


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                      Single Payer Stalls In California



                          If there's a smart path to single payer healthcare

                          in California, we haven't found it yet

                          State Sen. Ricardo Lara, D-Bell Gardens, accompanied by members of the California Nurses Association, discusses his single-payer health care bill at a Capitol news conference on May 31 in Sacramento, Calif.

                          (Rich Pedroncelli / Associated Press)

                          Los Angeles Times

                          Editorial Board

                          June 27, 2017

                          California Assembly Speaker Anthony Rendon did the state a favor late Friday afternoon when he slammed the brakes on a fast-moving Senate bill to create a single-payer healthcare system in California. As should be obvious from the flailing Republican efforts in Washington, it’s easy to talk about drastic changes in the way healthcare is financed, but hard to make those changes work without hurting many of the people you’re trying to help.

                          Dubbed the Healthy California Act, SB 562 by Sens. Ricardo Lara (D-Bell Gardens) and Toni Atkins (D-San Diego) would create a first-in-the-nation state insurance program to replace all private insurers and, if possible, public programs as well. Its laudable goal is to make healthcare in California universally available and more cost-effective by eliminating the complexity and costs imposed by the current system of multiple private and public insurers.

                          It’s understandable why lawmakers would look for a way to shield their constituents from the disastrous coverage losses that are sure to happen if the congressional bills to “repeal and replace” the ACA and slash Medicaid become law. But the last state to try to create a single-payer system — Vermont — abandoned the effort in 2014 because of the huge projected cost to taxpayers.

                          SB 562, which the California Nurses Assn. sponsored, ducks the question of costs entirely, saying simply that the system it would create cannot go into effect until the state finds a way to pay for it — as if the cost issue were somehow separate from the question of how to run a single-payer system. It is, in fact, integral. Just look at Medi-Cal, the state’s $103-billion Medicaid program, which placed so much pressure on the state budget that lawmakers cut back services, eligibility and arguably the quality of care provided. The proposed single-payer system would dwarf the size of Medi-Cal.

                          The nurses union has countered with a study it financed showing that a single-payer system would actually save the state money. The public should be no less skeptical of this research than of any single study financed by any other stakeholder group.

                          But the cost issue is just the most obvious one posed by the proposal. Others revolve around the question of what care the state will pay for — the bill says whatever is “medically necessary,” but it doesn’t define what that means — and how much the state will pay for it. If the state is the only entity negotiating with doctors and hospitals, how does it pay enough to keep them here and afloat while still doing more than the current system to hold down the rapid growth in medical costs?

                          How would the state avoid becoming the go-to destination for anyone outside of California who needs care but can’t afford it? How would it integrate people who are eligible for Medicare and employer-provided retiree benefits for which they’d already paid?

                          These are all difficult questions that involve important policy choices. Yet the measure — which is barely 35 pages long — is so light on detail, it leaves those issues unresolved. And it blitzed through the Senate after only two committee hearings. That’s not legislating, that’s posturing. There’s an enormous amount of legislative spade work to be done to determine whether single payer is the right direction for California, and if so, to design a feasible system. If lawmakers really wants to pursue this, they need to get serious.

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