Medicaid Under Attack – The Wrongologist

How Can America Handle The Costs Of Elder Care?

The Daily Escape:

The start of US Highway 6, outside of Bishop, CA – September 2023 photo by Steve Wolfe

(There will be no Saturday Soother this week. Wrongo is on the road.)

Millions of older Americans from the Silent Generation and the Baby Boomers are facing a dilemma as they “age in place.” They must figure out how to pay for increasingly complex medical care. The NYT quotes Richard W. Johnson, director of the program on retirement policy at the Urban Institute:

“People are exposed to the possibility of depleting almost all their wealth….”

The prospect of dying broke is an imminent threat for the Boomers. About 10,000 of them turn 65 every day between now and 2030. They’re expecting to live into their 80s and 90s at the same time as the price tag for long-term care (LTC) is exploding. Currently LTC expense is outpacing inflation and approaching a half-trillion dollars a year, according to federal researchers.

By 2050, the population of Americans 65 and older is projected to increase by more than 50% to 86 million. The number of people 85 or older will nearly triple to 19 million. The Times has a chart of how many of those who need long-term care will die broke:

Some older Americans have prepared for this possible future by purchasing LTC insurance back when it was still affordable. Since then they’ve paid the monthly premiums, even as those premiums continued to rise. But this isn’t the norm. Many adults have no plan at all or assume that Medicare, which kicks in at age 65, will cover their health costs. But Medicare doesn’t cover the kind of long-term daily care, whether in the home or in a full-time nursing facility, that millions of elderly Americans require.

For that, you either pay out-of-pocket or you spend down your assets until you have less than $2,000 in assets in order to qualify for Medicaid. Remember that Medicaid provides health care, including home health care, to more than 80 million low-income Americans.

And even if you qualify, the waiting list for home care assistance for those on Medicaid tops 800,000 people and has an average wait time of more than three years.

Here is a snapshot of how long-term care is paid for in the US:

Governments provide 71.4% of the total. The largest non-government source is people who pay out-of-pocket, and private insurance is becoming increasingly expensive. More from the NYT:

“The boomer generation is jogging and cycling into retirement, equipped with hip and knee replacements that have slowed their aging. And they are loath to enter the institutional setting of a nursing home. But they face major expenses for the in-between years: falling along a spectrum between good health and needing round-the-clock care in a nursing home.”

That has led them to enter assisted-living centers run by for-profit companies and private equity funds. The NYT says that about 850,000 people aged 65 or older now live in these facilities and when in them, they are largely ineligible for federal funds. Some facilities provide only basics like help getting dressed and taking medication while others offer luxury amenities like day trips, gourmet meals, and spas.

In either case, the bills can be staggering. More:

“Half of the nation’s assisted-living facilities cost at least $54,000 a year, according to Genworth, a long-term care insurer. That rises substantially in many metropolitan areas with lofty real estate prices. Specialized settings, like locked memory care units for those with dementia, can cost twice as much.”

Home care is costly, too. According to Genworth, agencies charge about $27 an hour for a home health aide. Hiring someone who spends six or seven hours a day cleaning and helping an older person get out of bed or take medications can add up to $60,000 a year.

It’s worse for people with dementia because they need more services. The number who are developing dementia has soared, as have their needs. Five million to seven million Americans over age 65 have dementia, and that’s expected to grow to nearly 12 million by 2040.

The financial threat posed by dementia also weighs heavily on adult children who in many cases become guardians of aged parents. The Times included this chart:

The reality is that families go broke either caring for, or finding care for their loved ones. The alternative: Women in the family give up their lives and jobs to care for their family members instead, which worsens the gender wage gap.

The NYT article makes it clear that older Americans receive far less government support than their peers in other countries. The “why” question is easily answered: It’s a combination of the concerted effort for any public support to be demonized as “welfare”. It’s also partly the result of our failed experiment with long term care insurance. The politicians’ idea was that “the market” would take care of it, so government help for retirees could be limited to Medicaid-paid nursing homes.

But, the LTC insurance industry has largely imploded. Insurers had little experience with the product and grossly overestimated the lapse rates. If a policyholder stops paying, the insurer gets to keep the money and use it to provide services to everyone remaining in the pool. The surprise was that very few people stopped paying. A second miscalculation was that people who held these policies were living longer than forecasted. Longer life equaled higher and larger payouts (insurers also benefit when customers die before they’ve used up all the policy benefits).

A final factor is the rising levels of dementia described above.

And since demand for support outside of family members exceeds the supply of beds, nursing homes and assisted living facilities that aren’t terrible want residents to join during the independent living phase (which requires very little care, so those fees subsidize intensive nursing home care). Many of these facilities require a $400,000-$500,000 buy-in, which may not be refundable at death, even if the resident is current on their monthly fees.

There’s got to be a better way. Medicaid can’t be the only option to pay for LTC. Congress needs to establish a better system for middle-class Americans to finance LTC.

How we handle the growing costs of long-term care is just another reminder that we get LITTLE for our tax dollars beyond a giant military. Americans are responsible for their own medical care, childcare, college tuition, retirement and nursing home care. Some or all of which are provided in other rich countries.

This is a loudly ticking time bomb, and the demographics of the problem won’t change for decades. And yet, the Republicans seem bent on making it worse. They’re actively trying to bring about their dream of privatizing Social Security and Medicare.

Wake up America! We have real problems to solve.

What To Do About Social Security and Medicare

The Daily Escape:

Lupine and poppies, near Glendale, AZ – March 2023 photo by Marion Cart

From Joe Perticone:

“Social Security and Medicare are headed for insolvency—that’s just a mathematical, demographic fact. But when it comes to addressing the problem, there’s virtually nothing the two parties actually agree on. For years, Republicans have waffled between proposing cuts and kicking the can down the road.”

Republicans are correct that Social Security (SS) and Medicare (M) are marching toward insolvency. But they trip over their own feet with their proposals to save them. Republicans are wrong to think they can solve the solvency questions without raising taxes. Once the Republicans take taxes off the table, they’re left without any real solutions to propose.

The Biden administration has done a good job in pre-emptively going after Republican’s ideas about cuts in Social Security and Medicare benefits. The result is that the GOP is squabbling between themselves and scrambling to come up with a plan they could take to the public.

It’s not just the federal debt that should be discussed. Dr. Donald Berwick head of Medicare and Medicaid during the Obama administration wrote in JAMA: (emphasis by Wrongo):

“A total of 41% of US adults, 100 million people, bear medical debts. One of every 8 individuals owes more than $10,000. In Massachusetts, 46% of adults say they skip needed care because of costs. As of 2021, 58% of all debt collections in the US are for medical bills.”

The WaPo explains why people who live in the American South have bad credit scores. It turns out that neither race nor poverty were the deciding factors. It was medical debt:

“Of the 100 counties with the highest share of adults struggling to pay their medical debt, 92 are in the South, and the other eight are in neighboring Oklahoma and Missouri…”

But why the South? Yes, as a region, it’s unhealthy. But there are several Northeastern states where residents struggle with chronic health conditions but have good credit. One thing that stands out is the lack of Medicaid:

“…a recent analysis in the Journal of the American Medical Association…found that medical debt became more concentrated in lower-income communities in states that did not expand Medicaid after key provisions of the Affordable Care Act took effect in 2014.”

So bad health and bad credit are because of Republican governors’ refusal to expand Medicaid to cover more poor people. Leave it to the south to show a MAGA future for all of us: undereducated, unhealthy, and neck-deep in debt.

Today’s Conservatives’ Southern Roots

The Daily Escape:

Vasconcelos Library – Mexico City

From The Atlantic’s Sam Tannenhaus:

…the most populous region in America, by far, is the South. Nearly four in 10 Americans live there, roughly 122 million people, by the latest official estimate. And the number is climbing. For that reason alone, the South deserves more attention than it seems to be getting in political discussion today.

Ain’t demographics great? Tannenhaus continues:

The South is the cradle of modern conservatism. This, too, may come as a surprise, so entrenched is the origin myth of the far-westerners Barry Goldwater, Richard Nixon, and Ronald Reagan as leaders of a Sun Belt realignment and forerunners of today’s polarizing GOP. But each of those politicians had his own “southern strategy,” playing to white backlash against the civil-rights revolution—“hunting where the ducks are,” as Goldwater explained—though it was encrypted in the states’-rights ideology that has been vital to southern politics since the days of John C. Calhoun.

Tannenhaus is reviewing Nancy MacLean’s Democracy in Chains, and using it as a jumping off point to explore the roots of modern conservatism. Why does all this matter today? Donald Trump.

Tannenhaus points out that Trump won the South bigly:

Lost amid the many 2016 postmortems, and the careful parsing of returns in Ohio swing counties, was Donald Trump’s prodigious conquest of the South: 60% or more of the vote in Alabama, Arkansas, Kentucky, Oklahoma, Tennessee, and West Virginia, with similar margins in Louisiana and Mississippi.

And we need to look at Trump’s Cabinet: 10 Cabinet appointees are from the South, including Attorney General Sessions (Alabama) and Secretary of State Tillerson (Texas).

MacLean’s view is that modern conservatives draw on Southern resistance to 1954’s Supreme Court decision in Brown vs. Board of Education. After the New Deal, conservatives pushed back hard against the expanding federal government. Tannenhaus says:

But it was an uphill battle; the public was grateful for Social Security. Brown changed all that. More than the economic order was now under siege…A new postwar conservatism was born, mingling states’-rights doctrine with odes to the freedom-loving individual and resistance to the “social engineering” pursued by what conservative writers in the mid-1950s began to call the “liberal establishment.”

MacLean focuses on James Buchanan, a Virginian, and a Nobel Prize-winning economist, who argued that the crux of the desegregation problem was that “state-run” schools had become a “monopoly”.

Buchanan argued for privatization of schools. If local towns and cities limited their involvement in education to setting minimum standards, then many kinds of schools might flourish. Each parent “would cast his vote in the marketplace and have it count.”

Sounds like Betsy DeVos.

But, Buchanan wasn’t done. In his book “The Calculus of Consent” (1962), he argued that politicians were looking out for themselves, and they could do real damage that citizens were unable to avoid. The high-priced programs they devised were paid for by taxes, and citizens had little choice but to pay them. Reinforced by the steep progressive tax rates of the time, he called it licensed theft. Not long after Buchanan’s book, Medicare was passed, then the War on Poverty, and then the Great Society— each another example of social engineering delivered by the liberal establishment.

Buchanan’s ideas live on today. The right believes that liberal values cost us our liberty.

Today’s Freedom Caucus is Buchanan’s ideological descendant. They believe they are the guardians of liberty, that drastic measures, like shutting down the government, or defaulting on the national debt are legitimate uses of political power that serves their higher objective. More from Tannenhaus:

This is what drives House Republicans to scale back social programs, or to shift the tax burden from the 1% onto the parasitic mob, or to come up with a health-care plan that would leave Trump’s own voters out in the cold.

Conservatives and Libertarians say that “government is trampling our way of life”. That sets people against government programs, even when the specific program doesn’t need to be attacked. Consider Medicaid. It is attacked as both social engineering and a gift to minorities, even though the majority of those benefiting from it are elderly or white.

Conservatives and Libertarians prefer “individual choice” for poor elderly, or children who can’t afford healthcare. A broadly-based social safety net isn’t consistent with their ideological purity.

They fail to see the value of government as a moderating force in markets.

Accordingly, their thinking cannot advance human society in any meaningful way.

Today’s tune: “Revolution” by The Beatles recorded in September 1968. It was released as the B-side of the “Hey Jude” single in late August 1968, and we hear the live studio version from a month later:

Takeaway Lyric:

You say you’ll change the constitution
Well, you know
We all want to change your head
You tell me it’s the institution
Well, you know
You better free you mind instead

Those who read the Wrongologist in email can view the video here.

Saturday Soother – July 1, 2017

The Daily Escape:

Matsumoto Castle, Japan – photo by Aaron Bedell

Wow! Trump outdoes himself with his Twitter attack on America’s sweethearts, Joe and Mika.

But today, let’s focus on Medicaid, and the possibility that it will be phased out by Mitch McConnell and his Republican Senate colleague’s effort to save America by giving more tax cuts to the rich.

Amy Davidson at the New Yorker wrote about “The Senate’s Disastrous Health Care Bill” in the July 3^rd issue: (emphasis by the Wrongologist)

Medicaid, for example, covers seventy-four million low-income Americans—a fifth of the population. There is no simple picture of this group; according to the Kaiser Family Foundation, thirty-four million are children, eleven million are disabled, and seven million are elderly, a large number of whom live in nursing facilities. Many of those people led middle-class or even affluent lives, until their savings were consumed by the cost of residential care, which, in large part, is not covered by Medicare; nearly two-thirds of nursing-home patients are, at some point, on Medicaid.

One of Obamacare’s innovations was to expand Medicaid eligibility to include people slightly above the poverty level. The federal government now pays the states a percentage of what it costs them to care for eligible residents: if a state spends more, it gets more, within certain parameters. Both Republican plans would radically restructure the program, giving states limited sums. The states would then have to use their own money to make up for the shortfall—or they could choose to spend even less. This change would place particularly devastating financial pressures on the elderly, at a time when the population is aging.

We’ll see whether the GOP is successful in gutting Medicaid after the July 4^th break. Josh Marshall of Talking Points Memo made a great point about how Republican goals for health care were not what they campaigned on, while talking to CNN’s Wolf Blitzer:

When you try three times to ‘repeal and replace’ and each time you come up with something that takes away coverage from almost everyone who got it under Obamacare, that’s not an accident or a goof. That is what you’re trying to do. ‘Repeal and replace’ was a slogan that made up for simple ‘repeal’ not being acceptable to a lot of people. But in reality, it’s still repeal. Claw back the taxes, claw back the coverage.

It is detestable to spin their dismantling of Medicaid as “reform”. It is even more detestable to say that with Repeal and Replace, people will have better health insurance.

So, we need to relax and try to forget all about this for a few days. Wrongo’s suggestion is that you grab a cup of Kick Ass coffee, settle in a comfortable chair where you can look out a window, and listen to Ralph Vaughan Williams’s “The Lark Ascending”.

Today’s soother was suggested by blog reader Shelley VK. We have it performed by violin soloist, Janine Jansen with Barry Wordsworth conducting the BBC Orchestra at the Royal Albert Hall in 2003. Jansen is playing a 1727 Stradivari “Barrere” violin:

https://www.youtube.com/watch?v=f4NMf2PO_mQ

Those who read the Wrongologist in email can view the video here.

Is a Single-Payer Experiment on the Horizon?

The Daily Escape:

Breaking the Ramadan fast, Dubai – photo by Francois Nel

From Sarah Kliff:

Nevada, with little fanfare or notice, is inching toward a massive health insurance expansion — one that would give the state’s 2.8 million residents access to a public health insurance option.

The Nevada legislature passed a bill Friday that would allow anyone to buy into Medicaid, the public program that covers low-income Americans. It would be the first state to open the government-run program to all residents, regardless of their income or health status.

This is “Medicaid for All”, not “Medicare for All”, which several Democrats have proposed over the years. Medicare for all has always fizzled out, due to a lack of political support.

Medicaid for all offers an interesting alternative. Medicaid coverage generally costs less than Medicare for all because the program pays doctors lower rates. This could make it cheaper for low-income price-sensitive consumers who can’t afford the Obamacare monthly premiums. More from Sarah Kliff:

Nevada’s bill to allow a broader Medicaid buy-in is short, running just four pages. It would allow any state resident who lacks health insurance coverage to buy into the state Medicaid program, which would sell under the name the Nevada Care Plan.

Under the Nevada bill, people who qualify for tax credits under the Affordable Care Act would be able to use those credits to buy Medicaid coverage instead. People who don’t qualify for credits would be able to use their own money to buy in. It is likely that the plan would be sold on Nevada’s health insurance marketplace, making it a public option that competed against the private health insurance plans selling there.

Early versions of the Affordable Care Act included a buy-in provision. But the Senate was forced to drop the Medicare buy-in from its bill when it couldn’t get the entire Democratic caucus behind the idea. Health insurers fought aggressively against the idea, which disadvantages insurers by reducing their market share.

After Trump’s election, health policy experts started to explore whether it might make more sense to build a national health care system around Medicaid rather than Medicare.

Medicaid and Medicare are similar programs in that they are large and publicly run, covering 62 million and 43 million Americans, respectively. They use their large membership to negotiate lower prices with hospitals and doctors. Medicaid tends to have the lowest payment rates. On average, Medicaid pays 66% of what Medicare pays doctors. In Nevada, Medicaid pays 81% of Medicare rates.

This means Medicaid is a relatively lower-cost program, but some doctors do not accept Medicaid’s lower rates. A recent federal survey estimates that 69% of doctors are accepting new Medicaid patients, compared to 85% accepting new patients with private insurance.

States have significant control over how their health insurance programs work and whom they cover. Thirty-two states participate in a Medicaid buy-in program that lets certain disabled Americans who don’t otherwise qualify for coverage, buy into the program.

This flexibility provides an opportunity for states that want to experiment with a public program by tacking on a buy-in option. If Nevada’s bill does become law, it will show other states how such a program might work, and if it works well, other states may be inclined to try it.

States that want to enroll new populations into their Medicaid programs will need permission from the federal government. This means that the Trump administration — which has proposed slashing the Medicaid budget in half — would need to get on board with a significant expansion of the program, perhaps a doubtful possibility. But as Kliff says: (brackets by the Wrongologist)

The Nevada idea in theory shouldn’t expand federal costs. Individuals would be responsible for paying their own way onto the program, although it will likely be a challenge to set the right premium [rates] to ensure this outcome.

California is considering a single-payer bill as well. Whether other states might follow the Nevada example will depend on what outcomes it produces.

Here is another tune from the One Love Manchester concert. Watch “Happy” by Pharrell Williams and Miley Cyrus, who turn the song into a soul number, something closer to Motown than to Disney. They make it something more than it was when it was so popular. Also, the whole audience sings along, and that’s fun:

Those who read the Wrongologist in email can view the video here.

Saturday Soother – May 6, 2017

The Daily Escape:

Tulips, Lisse Netherlands, April 2017 – photo by Peter Dejong

We ended the week with Republicans in the House passing the latest version of Trumpcare by a vote of 217-213. All Democrats voted against it, with 20 Republican members defecting to join them. The changes Republicans made to get this version of bill through the House will not be what passes in the Senate. It’s up to Mitch McConnell to craft a bill that can get through the Senate using the budget reconciliation process, which will require 51 votes to pass.

That will most likely be the “real” bill, and then the negotiations between the House and Senate versions will begin.

The problem for America is that the Senate has to pass something awful enough that the House will still vote for it. We are a long way from replacing Obamacare, but Republicans now own the process whereby tens of millions of Americans losing health insurance.

If that isn’t enough to worry about, Buzzfeed has a long read about tiny drones that can be used in a swarm to kill people:

A very, very small quadcopter, one inch in diameter can carry a one- or two-gram shaped charge. You can order them from a drone manufacturer in China…A one-gram shaped charge can punch a hole in nine millimeters of steel…You can fit about three million of those in a semi-tractor-trailer. You can drive up I-95 with three trucks and have 10 million weapons attacking New York City. They don’t have to be very effective, only 5 or 10% of them have to find the target.

The concept is achievable, while the potential consequences are unthinkable:

There will be manufacturers producing millions of these weapons that people will be able to buy just like you can buy guns now, except millions of guns don’t matter unless you have a million soldiers. You need only three guys to write the program and launch them. So you can just imagine that in many parts of the world humans will be hunted…This is the ever-present cloud of lethal autonomous weapons.

They could be here in two to three years.

— Stuart Russell, professor of computer science at the University of California Berkeley

They are called lethal autonomous weapons systems (LAWS); weapons that have the ability to independently select and engage targets once a human releases the machine to perform: no supervision, no recall, and no stop function.

Can we prevent them? Nope, they already exist. Many countries including the US already have (much larger) systems with autonomous modes that can select and attack targets without human intervention: Israel’s Harpy and second-generation Harop, can enter an area, hunt for enemy radar, and kamikaze into it, regardless of where they are set up, as long as the radars are operating.

The Pentagon now is testing drone swarm technology: Weapons moving in large formations with one controller somewhere far away on the ground clicking computer keys. Think hundreds of small drones moving as one, like a lethal flock of bees. You can see a YouTube video of a US drone swarm test here. 103 mini drones were released from two US fighter jets during the test. The drones operate autonomously and share a distributed brain. These drones will make it economical to target people (troops?) in other countries, en masse, without having to send in our own soldiers, or declare war.

Why are we wasting even more human potential devising even more ways to kill each another?

Sorry, this story adds to your stress levels after a tough week, but Wrongo thought you should know. OTOH, with all that is going on, you really need soothing. Wrongo is going for some Stumptown Colombia El Admirador coffee and a listen to “Spring”, from Vivaldi’s Four Seasons, arranged for four pianos.

The pianos are played by Yuja Wang, Emanuel Ax, Nelson Goerner, and Julien Quentin. The performance was recorded at the Salle Médran in Verbier, Switzerland, in 2009:

Those who read the Wrongologist in email can view the video here.

Bonus video in honor of Trumpcare: Jimmy Reed singing “Get Your Insurance” from 1959:

Those who read in email can view the video here.

50% of American Births are Now Financed by Medicaid

The Daily Escape:

(Street art, Panama City Panama, 2015 – photo by Wrongo)

A report by the Kaiser Family Foundation is an eye opener. The 2016 Kaiser Family Foundation Medicaid Budget Survey asked states to report the share of all births in the state that were financed by Medicaid in the most recent 12 month period for which state data were available.

The results are staggering. Half of the states in the country reported that 50% or more of births were financed by Medicaid, with New Mexico reporting the highest number of births financed by Medicaid, 72% in 2015. New Hampshire was the lowest at 27%. Eight states said that 60% or more of births were financed by Medicaid, while in another eight states, Medicaid had financed between 27% and 37% of the births. These figures show how important and widespread Medicaid is and what it means to people from low-income families. For those who are not on a Medicaid plan, they may want to see here about how to do that, so that they can make sure their health and wellbeing is taken care of.

Kaiser provided no analysis for their survey, and an interesting question to answer would be the demographics of Medicaid-financed births. Kaiser did include this map showing percentage of births financed by Medicaid:

(Source: Kaiser Family Foundation)

The map shows us the states which would have been hurt the most by the proposed cuts in Medicaid that the GOP tried to enact in the failed Trumpcare bill. Of the 14 states with more than 54% of births financed, only New Mexico and Nevada voted for Hillary in 2016.

So, Trump and the GOP will have plenty of explaining to do if Medicare is cut deeply on their watch, since these are many of the states that helped elect Trump, and put both houses of Congress in Republican hands.

One question is, what will be different if the government cuts Medicaid? We have an indication from Texas. The state cut off money to Planned Parenthood clinics in 2013, and that led to thousands of women failing to get birth control. Medicaid pregnancies subsequently increased by 27%, according to a research paper published in The New England Journal of Medicine last year.

The time for an economic reset in America is long overdue. Conservatives will blame the poor, or Obamacare, or both for the surprising data on government-financed births. Liberals will say it is a failure of the social contract. But, when 50% of births occur to people who can’t afford them, it is clear that our economic system needs fixing.

OTOH, it is good thing that we encourage pre-natal care for all, which gives these babies a better start in life.

Our unequal economy rolls along unchanged, because the comparatively well off middle and professional classes keep electing politicians that defend the current system against the 50% who are America’s working poor. Creating a war between the have some’s and the have little’s has worked throughout history.

This is the new America. Many in the former middle class are living on the edge of poverty, and we know it. Is inequality changing America? You bet.

It is incumbent on both parties to deal with Medicaid-financed births.

Time for a tune. Here is Madonna with “Papa, Don’t Preach“, released in 1986. At the time, the song caused discussions about its content, with women’s groups and those in the family planning field criticizing Madonna for encouraging teenage pregnancy, while anti-abortion groups saw the song as having a pro-life message. Decide for yourself. Here is “Papa Don’t Preach“:

Those who read the Wrongologist in email can view the video here.

Takeaway Lyric:

Papa I know you’re going to be upset
‘Cause I was always your little girl
But you should know by now
I’m not a baby

The one you warned me all about
The one you said I could do without
We’re in an awful mess
And I don’t mean maybe, please

Papa don’t preach I’m in trouble deep
Papa don’t preach, I’ve been losing sleep
But I made up my mind, I’m keeping my baby,
I’m gonna keep my baby

CBO and Ides of March UPDATE

Further to the column below, Bloomberg has a nice chart that puts the CBO report on Trumpcare in a better context. It compares the number of uninsured in CBO’s future forecast for Obamacare (if it remained in place) with their future forecast for Trumpcare. The difference is staggering, particularly if you think America shouldn’t cast aside its people for profits:

The difference between 10% of Americans uninsured and the 19% uninsured under the GOPocalypse Plan must be made clear to voters. Importantly, the GOP version will insure even FEWER people than were uninsured before we had Obamacare!

New HHS secretary Tom Price joined the parade of Republicans who tried to discredit the CBO report. He told reporters that the CBO didn’t analyze the entire plan for health care, including regulatory changes that can be made by HHS:

We disagree strenuously with the report that was put out…We believe that our plan will cover more individuals at a lower cost and give them the choices that they want, the coverage that they want for themselves and their families.

This is hilarious, considering that Price, in his previous role as House Budget chairman, helped to pick the current CBO director. Do you believe for a moment he picked someone who didn’t see things his way?

Finally, hidden in the CBO report on page 33, footnote f, is an assumption that should be headlined around the media today. It states that more people will die if Trumpcare is enacted. TPM reports:

Approximately 17,000 people could die in 2018 who otherwise would have lived if a House Republican health proposal endorsed by the Trump administration becomes law. By 2026, the number of people killed by Trumpcare could grow to approximately 29,000 in that year alone.

You might think that a CBO report showing that your plan will kill thousands of people a year and inflict physical and financial misery on countless more in order to pay for another tax cut for the wealthy would scare the GOP leadership, and some cracks are starting to show.

But, these are people who think that freedom requires that toddlers and those with schizophrenia be allowed to have access to guns, so very few are likely to be moved by the CBO’s forecast.

The disingenuousness of the GOP is to tout that the CBO estimates $935 billion in spending reductions via smaller tax credits and Medicaid cuts. All this mostly affects the working poor who will pay for its $599 billion in tax cuts, mostly going to the wealthy.

That’s not a winning argument to take to voters in 2018.

It’s a point of theology with Republicans. The market can’t fail, it can only be failed. They have never accepted the concept, widely shown to be correct, that healthcare is not a commodity good like other goods and does not conform to their free market religion.

Read on below.

The CBO and the Ides of March

The Daily Escape:

(Provence – Photo by Veronika K. Ko.)

The Ides of March are today. The Netherlands holds its parliamentary election, the US debt ceiling agreement expires, and Trump is gonna get a ton of postcards.

Congressional Budget Office estimates for Trumpcare (AHCA) came out on Monday, and they’re worse than expected. Sarah Kliff, Vox’s healthcare reporter, has this:

CBO estimates 14 million would lose coverage in 2018. The report projects that much of the early coverage loss would stem from repealing Obamacare’s mandate that all Americans purchase coverage or pay a fine.

After that, increases in the uninsured would be from Medicaid cuts. After 2018, CBO thinks that most of the increase in the number of uninsured would stem from changes the AHCA would make to Obamacare’s expansion of Medicaid, an expansion that allowed many more low-income adults to enroll in the program.
The bill would “freeze” enrollment in that program on January 1, 2020. Medicaid enrollees would trickle off the rolls as their incomes changed. And this would lead to another big decline in coverage.
The number of uninsured, CBO projects, would rise by 21 million in 2020 and hit 24 million in 2026.
The CBO projects that as the individual market shrinks, premiums would rise between 10% and 15% as some healthy people flee in 2018. But over the next few years, the agency expects premiums to go down to 10% lower than under Obamacare.
CBO thinks more young people will come into the market, as the GOP plan offers incentives to make the market more appealing to younger, (healthier) enrollees.
AHCA would be a huge cut to Medicaid. CBO estimates it would reduce spending on the health program for low-income Americans by $880 billion over the next decade. This helps explain why AHCA would reduce the deficit: The bill spends a lot less money on entitlement programs.

When Paul Ryan’s talking points are that their plan will reduce the deficit, and that premiums will go down by 10% OVER THE LONG TERM, you know that he doesn’t care that 24 million people will lose healthcare insurance.

That the GOP is choosing deficit reduction over covering American citizens is what the public will remember. When you kick out the poor and older folks, of course premiums will go down. But premiums will remain high for those in the 50-64 age bracket, and their premiums will be higher than currently.

The CBO report also finds that this legislation will provide massive tax relief, and make the most fundamental entitlement reform in more than a generation, if throwing people off Medicaid truly is “reform”.

Even before the CBO report was released, the Trump administration began laying the groundwork to discredit the agency and their report. White House press secretary Sean Spicer:

If you’re looking at the CBO for accuracy, you’re looking in the wrong place…they were way, way off last time in terms of how they scored and projected Obamacare.

Since this is the Ides of March, you should have expected some stabbing.

Their criticism is centered on the fact that CBO previously overestimated the number of people who would enroll in the marketplaces. That’s true: Earlier CBO reports estimated that the Obamacare marketplaces would have 26 million enrollees this year. Last year, CBO revised that estimate to 15 million.

Critics don’t mention that the CBO also underestimated how many people Medicaid expansion would cover. The overestimate and the underestimate essentially cancel each other out: Obamacare is covering just about as many people as CBO expected back in 2013.

Curiously, Trump said his health care plan would cover EVERYONE, and it would be much cheaper and much better. Except it won’t.

When you think about bad data, remember that Trump said we shouldn’t trust the Bureau of Labor Statistics numbers on monthly employment last year, he said they were fake. Now, Trump says the numbers in this month’s data release are real. You be the judge:

Obama in February 2016 — 237,000 new jobs
Trump in February 2017 — 235,000 new jobs

Trump: Making America a Slightly Less Great Again.

Your daily musical interlude appropriately is from the group the Ides of March. Here is “Vehicle”, their only hit, originally published in 1970, and performed live at the Chicago House of Blues in 2014:

https://www.youtube.com/watch?v=2aHe5-2SsJY

That 70 year-old guy can still sing.

Those who read the Wrongologist in email can view the video here.

Sample Lyrics:

Well, I’m the friendly stranger in the black sedan

Won’t you hop inside my car?

I got pictures, candy, I’m a lovable man

And I can take you to the nearest star

Kinda like the GOP promises on healthcare.

The Wrongologist

Geopolitics, Power and Political Economy

Tag: Medicaid Under Attack

Saturday Soother – July 1, 2017

Is a Single-Payer Experiment on the Horizon?

Saturday Soother – May 6, 2017

CBO and Ides of March UPDATE

The CBO and the Ides of March