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Guess What? Grandma is Moving In. She’s Got Medical Bills. Maybe to Share. It’s Medicaid Brought to You by Kochcare.

Is kicking senior citizens out of nursing homes good politics? That’s a question GOP asking itself these days. One of many questions related to the politics of health care [1]. Although not many are asking it since the public largely has no idea the question is being asked at all as recent polls show. With the Senate’s version of ‘Trumpcare’ finally released to the public, we’re now learning that, yes, the GOP appears to think kicking seniors out their nursing homes is good politics. Because transferring Medicaid costs to states [2] and individuals [2] has been a key GOP goal of Trumpcare’s congressional authors the entire time and nursing homes are paid for by Medicaid for the vast majority of people. So in addition to the many profound moral questions raised by the GOP’s health care ‘reform’ plans, a growing number of profound political questions are being raised the more we learn about Trumpcare as it takes form. Including whether or not putting nursing home coverage on a fiscal death spiral makes for good politics. Granny would probably say ‘no’, but she’s got competition [3].

******

But despite the deep antipathy polls showed towards the House version of Trumpcare, the American Health Care Act (AHCA), the question of how Americans will respond to the GOP’s proposal to dismantle American’s medical safety-net is still an open question. Why? Because the vast majority of Americans still don’t know that Medicaid is on the chopping block [4]:

Think Progress

New poll shows majority of Americans are unaware Trumpcare slashes Medicaid
Just 38 percent of people polled knew the Republican health care bill makes major cuts to Medicaid.

Kiley Kroh
Jun 24, 2017

As Senate Republicans aim to force a vote on their version of Trumpcare—a bill that was written in secret, without public hearings, despite the fact that it will reshape one-sixth of the U.S. economy and impact the lives of millions of Americans—most people have been left in the dark.

Last month, the House passed their version of the bill, which would strip health care from 24 million people [5], according to the nonpartisan Congressional Budget Office. The bill also makes major cuts and structural changes to Medicaid, a health insurance program relied upon by nearly 75 million Americans—primarily low-income, disabled, and elderly.

The Senate version of Trumpcare [6] goes even further, according to the draft released by Sen. Majority Leader Mitch McConnell (R-KY) on Thursday, effectively phasing out Medicaid entirely.

But according to a new poll [7] released by the Kaiser Family Foundation on Friday, only 38 percent of Americans are aware of the significant cuts to Medicaid that would be delivered by the House-passed bill (the poll was conducted before the details of the Senate bill were made public). Seventy-four percent of those polled, meanwhile, said they have a favorable opinion of Medicaid.

The Senate’s harsher Medicaid cuts were immediately met with fierce objections, however. Roughly 60 members of ADAPT, a U.S. disability rights organization that strongly opposes the Republican health care bill, staged a die-in outside of McConnell’s office [8] on Thursday. Wheelchair users were arrested and dragged from the Capitol by police.

Moderate Republicans have also expressed their discomfort with the severe cuts to Medicaid, with the strongest objection [9] thus far coming from Sen. Dean Heller (R-NV) on Friday. “I cannot support a piece of legislation that takes away insurance from tens of millions of Americans and hundreds of thousands of Nevadans,” the senator said [10] at a press conference in Las Vegas.

Hours later, America First Policies—a pro-Trump group run by several of the president’s top campaign advisers—announced it was launching a seven-figure advertising campaign against Heller, Politico reported [11]. Heller is widely viewed as one of the most vulnerable incumbents up for reelection in 2018.

Ironically, President Donald Trump made protecting Medicaid a key component of his campaign, vowing to “save Medicare, Medicaid, and Social Security without cuts” in the speech announcing his candidacy.

Trump told the Washington Post’s Abby Phillip [12] that the Senate version of Trumpcare needed “a little negotiation, but it’s going to be very good.” The president reportedly made calls [13] to Senate Republicans on Friday to try to gin up support for the measure. Trump acknowledged there is a “very, very narrow path” to passage, but that “I think we’re going to get there,” Reuters reported.

———-

“New poll shows majority of Americans are unaware Trumpcare slashes Medicaid” by Kiley Kroh; Think Progress; 06/24/2017 [4]

“But according to a new poll [7] released by the Kaiser Family Foundation on Friday, only 38 percent of Americans are aware of the significant cuts to Medicaid that would be delivered by the House-passed bill (the poll was conducted before the details of the Senate bill were made public). Seventy-four percent of those polled, meanwhile, said they have a favorable opinion of Medicaid.”

Yep, even though only about 1 in 5 Americans approved of the House version of the House version of Trumpcare [14], only 38 percent of them even knew about the most extreme parts of proposal, the plan to severely cut and fundamentally change Medicaid. So unless the public actually wants Medicaid to be gutted, it’s hard to see how growing awareness of the planned Medical cuts are going to increase public support, making the GOP’s ongoing push to pass Trumpcare an remarkable political risk. Especially when you consider that, while Trumpcare will have a profound (largely negative) impact across the US health care system, it’s primarily a Medicaid phase out scheme and Medicaid covers even more people than Medicare [15]:

The New York Times

G.O.P. Health Plan Is Really a Rollback of Medicaid

Limiting the amount that the federal government would pay for each person would leave states with difficult choices, and would be a fundamental shift of financial risk.

By MARGOT SANGER-KATZ
JUNE 20, 2017

Tucked inside the Republican bill to replace Obamacare is a plan to impose a radical diet on a 52-year-old program that insures nearly one in five Americans.

The bill, of course, would modify changes to the health system brought by the Affordable Care Act. But it would also permanently restructure Medicaid [16], which covers tens of millions of poor or disabled Americans, including millions who are living in nursing homes with conditions like Alzheimer’s or the aftereffects of a stroke.

“This is the most consequential change in 50 years for low-income people’s health care,” said Joan Alker, the executive director of the Center for Children and Families at Georgetown University. “This is a massive change that has hardly been discussed.”

Since its founding, Medicaid has operated as a partnership between the federal government and the states. Each pays a share of patients’ medical bills, with no overall limit on spending. The American Health Care Act would try to slim down the federal share of that spending, by limiting how much the federal government would pay for each person enrolled in the program. The Senate version of the legislation, expected this week, is likely to make the payments still leaner in later years.

The results, according to independent analyses, would be major reductions in federal spending on Medicaid over time. States would be left deciding whether to raise more money to make up the difference, or to cut back on medical coverage for people using the program. The Congressional Budget Office estimates that the changes would lead to a reduction in spending on Medicaid of more than $800 billion over a decade. (That figure also includes additional cuts to the Obamacare Medicaid expansion.)

[see chart showing percentage of Americans covered by Medicaid in different categories [17]]

Medicaid is the country’s largest government health care program, covering more Americans than its better-known sibling, Medicare.

Its reach is broad: About half of all births in the country are covered by Medicaid, and nearly 40 percent of children are covered through the program. Medicaid covers the long-term care costs of two-thirds of Americans living in nursing homes, many of them middle-class Americans who spent all of their savings on care before becoming eligible.

It covers children and adults with disabilities who require services that most commercial health insurance doesn’t include. It covers poor women who are pregnant or raising young children. Those populations were all included in the program before Obamacare became law.

It also provides insurance for poor adult Americans, and recent evidence shows that its expansion under Obamacare has given more poor people access to health care services and reduced their exposure to financial shocks.

The Republican approach would set a formula for determining a maximum payment for each person in the program. Then that cap would grow by a set rate each year. Lawmakers are negotiating about the rate to use, but all of the options are intended to grow more slowly than expected under the current system. The gap would be left for states to fill — or cut.

“While details remain elusive, this is shaping up to be the largest intergovernmental transfer of financial risk in our country’s history,” said Matt Salo, the executive director of the National Association of Medicaid Directors, in an email. Mr. Salo said that some of his directors would welcome caps if they came with more program flexibility, but said the current approach amounted to a funding cut.

The growth in medical spending tends to be uneven year over year, which means states might hit the caps in one year and fall under them in another, even without any program changes. Researchers at the Brookings Institution recently looked back at historical Medicaid spending to see what would have happened under a cap. They found that random variation was substantial [18].

Medicaid advocates worry particularly that a fixed growth rate doesn’t account for this varying pattern of health expenditures, which might shoot up in a year where there’s an epidemic or an important new treatment. Many Medicaid budgets increased in recent years after the introduction of expensive but effectivemedications for hepatitis C, for example. States had to pay more for the drug, but federal spending also increased to match it.

Advocates for the structural change point to inefficiencies and waste in the current program. There is some evidence that Medicaid programs enroll some people who are not eligible and sometimes cover some services that are not medically necessary. James Capretta, a fellow at the conservative American Enterprise Institute, said that the current system, where the federal government matches all state spending, discourages efficiency.

But he and co-authors have also suggested a different, more generous approach [19] than the one in the Republican legislation.

Most researchers who study the program closely say that it is already quite lean. Major savings, they say, will be hard to achieve without reducing medical benefits or cutting higher-cost patients from the program.

Trump administration officials and Republican members of Congress have argued that the Medicaid changes won’t cause anyone to lose insurance coverage directly. That statement is true in only the narrowest sense.

Because the funding cuts would fall to states, it is state officials who would decide whether to save money by raising taxes, reducing payments to nursing homes or eliminating benefits like home-based care for disabled beneficiaries, a few available options under the law.

The Congressional Budget Office estimates that enrollment in Medicaid would decline substantially over a decade, as states pursued a variety of strategies to save money, some of which would push people out of the program.

Still, the Medicaid caps have not drawn the same public outcry as other provisions of the law that would cut back on coverage more directly. Several Republican senators have expressed concerns about changes to Obamacare’s Medicaid expansion, which broadened the program to include more low-income adults in 31 states.

Others worry about changes to private insurance subsidies that would make insurance less affordable to older, middle-class Americans. Fewer have spoken out about the cuts to Medicaid’s legacy beneficiaries. That means that, as the Senate works out final details, the forced diet for Medicaid is likely to stay in the bill.

———-

“G.O.P. Health Plan Is Really a Rollback of Medicaid”
by MARGOT SANGER-KATZ; The New York Times; 06/20/2017

The results, according to independent analyses, would be major reductions in federal spending on Medicaid over time. States would be left deciding whether to raise more money to make up the difference, or to cut back on medical coverage for people using the program. The Congressional Budget Office estimates that the changes would lead to a reduction in spending on Medicaid of more than $800 billion over a decade. (That figure also includes additional cuts to the Obamacare Medicaid expansion.)”

Is America’s health care safety-net going to be primarily a state-by-state issue? That’s the plan. With large state-by-state cuts to Medicaid expected. At least expected by health care experts who study these issues. But for the Americans either on Medicaid or with family members on Medicaid it’s hard to see how they can expect these dramatic changes to the saftey-net if they don’t even know about them. It’s going to be a horrible surprise. And that’s part of what makes Trumpcare such a remarkable political risk for the GOP: it’s bound to be far worse than people expect because most people have no idea how bad it is.

Beyond that, note one of the populations set to be directly impacted by these proposed Medicaid cuts: people in nursing homes. Yep, Trumpcare isn’t simply planning on metaphorically ‘throwing granny off the cliff’. It’s a plan to literally throw granny out of the nursing home:


Medicaid is the country’s largest government health care program, covering more Americans than its better-known sibling, Medicare.

Its reach is broad: About half of all births in the country are covered by Medicaid, and nearly 40 percent of children are covered through the program. Medicaid covers the long-term care costs of two-thirds of Americans living in nursing homes, many of them middle-class Americans who spent all of their savings on care before becoming eligible.

It covers children and adults with disabilities who require services that most commercial health insurance doesn’t include. It covers poor women who are pregnant or raising young children. Those populations were all included in the program before Obamacare became law.

“Its reach is broad: About half of all births in the country are covered by Medicaid, and nearly 40 percent of children are covered through the program. Medicaid covers the long-term care costs of two-thirds of Americans living in nursing homes, many of them middle-class Americans who spent all of their savings on care before becoming eligible.”

Two-thirds of Americans in nursing homes are there because Medicaid is covering their expenses. But under Trumpcare there’s going to be less and less federal funding available for those costs every year.

Throw Granny Off the Cliff [20] Out of the Nursing Home

So while today’s nursing home recipients may or may not live long enough to see an impact from these cuts, the grannies of tomorrow are set to be increasingly in peril. The younger you are now the more Medicaid will be gutted by the time you’re old enough for a nursing home. Which, again, is part of what makes Trumpcare such a remarkable political gamble: If Americans actually learn about these planned ever-growing cuts to Medicaid it might dawn on them that almost everyone is potentially impacted. Including younger people financially well-off today. Eventually. Because even today’s affluent can become tomorrow’s destitute elderly in need of Medicaid just to live. That’s what happens if you simply live long enough and you’re not rich. And maybe if you are rich [21]:

The New York Times

Cuts to Medicaid May Limit Access to Nursing Homes

By JORDAN RAU
JUNE 24, 2017

ORANGE, Va. — Alice Jacobs, 90, once owned a factory and horses. She raised four children and buried two husbands.

But years in an assisted living center drained her savings, and now she relies on Medicaid to pay for her care at Dogwood Village, a nonprofit, county-owned nursing home here.

“You think you’ve got enough money to last all your life, and here I am,” Ms. Jacobs said.

Medicaid pays for most of the 1.4 million elderly people in nursing homes, like Ms. Jacobs. It covers 20 percent of all Americans and 40 percent of poor adults.

On Thursday, Senate Republicans joined their House colleagues in proposing steep cuts to Medicaid [22], part of the effort to repeal the Affordable Care Act. Conservatives hope to roll back what they see as an expanding and costly health care entitlement. But little has been said about what would happen to older Americans in nursing homes if these cuts took effect.

Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.

The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”

States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.

The 150 residents of Dogwood Village include former teachers, farmers, doctors, lawyers, stay-at-home parents and health aides — a cross section of this rural county a half-hour northeast of Charlottesville. Many entered old age solidly middle class but turned to Medicaid, which was once thought of as a government program exclusively for the poor, after exhausting their insurance and assets.

A combination of longer life spans and spiraling health care costs has left an estimated 64 percent of the Americans in nursing homes dependent on Medicaid. In Alaska, Mississippi and West Virginia, Medicaid was the primary payer for three-quarters or more of nursing home residents in 2015, according to the Kaiser Family Foundation [23].

“People are simply outliving their relatives and their resources, and fortunately, Medicaid has been there,” said Mark Parkinson, the president of the American Health Care Association, a national nursing home industry group.

With more than 70 million people enrolled in Medicaid at an annual cost of more than $500 billion [24], the program certainly faces long-term financial challenges. Federal Medicaid spending is projected to grow 6 percent a year on average, rising to $650 billion in 2027 from $389 billion this year, according to the Congressional Budget Office [25].

Even if Congress does not repeal the Affordable Care Act, Medicaid will remain a target for cuts, experts say.

“The Medicaid pieces of the House bill could be incorporated into other pieces of legislation that are moving this year,” said Edwin Park, a vice president at the Center on Budget and Policy Priorities, a Washington nonprofit that focuses on how government budgets affect low-income people. “Certainly, nursing homes would be part of those cuts, not only in reimbursement rates but in reductions in eligibility for nursing home care.”

While most Medicaid enrollees are children, pregnant women and nonelderly adults, long-term services such as nursing homes account for 42 percent of all Medicaid spending — even though only 6 percent of Medicaid enrollees use them.

“Moms and kids aren’t where the money is,” said Damon Terzaghi, a senior director at the National Association of States United for Aging and Disabilities, a group representing state agencies that manage programs for these populations or advocate on their behalf. “If you’re going to cut that much money out, it’s going to be coming from older people and people with disabilities.”

The House health care bill targets nursing home coverage directly by requiring every state to count home equity above $560,000 in determining Medicaid eligibility. That would make eligibility rules tougher in 10 states — mostly ones with expensive real estate markets, including California, Massachusetts and New York — as well as in the District of Columbia, according to an analysis by the Center for Budget and Policy Priorities.

Dogwood Village receives about half of its $13 million annual operating costs from Medicaid, with rates from $168 to $170 a day. Some residents who come to the nursing home after a hospital stay are initially covered by Medicare, but if they stay longer than 100 days, that benefit ends, and those without savings move to Medicaid.

Medicaid helps pay for care for people with disabilities, like Nancy Huffstickler, 65, who has been here for four years and regards herself as “a medical disaster.”

She listed her ailments: spinal cancer in remission, restless leg syndrome, high blood pressure and multiple ulcers. She has had spinal reconstructive surgery and a hip replacement. She is undergoing physical therapy with the hope that one day she will be able to leave her wheelchair and use a walker.

Ms. Huffstickler is fearful of Republicans’ health care changes. “It may save the federal government money, but what about us?” she asked.

Major Medicaid cuts would compel Dogwood Village to cut staff, supplies and amenities — changes that would affect the quality of care for all residents, not just those on Medicaid.

If that does not save enough money, the nursing home might have to reduce the number of Medicaid residents, said Vernon Baker, who resigned as administrator in April. “It’s not like our toilet paper or paper towels are like the Ritz-Carlton’s,” he said.

Some residents do not even know they are on government insurance; administrators often complete the paperwork to start Medicaid once other insurance expires. Others are embarrassed that they are dependent on a program that still carries stigma.

They should not be, said Jennifer Harper, the assistant director of nursing. Relying on Medicaid for nursing home care has become the new normal.

“These folks have worked their whole lives, some with pretty strenuous jobs, and paid into the system,” she said. But with changes looming, she said, “it may be a system that fails them.”

———-

“Cuts to Medicaid May Limit Access to Nursing Homes” by JORDAN RAU; The New York Times; 06/24/2017 [21]

“People are simply outliving their relatives and their resources, and fortunately, Medicaid has been there,” said Mark Parkinson, the president of the American Health Care Association, a national nursing home industry group.”

For over half a century now, when elderly Americans in need of nursing home services outlived their savings at least they weren’t completely screwed. Medicaid was there. But once Trumpcare becomes law, the question of whether or not granny gets to stay in the nursing home, or gets admitted in the first place, its going to become an increasingly expensive question for the states. And answer just might include things like forcing family members to start paying to cover the costs the federal government used to cover. So it’s going a state issue and a family issue…are you willing to pay the state to help give your parents or grandparents nursing home care? That’s the question the GOP would like you to start answering soon:


Under federal law, state Medicaid programs are required to cover nursing home care. But state officials decide how much to pay facilities, and states under budgetary pressure could decrease the amount they are willing to pay or restrict eligibility for coverage.

The states are going to make it harder to qualify medically for needing nursing home care,” predicted Toby S. Edelman, a senior policy attorney at the Center for Medicare Advocacy. “They’d have to be more disabled before they qualify for Medicaid assistance.”

States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.

States might allow nursing homes to require residents’ families to pay for a portion of their care, she added. Officials could also limit the types of services and days of nursing home care they pay for, as Medicare already does.”

This is part of the new Trumplandian America and the vast majority of Americans have no idea this is about to become reality. Young parents won’t just have to start the college fund for their children as early as possible. They’re going to need a “mom and dad’s future nursing home fund” too. Soon. Maybe. Sure, that’s just the opinion of a Medicare Advocacy group attorney, but claiming the assets of Medicaid recipients after they die or charging relatives monthly fees is bound to get increasingly tempting to states as the federal participation in Medicaid erodes year after year. And in Trumpcare, states are going to be given lots of the “flexibility” to “experiment” with new ways to transfer the cost of medical services and other safety-net programs back onto the public. Especially the poor. If slowly killing Medicaid becomes a new national pastime, charging families for Medicaid nursing home costs is just a matter of time. And not just for nursing home services but potentially anything Medicaid related. Why not? That’s another tax cut for the Koch brothers. It’s possible [26]. One state at a time.

And if you think, “well, since the elderly are such an important voting block, especially for the GOP, there’s no way they’ll actually implement all these cuts for nursing homes. Surely there must be some sort of loophole they’ll add in at the last minute,” take a look at just how much of the total spending on Medicaid is spent on long-term services like nursing homes: 42 percent. So unless the GOP is planning on significantly curtailing the tax cuts for the rich in Trumpcare – and don’t forget that Trumpcare is basically a tax cut for the rich paid for by cutting primarily Medicaid – there’s almost no way they’re going to give poor seniors anything other than token help. Cutting seniors off Medicaid is where the big money is at:


While most Medicaid enrollees are children, pregnant women and nonelderly adults, long-term services such as nursing homes account for 42 percent of all Medicaid spending — even though only 6 percent of Medicaid enrollees use them.

“Moms and kids aren’t where the money is,” said Damon Terzaghi, a senior director at the National Association of States United for Aging and Disabilities, a group representing state agencies that manage programs for these populations or advocate on their behalf. “If you’re going to cut that much money out, it’s going to be coming from older people and people with disabilities.”

Moms and kids aren’t where the money is. Grandma and grandpa had better get their checkbooks.

Throwing Granny Out of the Nursing Home Isn’t a New Idea. Or a Popular One. for Obvious Reasons

So what’s the public response to this going to be once they finally figure Trumpcare’s plans for elderly Americans? Well, while we don’t have current polling data available given the public ignorance on this matter, we do have past polling data for similar GOP proposals. After all, Trumpcare is Ryancare. And House Speaker Paul Ryan has been trying to do this to Medicaid for years [27]. So while Americans don’t know what’s in Trumpcare today, the did learn about Ryancare’s very similar plans for Medicaid in 2011. And boy oh boy did seniors hate Ryancare. And what did they hate the most? The Medicaid cuts to nursing homes [28]:

The Huffington Post

Americans ‘Very Concerned’ GOP Budget Will Force Elderly From Nursing Homes: Poll

By Michael McAuliff
06/23/2011 10:39 am ET | Updated Aug 23, 2011

WASHINGTON — Democrats are getting set to ramp up the budget cut rhetoric with a new message: Don’t throw grandma from the nursing home.

The messaging comes after new polling by a Democratic-aligned polling firm found that messages about the impacts of the House Republican budget plan on elderly Medicaid recipients resonate even more powerfully than criticism about its impact on Medicare.

The budget blueprint crafted by House Budget Committee Chairman Paul Ryan (R-Wis.) turns the healthcare system for the elderly into a private program, which will double the cost of healthcare in 10 years for future seniors, according to the Congressional Budget Office.

The Ryan privatization plan is deeply unpopular: [29]: Fresh polling by Bloomberg released Thursday found that Americans think they would be worse off if Ryan’s Medicare proposal is adopted by a margin of 57 percent to 34 percent — including 58 percent of electorally key independents who dislike the plan.

But the new polling by Anzalone Liszt Research, the Democratic-aligned polling firm, found an even more dramatic response on Medicaid if respondents are told of the impacts seniors face.

Told that the Ryan budget “would cut $750 billion [30] from Medicaid, including funding for 80 percent of nursing home residents, forcing many seniors to be kicked out of their nursing homes,” 63 percent of respondents said they were “very” concerned. That figure was 69 percent for seniors and 64 percent for independents.

About 64 percent of senior nursing home residents [31] depend on Medicaid as the primary means of paying for their housing. Still more rely on Medicaid for other expenses or to be able to stay in their own homes.

The polling firm concluded those numbers make the issue a winner for Democrats, and they advise using similar language to bring the message home to voters.

Democrats, however, are not about to drop the complaints about the impacts of Ryan’s plan on Medicare, which are widely credited with helping Democrats win the New York special election that propelled Rep. Kathy Hochul into a seat long held by the GOP.

———-

“Americans ‘Very Concerned’ GOP Budget Will Force Elderly From Nursing Homes: Poll” by Michael McAuliff; The Huffington Post; 06/23/2011 [28]

“Told that the Ryan budget “would cut $750 billion [30] from Medicaid, including funding for 80 percent of nursing home residents, forcing many seniors to be kicked out of their nursing homes,” 63 percent of respondents said they were “very” concerned. That figure was 69 percent for seniors and 64 percent for independents.

69 percent of seniors were “very” concerned about the Medicaid cuts. Even more concerned than they were about the Medicare cuts. And unless something dramatically changed in senior attitudes over the last 6 years it’s hard to see why we wouldn’t see the same level of concern today…at least among ~38 percent of seniors who are actually aware today of what’s in Trumpcare.

Don’t Worry Granny. Here’s a Tax Credit (Granny Should Probably Worry).

So since the Senate bill is hurtling towards passage and Trumpcare’s dire implications loom large on a largely unsuspecting populace how is the GOP planning on explaining all this to a public that largely loathes the ideas of Trumpcare? And in particular, what is the GOP going to tell seniors, a critical and reliable voting bloc, about how the 2/3 of nursing home residents are either going to be increasingly at risk of getting kicked out or forced to beg their families for the money in coming years and decades? People can end up in nursing homes for decades if they live long enough and the way Trumpcare works those federal funds available for nursing home care is going to keep shrinking every single year. And not just nursing home care but any other medical services too. There’s a pretty clear ‘hurry up and die’ element to it all. How is the GOP going to explain this? We’ll see, but it will probably involve asking poor seniors to cover the costs themselves with the help of tax credits. Seriously [32]:

Think Progress

Republican Senators pretend people who get kicked off of Medicaid will just start buying insurance
Senate Republicans are trying (and failing) to justify cuts to Medicaid.

Amanda Michelle Gomez
Jun 23, 2017

The day after the Senate’s draft health bill was released, supporters looked to defend a key component of bill: cuts to Medicaid. Republican lawmakers will need to answer to its beneficiaries, who’ve grown dependent on this program for coverage.

On Friday, Senator Bill Cassidy (R-LA) on Morning Joe reconciled the Senate’s Medicaid cuts the following way: “If Medicaid expansion goes away and if there is no coverage, that’s a bad thing, Willie. On the other hand, if they move from Medicaid to private insurance, that could be a good thing.”

Cassidy claimed that Medicaid enrollees could join the individual marketplaces, which have been doing poorly because not enough people are opted in. They’ll be able to afford such plans with tax credits, which he characterized as “more generous” than the House.

Senate Rand Paul (R-KY), who does not support the bill as it currently stands, also appeared on the show and said he would like to “legalize inexpensive insurance,” and ultimately have Medicaid patients go on “inexpensive” plans—likely private plans.

Both senators believe that Medicaid enrollees could obtain coverage elsewhere. But health experts say Medicaid enrollees will likely forgo coverage altogether under the Senate Republicans’ health care bill, leaving them uninsured.

The Senate Republicans’ Better Care Reconciliation Act [33] (BCRA) ends Medicaid expansion by 2024, and also makes additional cuts to the overall program starting in 2025. The entire Medicaid program as Americans know it could end, and for many Republicans, that’s the entire idea. Medicaid overhaul has been a point of motivation for health care reform. House Speaker Paul Ryan (R-OH) had previously told the National Review [34] that he has been dreaming about making cuts to the Medicaid program since his keg-days in college.

The Senate bill, like the House bill, looks to undercut the Medicaid program in the following way: the current model, which is an open-ended commitment to states to pay most Medicaid enrollee’s bills, would become a per capita cap system. Under this system, states can get a lump sum from the government for each enrollee or request a block grant. The Senate bill breaks away from the House version of the bill after 2025. At that point, the rates at which the federal government assists states changes and becomes tethered to the consumer price index. The adjusted growth rate funds less than what Medicaid requires and could lead to a non-functioning program, according to the Urban Institute [35].

Tax credits under BCRA will not be helpful to Medicaid beneficiaries, Tara Straw, senior health policy analyst at the Center on Budget and Policy Priorities, told ThinkProgress.

Under the Senate bill, premiums tax credits are based on income, age, and geography. Cassidy is right in that credits under the Senate are more generous than the House, which is based solely on age. However, the Senate bill changes the Obamacare formula for credits, making them less generous. The Senate plans are set up like bronze plans under Obamacare [36]. Essentially, plans would see lower monthly premiums but raises costs when patients need care. And deductibles—the amount of medical costs patients pay themselves before the insurance plan starts to pay—could become more expensive. A median bronze plan deductible is $6,300, said Straw. Under the senate bill, cost sharing reductions?—?that help pay for out-of-pocket costs are repealed by 2020.

Straw says that even if Medicaid patients agree to funnel 2 percent of their income to pay for these insurance plans, the plans cover less because states could waive coverage requirements.

When Cassidy says Medicaid enrollees will see lower premiums under the Senate’s restructure, that’s likely true. But what he neglects to mention is that patients will instead see expensive co-payments and deductibles.

“Someone could scrap to pay for premiums. But could they ever use?” asked Straw, “No because deductibles.”

———-

“Republican Senators pretend people who get kicked off of Medicaid will just start buying insurance” by Amanda Michelle Gomez; Think Progress; 06/23/2017 [32]

Both senators believe that Medicaid enrollees could obtain coverage elsewhere. But health experts say Medicaid enrollees will likely forgo coverage altogether under the Senate Republicans’ health care bill, leaving them uninsured.”

And how do Senators Cassidy and Paul propose Medicaid recipients – people who make less than the poverty line – afford to buy their own private medical services? Tax credits. That’s seriously their response:


On Friday, Senator Bill Cassidy (R-LA) on Morning Joe reconciled the Senate’s Medicaid cuts the following way: “If Medicaid expansion goes away and if there is no coverage, that’s a bad thing, Willie. On the other hand, if they move from Medicaid to private insurance, that could be a good thing.”

Cassidy claimed that Medicaid enrollees could join the individual marketplaces, which have been doing poorly because not enough people are opted in. They’ll be able to afford such plans with tax credits, which he characterized as “more generous” than the House.

Senate Rand Paul (R-KY), who does not support the bill as it currently stands, also appeared on the show and said he would like to “legalize inexpensive insurance,” and ultimately have Medicaid patients go on “inexpensive” plans—likely private plans.

It’s kind of hard to see how that isn’t going to be perceived as a ghastly insult to elderly GOP voters. But that ghastly insult, tax credits for the poor appears, really does appears to be the likely GOP explanation for what people are supposed to do. And it’s the response that will presumably not just apply to medical services but nursing home services too.

The GOP’s Trumpian ‘New Coke’ Sure Tastes LIke ‘Old Koch’

Ok, so could tax credit’s for poor seniors seriously be the GOP’s plan? Is that really about to become the new safety-net for elderly Americans? Well, unless those plans change, and change very soon since Senate Majority Leader Mitch McConnell is trying to pass it in the Senate by July 4th, it looks like that’s the plan. And if the plan does change it’s probably going to become a worse plan [3]:

Bloomberg Politics

Koch Group Says Republican Health Plan Doesn’t Go Far Enough

By John McCormick
June 24, 2017, 9:30 AM CDT June 24, 2017, 6:24 PM CDT

* Americans for Prosperity says it will work to improve measure
* Bill faces perilious path with five Republicans doubtful

Leaders from the influential Koch political network expressed concern about the Senate Republican plan to reshape the nation’s health system, saying as they met with donors at a Colorado resort that the measure isn’t sufficiently conservative.

<b>“We’ve been disappointed that movement has not been more dramatic toward a full repeal or a broader rollback of this law, Obamacare,” Tim Phillips, the president of the Koch-affiliated political advocacy group, Americans for Prosperity, told reporters.

“We worked to make the House bill better and it did get better,” he said. “We’re doing the same thing on the Senate front.”

Unveiled on Thursday as a discussion draft after weeks of work done in secret by a small number of lawmakers, the Senate plan was immediately criticized by Democrats and some Republicans. Five Senate Republicans have said they oppose the bill in its current form.

Senate Majority Leader Mitch McConnell can only afford two defections from his party to pass the bill in the 100-member chamber.

Opposition from the Koch network, which has delivered tens of millions of dollars to Republican candidates and causes in recent years, promises to further complicate the perilous path McConnell faces.

‘Can Get Done’

“We still think this can get done,” Phillips said. “It has to get better.”

Phillips spoke on the first day of a three-day donor retreat at a luxury Rocky Mountains resort. He was also among those who met Friday evening with Vice President Mike Pence ahead of the event.

“It was a good, cordial discussion of issues, including health care,” Phillips said of his talk with Pence.

———-

“Koch Group Says Republican Health Plan Doesn’t Go Far Enough” by John McCormick; Bloomberg Politics; 06/24/2017 [37]

““We still think this can get done,” Phillips said. “It has to get better.”

It has to get better better. And by better, the president of the Koch network means much, much worse health care for Americans. Any good parts of Obamacare that were left in the Senate GOP’s draft version of Trumpcare have to go for things to “get better”:


“We’ve been disappointed that movement has not been more dramatic toward a full repeal or a broader rollback of this law, Obamacare,” Tim Phillips, the president of the Koch-affiliated political advocacy group, Americans for Prosperity, told reporters.

“We worked to make the House bill better and it did get better,” he said. “We’re doing the same thing on the Senate front.”

“We’ve been disappointed that movement has not been more dramatic toward a full repeal or a broader rollback of this law, Obamacare”

And don’t forget, it’s not just that Trumpcare is repealing almost all the good parts of Obmaacare. It’s repealing the good parts of the New Deal and Great Society that are still left. This is a deep gutting. Nursing home vouchers are a serious possibility. Steadily shrinking nursing home vouchers.

Again, it’s truly amazing just how massive a political gamble Trumpcare is turning out to be be for the GOP but it’s a gamble the party is clearly intent on making because Trumpcare is Ryancare and Ryancare is Kochcare. The GOP is in control of everything so there’s almost no way the Kochcare isn’t going to become a reality. Unless GOP voters suddenly turn anti-Koch. Which could happen. That’s sort of what the Trump phenomena in the 2016 GOP primary was all about: the rise of the anti-Koch wing of the GOP. And here we are, with the Senate on the verge of passing TrumpRyanKochcare and the only real obstacle is the handful of hold out GOP Senators who are just doing a song and dance ‘negotiation’ – mostly with demands that it be more Koch-ish. So unless being anti-Koch suddenly gets bach in vogue in the GOP base giving political cover to at least three GOP Senators to vote against it, grandma is moving into the basement room. With large medical bills. And the state might start charging grandma’s relatives for her new awesome Medicaid services.

At this point one of the big questions is whether or not the GOP will expand its extensive voter suppression efforts to include seniors on Medicaid now too? That seems like a real possibility although considering that the elderly people most negatively impacted by Trumpcare are also the most likely to die prematurely as Medicaid gets increasingly underfunded maybe voter suppression efforts won’t be necessary. Still, in terms of political risks, when you consider just how much TrumpRyanKochcare presents a mortal danger to the most reliable voting demographic in America – a demographic that most people will join someday, although a lot fewer if this becomes law – and how that demographic largely has no idea what’s in store for it, the TrumpRyanKochcare tax cut gambit is turning out to be truly breathtaking [38].