A blow to Obamacare is one more reason not to like the Republican tax bill. I have mentioned that the present tax renovation tax bill repeals the individual mandate included in the Affordable Care Act In its failure to repeal Obamacare this fall, Congress should have learned a simple lesson: Americans want the government to see that everyone has health insurance. Instead, the Republican majority tirelessly insists on moving in the opposite direction. Thus, their shambles of a tax bill repeals Obamacare’s requirement that everyone have health insurance.

This change would cause some 13 million fewer people to have insurance by 2026. While that’s less than the million who would have lost insurance had Obamacare itself been repealed, it’s a giant backward stride.

President Donald Trump and other Republicans like to out that the individual mandate is unpopular. Maybe. Nonetheless, it’s essential to the effort to keep health insurance affordable and cover as many people as possible.

Keep in mind that, in the U.S., the private insurance market is the mechanism that shares out the cost of health care. The premiums that people (and their employers) pay create pools of money used to finance care. The Affordable Care Act makes this mandatory: Everyone must have insurance — whether it’s an individual policy, one provided through an employer, or a public benefit such as Medicaid or care provided by Veterans Affairs — or pay a tax penalty.

People may resent being told to buy something. But if they don’t buy health insurance, premiums rise for those who do. And taxpayers are on the hook for the emergency care that many uninsured people fail to responsibly anticipate.

Those 13 million people who will go without insurance if the individual mandate is lost can be expected to delay doctor visits, struggle to pay medical bills, and generally experience poorer health, much evidence suggests.

Republican Senator Susan Collins of Maine seems to understand this. She was willing to block the repeal of Obamacare — but now she says she’s willing to see the individual mandate go if Congress promises two years’ worth of other funding to keep premiums down. That might help in 2019, but it would not make up for the loss of the individual mandate in the long run.

Fact is, no workable replacement for the mandate has been proposed. Sound familiar? Just like the “Repeal and Replace” venture.                                                                                                 There’s still time for Collins and other reasonable Republicans to grasp this truth, preserve the

individual mandate, and keep the U.S. health-care system moving toward its rightful goal of truly universal coverage.

Consumers as of last week are still Hunting For Health Insurance Find High Prices — And Some Great Deals. My wife and I received a notification that in fact, we still need to have health care insurance or suffer a penalty on our tax returns.

The open enrollment period to sign up for a health plan on HealthCare.gov runs through Dec. 15; several states with their own health care exchanges have later deadlines.

Gene Kern, 63, retired early from Fujifilm, where he sold professional videotape. “When the product became obsolete, so did I,” he says, “and that’s why I retired.”

Kern lives in Frederick, Md., and has been an enthusiastic enrollee in Maryland’s health exchange since it began in 2014. But this fall he received a letter from his insurer explaining that the cost of his policy’s premium would jump from $800 a month to $1,300 in 2018.

Premiums have risen for many 2018 policies, though most people won’t actually have to swallow those higher costs, because subsidies have gone up, too. Gene Kern is one of the exceptions.

“Because of my income, I am slightly above the 400 percent poverty level,” he says, “and as a result, I get no subsidy from the government.”

So Kern has switched to an HMO plan on the insurance exchange for around $900 a month. That’s more than 20 percent of his income, which comes partly from Social Security and partly from his retirement account. But, he says, “It’s the best I can get,” and he wants very much to stay insured for the next two years, at which point he will qualify for Medicare.

Louise Norris is a health insurance broker and analyst in Colorado. She says there are a number of people like Kern who earn too much for a subsidy and will pay more for health insurance next year than they did in 2017. “Rates are high,” she says. “There’s no way to sugarcoat that.”

But she warns her clients against the temptation to get a less expensive plan that doesn’t comply with the minimum standards set out by the ACA.

“It seems like a good deal because it’s cheap,” Norris says. “But then you find yourself being that person who has a heart attack and needs a triple bypass. And hundreds of thousands of dollars later you wish you had that ACA-compliant plan.”

Prices for ACA-compliant health policies went up in Tennessee, too, where state regulators approved average rate increases ranging from 20 to 40 percent.

Brenda Linn has already been paying $750 a month just to cover her own medical needs; so the retired kindergarten teacher and her husband logged on to HealthCare.gov to check the price of 2018 plans. To her surprise, the website brought up a great deal.

“And I’m like, ‘Dave, this has to be a mistake,’ ” she says. The price Linn was quoted was less than $5 a month. Why? A slight loss of income had made her eligible for a subsidy for 2018. “Because we didn’t qualify last year, I wasn’t really that hopeful,” Linn says.

But a large majority of marketplace shoppers do get subsidies. And for 2018, on aggregate, these subsidies are larger.

Tony Garr, a volunteer application assistant with the Tennessee Health Care Campaign, says more than ever this year, people should shop around on the exchange to see what kind of subsidies they may be eligible for.

“Generally speaking, they will find out that help is there,” he says.

Any many people who got a price break in the way of a subsidy in the past can get even more for their money this year.

For example, Daniel Prestwood, who is self-employed and cleans fish tanks around Nashville, says he found a better plan for 2018, with monthly premiums that dropped from $300 to $200. He says he tries not to get too frustrated by the political wrangling over health care.

“All I know is that for 2018 I’ll have a good health care plan in place,” he says, “and that’s the best I can hope for at this point.”

And even with the Trump administration’s efforts to hobble the ACA, in Tennessee, the number of applications processed by federally funded insurance guides — known as navigators and certified application counselors — has already surpassed last year’s. As of early last week, with 10 days left in open enrollment, more than 1,200 individuals had applied with official help, eclipsing the total from all of 2016, when the enrollment period was several weeks longer.

While application assistants only work with a tiny fraction of the 235,000 Tennesseans who have marketplace plans, Sandy Dimick of Family and Children’s Services Nashville, says she expects total enrollment will exceed last year’s total, as well. Navigators around the U.S. have worried that cuts to the federal advertising budget in 2017, and a lack of cheerleading from the White House, could drive down enrollment.

Take note: Though enrollment for most states ends Friday night, residents of nine states (California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, New York, Rhode Island and Washington) and the District of Columbia have slightly more time to sign up.

Peter Sullivan wrote that Speaker Paul Ryan (R-Wis.) said Thursday that lawmakers need to “revisit” ObamaCare, but also pointed to welfare reform as the focus of next year.

“ObamaCare is collapsing and failing, so we won’t be able to ignore that problem,” Ryan said at a news conference. “So we’re going to have to revisit the problem of a health-care marketplace that is collapsing and that is something that we’re just going to have to get on to.”

However, Ryan did not make clear whether ObamaCare repeal would be part of next year’s fast-track process known as reconciliation to get a measure through the Senate without needing Democratic votes.

Republicans only get one shot at that process next year, and Ryan mentioned health care after saying that welfare reform would be the focus of the fast-track process next year.

“Next year, we want to take on criminal justice reform, we want to take on skills, getting people the skills they need to get the jobs they want, career and technical career education and welfare reform, so those are the kind of entitlement reforms that we’re talking about,” Ryan said.

Some conservatives want the fast-track reconciliation bill to include both welfare reform and ObamaCare repeal.

Any effort on health care faces long odds in the Senate, made even tougher by the victory of Democrat Doug Jones in Alabama this week. Senate Republicans will be able to lose only one vote, and more than that number of Republican senators opposed various ObamaCare repeal efforts earlier this year.

Democrats have also been warning that Ryan would target Medicare and Medicaid next year, programs the Speaker said this month that he wanted to reform next year.

Ryan’s comments on Thursday, though, did not mention Medicare or Medicaid, instead focusing on welfare and workforce issues as “entitlement reform.”

And as we start to explore the concept of a Single payer system we still find that Healthcare for veterans needs another big fix.

John McCain and Jerry Moran reviewed some of the ongoing problems of the VA system. The VA is not coordinating well with community care programs or paying them promptly, and funding crises threaten access to private care.

More than a century ago, President Abraham Lincoln signed a law establishing a new agency dedicated to the support of our Civil War veterans. Its mission was “to care for him who shall have borne the battle, and for his widow, and his orphan.” Today, our Department of Veterans’ Affairs (VA) provides essential services to 22 million Americans who have served in the armed forces.

All Americans are indebted to our veterans for the enormous sacrifices they have made on our behalf. These men and women took an oath to defend the Constitution and served dutifully to preserve our way of life. Like their valiant forebears who humbled dictators and liberated millions from oppression, they exemplify what is best in our country.

Regrettably, the VA has at times struggled to uphold its obligations to our veterans. In 2014, our country was shocked to learn that thousands of veterans were denied care or experienced unconscionable delays in treatment at the Phoenix VA. Dozens of those veterans died while waiting for care. Unfortunately, this wrongdoing was not confined to Phoenix. The VA Office of Inspector General has completed at least 100 criminal investigations related to wait-time manipulation at VA facilities nationwide.

In the wake of that scandal, Congress gave veterans the freedom to receive medical care from providers in their local communities through the Veterans Choice Program. The program was intended to make certain that veterans would never again be forced to wait in long lines or drive hundreds of miles to access the care they deserve. Demand for Choice has since grown considerably; more than a million veterans are receiving care closer to home, through millions of appointments with community providers.

From the program’s inception, however, we emphasized that Choice was only the first step toward broader reform of veterans’ health care. That’s why we have introduced legislation that incorporates lessons learned from Choice to transform the VA into a modern, high-performing and integrated health care system that will improve veterans’ access to timely and quality care — within the VA and in the community. This bill tackles some of the most significant flaws and problems we’ve seen in recent years, including the VA’s slow payment process to community providers, poorly coordinated community care programs and — crucially — an inability to accurately predict demand for Choice, which has resulted in multiple funding crises that threaten veterans’ access to community care.

One of the fundamental undertakings in our bill is the creation of a Veterans Community Care Program, which would consolidate existing community care programs at the VA and increase care coordination with community providers. We would require the VA to use objective data on health care demand to set standards for access and quality, and to identify and bridge gaps in veterans’ care. We would also ensure that the VA promptly pays community providers, opens access to walk-in clinics, offers telemedicine, increases graduate medical education and residency positions for employees, and improves VA collaboration with community providers.

Unlike other proposals, our legislation creates and specifies the tools the VA must use to reform health care rather than relying on the bureaucracy to determine the rules. We have learned over time that Congress must provide clear direction and guidance to the VA to prevent inconsistent experiences, enhance veterans’ quality of life, and achieve better health outcomes.

Key veterans’ service organizations such as American Legion, AMVETS and Concerned Veterans for America have expressed their support for this effort, which will transform the VA into a 21st-century healthcare system that seamlessly weaves together both VA and community health care services.

We need to know this information, including the goods as well as the bad effects, on one of this Country’s long-standing Single Payer system as we go forward to define and investigate the option of a single-payer health care system for our country. Let’s see whether this new tax bill gets passed this week!

And finally, our community just learned of another suicide in a young person. We are devastated and continually ask our selves why.

Look at this headline-“U.S. suicide rate highest in 30 years, CDC report shows.”

Nina Flanagan reported a while ago that a new report from The Centers for Disease Control and Prevention (CDC) shows the U.S. suicide rate is the highest it’s been in 30 years, increasing 24% from 1999 to 2014.

• Middle-aged women between the ages 46 to 64 had the second largest increase in suicides since 1999 at 63% and women in other age groups showed an average increase from 31% to 53%. The suicide rate for men in the same age bracket increased by 43%. Older men aged 75 and above had high suicide rates but only fewer deaths
• Only one group in the U.S. showed a declining suicide rate: African-American men over age 75.

 The data come after another recent CDC report that showed life expectancy for white, non-Hispanic U.S. women went down by about one month from 2013 to 2014, from 81.2 to 81.1 years. Though the difference for white women is small, such a dip for a major demographic group is rare and troubling, experts said, particularly because of the reasons why: Suicide, drug overdoses, and complications from alcohol and smoking.

A blog on healthinsurance.org in response to the CDC study suggested Medicaid may alleviate the high suicide numbers. The author, Harold Pollack, said many states with the worst public health problems are denying Medicaid coverage to the lowest-income citizens, and in turn, harming their mental health.

Oregon did an insurance study, the Oregon Health Insurance Experiment, where Medicaid was allotted by a lottery between treatment and a control group. Those who received Medicaid had large and immediate reductions in depressive symptoms and stress. However, the same experiment showed disappointing results when it came to physical health. The mental health benefits may not have been specifically from improved treatment, the author suggested, but because those with Medicaid had less anxiety over medical bills or their circumstances if they became ill.

Our community’s last experience with suicide was a physician that I also knew personally and also asked why.

To this person’s family, we grieve also and offer our heartfelt sorrow and wishes for comfort and empathy. We all will never understand why this happened and what would lead a young person to give up on life.