Category Archives: Voters on health care

What the New Democratic House majority might actually pass on health care; and It Looks Like VA Healthcare Maybe Improving!

 

 

18670832_1206383419491315_6469395384583311089_nI had prepared two posts for tonight and wanted to hold off on the recent shootings until next week as we digest what the effect really is in our country and the future strategies. Now let’s discuss the effect of the election and in looking at the House Democrats, who have a lot to figure out on their signature issue.

Healthcare carried House Democrats to victory on Election Day. But what now?

Remember my past post reminding the Republicans the importance of healthcare in the midterm elections? We, it looks like it was an important factor in the outcomes of the “wave”. Dylan Scott spent some time looking at his prediction of what the new majority will bring to our health care system. In interviews this fall with half a dozen senior House Democratic aides, health care lobbyists, and progressive wonks, it became clear the party is only in the nascent stages of figuring out its next steps on health care.

The new House Democratic majority knows what it opposes. They want to stop any further efforts by Republicans or the Trump administration to roll back and undermine the Affordable Care Act or overhaul Medicaid and Medicare.

But Democrats are less certain about an affirmative health care agenda. Most Democrats campaigned on protecting preexisting conditions, but the ACA has already done that. Medicare-for-all is energizing the party’s left wing, but nobody expects a single-payer bill to start moving through the House. Drug prices offer the rare opportunity for bipartisan work with Senate Republicans and the Trump White House, but it is also a difficult problem with few easy policy solutions — certainly not any silver bullet that Democrats could pull out of the box and pass on day one, or even month one, of the next Congress.

Winning a House majority to ensure Obamacare’s safety is an important turning point after so many years in which health care hurt Democrats much more than it helped.

But the path forward for the party on their signature issue is surprisingly undefined.

The likely first item on the Democratic agenda: Obamacare stabilization

Democrats do have some ideas, of course. Democratic aides emphasized the various investigations they could launch into Trump’s health department, not only looking into any efforts by the White House to sabotage Obamacare but also focusing on more obscure issues like Medicare payment rates.

But wonky oversight inquiries probably aren’t the big-ticket item that new Democratic members and their voters are looking for, especially heading into the 2020 presidential election.

After campaigning in defense of Obamacare, warning about Republicans rolling back preexisting conditions protections and the Trump administration’s sabotage of the health care law, a bill to stabilize the Obamacare insurance markets would be the obvious first item for the new Democratic majority’s agenda.

Several sources pointed to a bill by Democratic Reps. Richard Neal (MA), Frank Pallone (NJ), and Bobby Scott (VA) — who have been serving as the top Democrats on leading health care-related committees — as the likely starting point. The plan is designed to build off Obamacare’s infrastructure to expand federal assistance while reversing the recent Republican efforts to undermine the law.

That bill would expand Obamacare’s premium subsidies, both by extending federal assistance to more people in lifting the current eligibility cutoff and by increasing the size of the tax credits people receive. It would also bolster the cost-sharing reduction subsidies that people with lower incomes receive to reduce their out-of-pocket costs while extending eligibility for those subsidies to people with higher incomes.

The Pallone-Neal-Scott bill would reverse the Trump administration’s recent regulations intended to funnel more people to insurance plans that are not required to meet all of Obamacare’s rules for preexisting conditions. It would also pump more money back into enrollment outreach, cut by the Trump administration, and establish a new program to compensate insurers for high-cost patients, with the hope of keeping premiums down.

Two things stick out about this bill: It would be the most robust expansion of Obamacare since the law first passed, and it is just narrow enough that, with a few sweeteners for Senate Republicans, it could conceivably have a chance to pass. Democrats are waiting to see how the GOP majority in the upper chamber reacts to losing the House.

“Undoing sabotage and bringing stabilization to the ACA markets, that’s something we should really be thinking about,” one House Democratic aide told me. “It depends on what kind of mood the Republicans are in. Maybe they’ll say that actually now that the tables are turned, we should probably sit down.”

Senate Republicans and Democrats did come very close to a narrow, bipartisan deal — it wasn’t even as robust as the Pallone-Neal-Scott bill — to stabilize Obamacare in 2017. It fell apart, ostensibly after a tiff over abortion-related provisions, but that near miss would be the reason for any optimism about a bipartisan deal on the divisive health care law.

Then again Senate Republicans might have no interest in an Obamacare compromise after gaining some seats. Democrats would still likely work on stabilization to send a message to voters on health care ahead of the 2020 campaign.

Shoring up Obamacare is a good start, but what next?

In the case, the Pallone-Neal-Scott bill might be a nice starting point — no Democrat really disagrees about whether they should help the law work better in the short term — but it still lacks any truly ambitious provisions. It is just about as narrowly tailored as an Obamacare stabilization bill offered by Democrats could be, a fact that aides and activists will privately concede.

Missing are any of the bolder policy proposals animating the left. Not even a hint of Medicare-for-all single-payer health care, which is or isn’t a surprise, depending on how you look at it.

Medicare-for-all is quickly becoming orthodoxy among many in the party’s progressive grassroots, and a single-payer bill proposed this Congress in the House (similar to the one offered by Bernie Sanders over in the Senate) has 123 sponsors.

But House Democratic leaders probably don’t want to take up such a potentially explosive issue too soon after finally clawing back a modicum of power in Trump’s Washington.

Still, the current stabilization bill doesn’t even include a Medicare or Medicaid buy-in, the rebranded public option that never made it into Obamacare but would allow Americans to voluntarily join one of the major government insurance programs. It is an idea that even the more moderate Democratic members tend to support, and polls have found three-fourths of Americans think a Medicare buy-in is a good idea.

The plain truth is House Democrats haven’t reached a consensus yet about what they want to do to cover more Americans. They agree Obamacare was an important first step, and they agree the status quo is unacceptable. But the exact mechanism for achieving those goals — single-payer, a robust public option, or simply a buffed-up version of Obamacare — is still very much up for debate.

“People will want to do something, but any further action is going to be a consensus-building process,” a senior House Democratic aide told me. “Democrats have lots of different ideas on how to continue working to reduce the uninsured.”

That is all well and good, but few issues are exciting the Democratic grassroots right now like Medicare-for-all. During the midterm campaigns, Democratic candidates and even grassroots leaders were happy to let those words mean whatever voters wanted them to mean. For some people, it meant single-payer; for others; it might mean a Medicare buy-in or something more limited.

The unreservedly progressive members who were just elected to Congress will only wait so long before they start pressing Democratic leaders to take more aggressive steps to pick up one of their top campaign issues. That pressure will only intensify as the 2020 presidential campaign heats up and Democrats debate what kind of platform they should run on as they seek to take back the White House.

For now, Democrats have tried to put off a difficult debate and focus on what unites them. But the debate is still coming.

The riddle of high drug prices still needs to be solved too

Even with Obamacare and preexisting conditions mobilizing Democratic voters this year, prescription drug prices remain a top concern for many Americans. That’s another area where Democrats know they want to act but don’t know yet exactly what they can or should do.

The issue could be an opening for serious dealmaking: Trump himself has attacked big pharma since his presidential campaign. His administration has actually launched some interesting initiatives to rein in drug costs — approving a record number of generic drugs, trying to even the playing field between America and foreign countries — that have some policy wonks intrigued, even if the impact is still to be determined.

Democrats have mostly stuck to slamming Trump for feigning to act on drug prices while cozying up to the drug industry. But it’s a top priority for both parties, and there could be some room for compromise. One progressive policy wonk thought a drug prices bill might actually be the first Democratic priority. It helps that drug prices are a populist issue that the new House majority might really be able to pass a bill on.

But first, Democrats have to figure out what exactly they are for — and what would actually make a difference.

The rallying cry for Democrats on drug prices has been letting Medicare directly negotiate prices with drug manufacturers, a proposal that Trump also embraced as a candidate, though he has since softened as president. The problem is the Congressional Budget Office doesn’t think Medicare negotiations would save any money unless the government is willing to deny seniors coverage for certain medications. But adding such a provision would surely invite attacks that Democrats are depriving people’s grandparents of the medications they need.

There are a lot of levers to pull to try to reduce drug prices: the patent protections that pharma companies receive for new drugs, the mandated discounts when the government buys drugs for Medicare and Medicaid, existing hurdles to getting generic drugs approved, the tax treatment of drug research and development. Lawmakers and the public view pharmacy benefits managers, the mysterious middlemen between health insurers and drugmakers, skeptically.

But none of those are silver bullets to lower prices, and they will certainly invite pushback from the politically potent pharmaceutical lobby, focused on the concerns about how much cracking down on drug companies to discourage them from developing new drugs. Democrats also don’t know yet what specific policies could win support from Senate Republicans or the Trump White House.

“How do you take this gargantuan Chinese menu of things and figure out how things fit together in a way that stem some of the abuses?” is how one Democratic aide summarized the dilemma.

It is a problem bedeviling Democrats on more than just drug prices. Health care was a winner on election night this year, and it has always been a priority for Democrats. Now they just need to figure out what to do.

Because tomorrow is Veterans Day I thought that I would include this article.             After A Year Of Turmoil, New VA Secretary Says ‘Waters Are Calmer’ 

Quil Lawrence in his Twitter post reported on a wide-ranging interview with NPR, Secretary of Veterans Affairs Robert Wilkie said his department is on the mend after a tumultuous 2018.”I do think it is better because the turmoil of the first half of this year is behind us, the waters are calmer. We’re not where we need to be, but we’re heading in that direction,” he said.

Early in Donald Trump’s presidency, the VA was considered an island of stability in an unpredictable administration.

Secretary David Shulkin was a hold-over from the Obama administration, already familiar with the VA’s massive bureaucracy. Bipartisan reforms moved through Congress with relative speed, and Trump could point to a list of legislative accomplishments.

But the president fired Shulkin last March after weeks of intrigue during which VA political appointees plotted openly to oust him. Trump’s first nominee to replace Shulkin, Rear Adm. Ronny L. Jackson, sank under accusations of misconduct (which are still being investigated by the Pentagon).

Numerous high-ranking officials left the department, and records showed that friends of the president outside of government – who weren’t even veterans – had been lobbying Trump at Mar-a-Lago on how to run the VA.

After a stint as acting VA secretary, Robert Wilkie was confirmed by the Senate last July. Since then, Wilkie says he’s been “walking the post,” visiting as many VA facilities as he can. And he’s reached the same conclusion as many of his predecessors.

“I have been incredibly impressed by the caliber of VA employee I’ve encountered everywhere, from Alaska to Massachusetts to Florida,” Wilkie told NPR’s, Steve Inskeep.

“I have no quarrel with the quality of medical care our veterans receive. My biggest problem is actually getting them into the system so that they can receive that care, which means the problems are primarily administrative and bureaucratic,” said Wilkie, himself a veteran of the Navy and a current Air Force reservist, who counts generations of veterans in his family.

“I am the son of a Vietnam soldier. I know what happened when those men and women came home,” Wilkie said. “So that is incredibly important to me.”

Wilkie is navigating an important moment for the VA – while Congress has already passed major reforms, he’s the one who has to implement them. And plenty of political controversy hides in the details.

The VA Mission Act of 2018 was signed into law in June. It’s intended to consolidate about a half-dozen programs The VA uses to buy veterans private healthcare at a cost of billions of dollars, into one streamlined system.

Critics fear that leaning too much on private care will bleed the VA’s own medical centers, and lead to a drop in quality there – and amounts to a starve-the-beast strategy of privatization.

Wilkie says that won’t happen and is not President Trump’s goal, but he has yet to present a budget for expanded private care to the White House and to Congress.

“You’re not going to privatize this institution. I certainly have never talked about that with anyone in this administration,” Wilkie said.

Wilkie also maintains that he has had little contact with the group of outside advisers who meet with the president at Mar-a-Lago, including CEO of Marvel Comics Ike Perlmutter and Florida doctor Bruce Moscowitz. Records show they had extensive communication with the previous VA secretary, sometimes influencing policy decisions.

“I met with them when I was visiting the West Palm Beach VA – my first week as acting (secretary), and have not had any meetings with them ever since that day,” Wilkie said. “I’ll be clear. I make the decisions here at the department, in support of the vision of the president.”

Despite rumors that Wilkie would clear out many of the Trump political appointees who clashed with former secretary Shulkin, he said he didn’t expect more staffing changes.

The one notable departure is Peter O’Rourke, who was acting secretary for two months while Wilkie went through the confirmation process. O’Rourke clashed repeatedly with Congress and the VA’s inspector general. Wilkie himself cited a Wall Street Journal reports that O’Rourke is poised to go and said he’s “on leave.”

“I think there will be an announcement soon about a move to another department in the federal government – I know that he’s looking for something new,” said Wilkie, “He’s on leave.”

Another major new plan that Wilkie must implement is a $10 billion, 10-year plan to make the VA’s medical records compatible with the Pentagon’s.

He once again mentioned his father’s experience as a wounded combat vet.

“He had an 800-page record, and it was the only copy, that he had to carry with him for the rest of his life. He passed away last year,” said Wilkie.

“One of the first decisions I made as the acting secretary was to begin the process of creating a complete electronic healthcare record that begins when that young American enters the military entrance processing station to the time that that soldier, sailor, airman, Marine walks into the VA.”

But that process has actually been underway for a decade – with little to show and about a billion dollars already spent on the effort. The non-partisan Government Accountability Office says it’s in part because neither the Pentagon nor the VA was put in charge of the effort — which is still the case. Wilkie says he has signed an agreement with the Pentagon to jointly run it with clear lines of authority.

“I think we’ll have more announcements later in the year when it comes to one belly-button to push for that office,” he said.

As for staff shortages, another perennial complaint at the VA, Wilkie acknowledged there are 35- to 40,000 vacancies at the agency.

“We suffer from the same shortages that the private sector and other public health services suffer from, particularly in the area of mental health,” he said.

New legislation passed this year gives Wilkie the authority to offer higher pay to medical professionals.

“I’m using it to attract as many people as we can into the system,” said Wilkie

But Wilkie also added that he was shocked, upon taking the post, that it’s not clear how many additional people are needed – because it’s not even clear how many people are working at VA.

“I had two briefings on the same day and two different numbers as to how many people this agency employs.”

Wilkie says he’s in the process of finding out the answer to that question, and many others, as he starts his second 100 days in office.

And to end this post I must include this note. I was raised in the Bronx, New York and are truly embarrassed to acknowledge that the new Congresswoman Cortes-Ortes who was elected, and not sure how when you look at her qualifications and knowledge. But more, she is a socialist and expects everything to be given to all and the government will foot the bill and now listen to this.

Alexandria Ocasio-Cortez, new youngest Congresswoman, says she can’t afford D.C. apartment

Ashley May, a reporter for the USA TODAY noted that the upset primary win in New York by Alexandria Ocasio-Cortez is a huge moment for the Democratic Party because it shows the left-wing base is energized heading into the midterms, according to AP National Politics Reporter Steve Peoples. (June 27) AP

Alexandria Ocasio-Cortez, the youngest woman elected to Congress in the midterm elections, is struggling to pay rent, according to a recent interview.

Ocasio-Cortez, 29, told The New York Times she’s not sure how she will be able to afford an apartment in Washington, D.C., without a salary for three months in an interview published online Wednesday.

She told the Times she has some savings from her job earlier this year as a bartender at a Union Square restaurant, and she’s hoping that will hold her over. Living without a paycheck is something she said her and her partner tried to plan for, but it’s a hardship that’s still “very real.”

“We’re kind of just dealing with the logistics of it day by day, but I’ve really been just kind of squirreling away and then hoping that gets me to January,” she told the Times.

Ocasio-Cortez is a New York activist and Democrat who will represent the 14th Congressional district, which covers the Bronx and Queens.

Thursday, she pointed to her lack of income as a reason why some people are not able to work in politics.

“There are many little ways in which our electoral system isn’t even designed (nor prepared) for working-class people to lead,” she said.

She said she hopes she can change that.

Yes, and now if she plays her cards right she has a job, paying better than any job that she is really qualified for life.

Buck it up Ocasio-Cortez, live outside of DC and take public transportation like most people do!

How did you fund your campaign? I don’t want to hear your sob story and yes I am ashamed that the borough of the Bronx has you for their representative. What a joke! You said that when you got to DC you were going to sign a whole lot of bills and laws to make things better. Do you even know anything about the process and have you ever taken a Civics course. You are in for some big surprises… called reality!

On a better note-Happy Veterans Day and thank you all who have served in our military and those who are still out there helping to make this world a better place to live and protecting our freedoms.

 

State of Health: Boston Doc Sees State Rep Run as a Way to Help Patients. Healthcare and the Mid Terms and a Summary of the Issues

45112654_1770213053108346_4596023887606579200_nNow that the Mid Term elections are upon us I can honestly state that I am somewhat ambivalent regarding the outcome. I’m pretty sure that the Democrats are going to claim the majority in the House and maybe the Republicans will hold onto the Senate. But to what end. The fighting will go on and probably nothing will get done. The Republicans have no one to blame but themselves for losing the House majority. Where was their leadership and don’t point fingers at the President? His leadership roles could be questioned but the big issue is that leader Ryan, although I like him was no leader as well as so many Republican Congressmen and women deciding to retire at such an important time and therefore not supporting their President.

The Democrats have disgusted me with their horrible behavior and attacks and playing the blame game Their leadership just sickens me during these last 2 years and them look who we have to run for the Presidency, again members who truly have made things worse, not better and not even trying to negotiate, be civil and spouting lies and attacks. As I said both parties have sunken to new lows in their behavior. I wish that we did have a significant Third Party for whom I would vote for. Again it holds your nose and vote.

Our friend, Joyce Frieden the News Editor of MedPage reported that Healthcare is expected to be a major issue in the November election — not just in Congress but also in the states. With that in mind, MedPage Today is profiling several candidates for statewide office who are focusing on healthcare issues. In our third and final profile, we speak with Jon Santiago, MD (D), an emergency room physician who is running for the Massachusetts House of Representatives.

Jon Santiago, MD, saw it firsthand every day. “I work in an ER at Boston Medical Center and it’s a great job,” Santiago said in an interview with MedPage Today. “It’s a job I love in a hospital I’ve wanted to work at since I was a kid.”

Naturally, Santiago, a fourth-year emergency medicine resident, tackles difficult problems as an emergency physician — including gunshot wounds, strokes, and heart attacks. “I live for those exciting moments, but you begin to realize that working in an ER, you’re taking care of a lot of social issues — poverty, racism, sexism, and lack of economic opportunity or housing — that ultimately manifest in some kind of medical condition, and that’s when we treat them.”

“We’ll literally or figuratively put a Band-Aid on them … but it’s not until we solve the social determinants of health that we begin to [really] solve their problem,” he continued. “That’s why I decided to run for office.”

Opioid ‘Ground Zero’

As a public hospital, Boston Medical Center is “ground zero” for the opioid epidemic, both in the city and the state, Santiago said. He cited the example of Long Island, an island near Boston that houses a number of homeless shelters and recovery services. “There was a bridge to an island near Boston that overnight had to be shut down because it was dangerous, so in a matter of days, we had to move about 400 people into the [South End] neighborhood, many of whom were homeless and had substance use disorder. It really changed the community.”

In addition, for those people that had to be moved, “their continuity of care stopped, and as a result, people died … My run for office is really for these patients I take care of who need the help, but also for significant quality-of-life issues in the community.”

Santiago noted that with its many world-class healthcare facilities, Boston is considered the “healthcare capital of the state, if not the country and the world.” But the state also has its own healthcare challenges — Massachusetts’ Medicaid program, known as MassHealth, takes up 40% of the state budget. “And Massachusetts likes to pride itself that we were the first to pass health care reform, providing universal coverage, but that doesn’t mean healthcare is affordable or accessible.”

For example, “MassHealth doesn’t cover everything; there is always talk of cutting certain services,” said Santiago. “Just this past year, the governor threatened to knock out about 140,000 people from MassHealth to save money.”

Technically, the coverage rate in the state is 97%, but “the question is, if you look at what people pay for the administration of private healthcare, the costs are significantly more than a public provider would have,” he said, noting that Medicare’s administrative cost is about 10%. “Other developed countries are able to provide more cost-effective healthcare with … better outcomes.”

Santiago supports single-payer universal health care coverage for all state residents through a “Medicare for all” system. The first step toward that goal, he said, would be to study single-payer and compare the current system to what single-payer would look like “and if it would save money, I would pursue that because what we have is not really sustainable.”

An Unlikely Winner

Santiago was an unlikely winner in the Democratic primary race in his district. “I beat a 36-year incumbent who was the majority leader, the fourth highest-ranking person in the state,” he said. “What people were looking for [was] people to provide political leadership on issues that matter, and when it comes to the opioid epidemic, people were looking for solutions.” Santiago attributes his victory to a very grassroots strategy. “I personally knocked on 8,000 doors; we knocked on every door in the district. If you talk to people and listen to them, you’re better able to serve their needs.”

“The person representing this district — the center of the epidemic — should be a leader on this issue,” he continued. “Massachusetts Avenue they call the ‘Methadone Mile’ here; I live close to that. The Boston Medical Center emergency department is located there, and as an emergency department provider, it gives me initial insight into what is going on, on the ground.”

He gave an example of how, 3 years ago, his experience helped him change the law. “In my first year as a doctor, with the prescription drug monitoring program (PDMP), if someone comes in with back pain, you check to see whether they have previously been given an opioid prescription — if they have, it’s a red flag. I tried to look [at the PDMP] during my first year as a doctor, and I couldn’t access the website. I turned to my attending and he said, ‘Only attendings can.'”

But since the residents do much of the work at the hospital, “I said, ‘This doesn’t make sense,'” said Santiago. “I got the doctors together and we started a petition to provide access [to the PDMP] to the residents who do all the work. I got the petition started, met with the Boston Globe, and they covered it; we met with the governor’s staff and they changed the law overnight. Within a week or so, residents across the state were able to access the PDMP.”

Post-Election Plans

If Santiago wins the election, “my plan is to continue working as an ER doctor because I think one job really informs the other,” he said. “One job really keeps you close to the community and the issues neighbors face day in and day out, and working as a state representative addresses those issues in the policy arena.” A total of 14 8-hour shifts per month are considered full-time; Santiago said he planned to work one to two shifts a week during the legislative session, “and I’d be the only physician [legislator] in the capital as well.”

Public service is nothing new to Santiago, who served as a Peace Corps volunteer in the Dominican Republic and is currently a captain in the Army Reserve. “I graduated from college and wanted to join the military, but I was not enthusiastic about the Iraq War,” he explained. “I wanted to serve my country, so I joined the Peace Corps … I told myself that if I became a doctor I would join the Army Reserve so I could serve in that capacity.” The reserves are pretty flexible since they only require one weekend a month and 2 weeks a year, and if you do deploy it’s only for 3 months, he added. “But they’re very flexible with you if you’re a doctor.”

In Trump midterms, one GOP congressman bets re-election on healthcare

Reporter Susannah Luthi noted that Rep. Peter Roskam (R-Ill.), in the final sprint for his congressional life, wants to talk about Medicare red tape. The message is a big deal in his hospital-dominated district that headquarters the state’s largest system, Advocate Health Care. His health subcommittee chairmanship for the powerful House Ways and Means Committee positions him to push measures that resonate when hospitals attribute 25% of their spending, or about $200 billion per year, to paperwork.

But while policy specifics may matter for his committee work and for the business of healthcare, analysts are skeptical they can prevail over the “Trump effect”—widespread rejection of the president by moderate suburban Republicans, which makes elections in places like the Illinois 6th District a national more than a local referendum.

Roskam now lags in the polls behind his Democratic challenger Sean Casten, a clean energy entrepreneur who has harnessed local opposition to President Donald Trump to pull ahead of a six-term congressman of a district that was designed as a GOP stronghold.

Questioning the 80/20 rule for healthcare

The 80/20 rule in health care underlies much of the common thinking about population health. Many value-based strategies about health care costs or utilization use this rule to describe the distribution of health care spending. Is the 80/20 rule accurate today? We analyzed recent data to find out.

He’s also struggling to make another national healthcare message local.

The term “pre-existing conditions” is headlining the cycle. The tagline has become particularly effective in light of the GOP state attorneys general lawsuit to strike down the Affordable Care Act. The Trump administration sided with the lawsuit, specifically asking the courts to overturn the provisions around community rating and other cover requirements that prohibit insurers from charging more for people with expensive, pre-existing conditions.

Roskam voted with most of his party for the GOP effort to repeal and replace the ACA, and Casten has been pounding him for it.

But on a rainy Friday in early October, as he toggled between campaign events and representational duties that involved a deep dive into CMS pay rules for disabled adults in the community, Roskam stuck with his policy line. He said this still matters in what he described as his “solution-oriented” district.

“My observation is that if the ACA were doing what it’s purported to do, the district wouldn’t be restless and they’d be quick to turn the page,” Roskam said. “But they are restless and there is a sense of vulnerability that’s out there and it’s largely financial.”

Then he pivoted to what he has been working on as a congressman: the Medicare Red Tape Relief project that culminated in a report late this summer, which he believes is more relevant for bringing costs down.

“The country feels stuck in a debate [over Obamacare] and it’s ready to get out of the ditch of the debate,” Roskam said. “It’s well litigated where both sides are on the ACA. And these continuous declarations—most people don’t find a level of connection. Which is why the red-tape relief effort resonates. ‘Yes, I get that, my doctor is looking at a screen half the time he’s with me. That’s not the way it used to be.'”

But that’s not the focus in this race. After millions of dollars in advertising from both sides, Roskam is trailing by five points in the latest FiveThirtyEight poll. The nonpartisan Cook Political Report rates the race as “lean Democratic” as Casten pummels Roskam’s record of voting 94% of the time for Trump’s agenda.

The flip is emblematic of what’s happening in moderate suburbs that voted for Hillary Clinton in 2016, said David Wasserman, House editor of Cook Political Report. That’s when Roskam cruised to a double-digit victory even though Clinton beat Trump by seven points in his district.

Casten, whose core issue is climate change, wasn’t necessarily the strongest Democratic candidate for the district, Wasserman added. He wasn’t the favorite in his primary and even Democratic strategists complain about his bombastic style. But none of this may matter.

“Roskam has failed to make the race a referendum on Casten, and it’s become about Trump and Roskam,” Wasserman said.

In Roskam’s case, there are also state-based headwinds: a deeply unpopular GOP governor who is motivating Democratic voters in the state, and a GOP president who is unpopular in a prosperous GOP district.

“If Peter wins, it’s because people are willing to look at him as someone who is independent of Trump and has been a good representative of the district,” a longtime GOP Illinois strategist said.

At a Casten sit-down with local members of the Illinois Alliance for Retired Americans as the group endorsed him, the dissatisfaction with healthcare played out in condemnations of Roskam’s 2017 vote to repeal the ACA. They talked about denials of care by insurers through pre-authorizations they didn’t understand, their fears about the future of coverage for pre-existing conditions, and Medicare’s solvency.

Kim Johnson, a retired state worker who is taking care of two of her grandchildren, said that one granddaughter was born with a heart condition and blasted Roskam for his 2017 vote saying that if he “had his way, she’ll have no insurance.”

But the status quo is also not enough, Johnson added, noting that she wants to see “universal healthcare.”

“I just want to see something,” she said. “I want to see something improve. We are a much better country than what our benefits are.”

Casten reiterated his support for the ACA and said he wants to look at a public option through an expansion of Medicare or Medicaid or both.

But he has steered clear of the more progressive Democratic positions. He criticized the Medicare for All proposal of Sen. Bernie Sanders (I-Vt.) as “irresponsible” and said it made him nervous. At the table of retirees, Casten also defended the for-profit nature of the U.S. system, which he said drives the right incentives for efficiency.

He has also drawn a hard line about what he thinks about Republicans, and about working with them. “On almost everything we are arguing about, there are no areas for compromise,” specifically on the confirmation of Justice Brett Kavanaugh to the Supreme Court, climate change and voting rights, Casten told a group of nursing home residents in one event.

Roskam recently ranked as the 25th most bipartisan House member out of 435 lawmakers, is banking on his district rejecting that approach. Issues like Medicare fraud and Medicare solvency matter, he said, but big policy pushes need buy-in from both Democrats and Republicans and work needs to be incremental.

Roskam has blasted Casten’s campaign speech—and his active Twitter feed—as Trump-like. But in the last stretch of the race, the rhetoric has intensified, thanks to the millions of dollars raised for ads that are barraging the district and even its surrounding counties. Campaign signs blanket lawns and the roads connecting this leafy, prosperous district.

James, a nursing home resident who had attended Casten’s event there and who declined to give his last name, said that what he will be watching for this election is what it will say about voters’ views of Trump.

“Are people catching on with what Trump is doing?” James said. “Everybody’s got a right to vote—that’s a good thing and a bad thing. Hopefully, people will catch on to what’s going on.”

Healthcare and the midterms: I’ve got you covered

Healthcare is top of mind for many 2018 midterm voters. As they select state and federal representatives, many ballots also include measures for Medicaid expansion, provider pay and other key healthcare issues. Federal policy on the future of the Affordable Care Act, drug prices and immigration reform will also affect the healthcare industry. I thought that I would use this article to summarize the MidTerm issues.

Modern Healthcare has been tracking how policy changes and discussion could affect the midterm elections. A change in House or Senate party control or governors’ races can tilt the scale on many hotly contested healthcare issues. Here we’ve rounded up our coverage on the upcoming midterm election.

Midterm elections 2018 at a glance

2018 elections: The future of healthcare could be purple: In the lead-up to the midterms, Democrats appear poised for gains in Republican-controlled legislatures and governor’s mansions, which could push the states to make the healthcare compromises that Washington can’t.

In Trump midterms, one GOP congressman bets re-election on healthcare: In an intense congressional race in the Chicago suburbs, hospital ally Rep. Peter Roskam (R-Ill.) is running on an anti-regulatory healthcare message. But in a referendum election about Trump, how will that play?

The 115th Congress on the State of Healthcare: Modern Healthcare’s 115th Congress on the State of Healthcare is a featured collection of commentaries from lawmakers and healthcare organization leaders. Included in this collection of Congressional commentaries are six editorials from U.S. Senators and eight House Representatives across both party lines.

Data Points: Healthcare tops the polls as midterms loom: The all-important 2018 midterm elections are less than two months away. As special elections and primaries, this summer has proven, healthcare continues to be a hot-button issue.

Editorial: Healthcare PACs voting for incumbent protection: Many Democratic congressional hopefuls are making healthcare their top talking point for the upcoming midterm elections, which is not surprising given the low unemployment rate. The early donations from political action groups lean toward the incumbents.

House Speaker Ryan to retire with a mixed legacy on health policy: House Speaker Paul Ryan’s upcoming retirement from Congress after leading the GOP’s charge to repeal the Affordable Care Act leaves his party in a challenging place on health care messaging ahead of the 2018 midterm elections.

Status of Medicaid expansion states and work requirements

Bullish post-election Medicaid expansion outlook may not match end result: Although a new report predicts 2.7 million people in nine states could soon become eligible for Medicaid, expansion could look very different state by state.

Medicaid expansion on the prairie: Nebraska’s ballot initiative heads to the polls: Four years into Obamacare, the majority of Nebraska voters support Medicaid expansion, a key measure on their midterm ballot. But even pro-expansion hospitals are taking a cautious view of how much it will impact the rural bottom line.

Verma touts Medicaid work requirement successes, despite coverage loss: CMS Administrator Seema Verma insisted that Medicaid work requirements are working as intended to move people out of poverty, despite criticism that they’re doing more harm than good.

Medicaid blues: Hospitals, insurers wage a political battle over managed-care dollars: Medicaid, the 50-year-old federal-state health coverage plan for the poor, has devolved into a political inter-industry feud in the impoverished Mississippi Delta. What does the fight foretell about the Medicaid industry and how it treats the nation’s poorest?

Could deep-red Miss. expand Medicaid? 2019 will tell: A Mississippi state senator has introduced a bill to expand Medicaid every year since Obamacare went into effect, but so far it’s been off the table. The 2019 governor’s race could change the picture.

Close governor races could decide future of Medicaid: Advocates say the single biggest factor in expanding Medicaid in balky states has been the election of a governor who supports it.

Editorial: Want people off Medicaid? Give them more access to it: New research found those who gained coverage through Michigan’s Medicaid expansion faced fewer debt problems, fewer evictions, and bankruptcies, and saw their credit scores rise just years after enrolling for coverage.

Wisconsin can impose Medicaid work requirements, time limits, but not drug testing: The CMS on Wednesday gave Wisconsin permission to impose work requirements on beneficiaries. It’s the first state to receive a green light for the policy without expanding Medicaid. The agency rejected the state’s mandatory drug testing proposal.

Tennessee joins push for Medicaid work requirements: Tennessee is the fourth state this month to introduce a work requirement proposal for its Medicaid enrollees. Officials there believe it has a better chance of CMS approval than other non-expansion states due to its coverage policies for adults.

House Democrats press HHS for Medicaid work requirement records: Two top Democrats on the House Oversight Committee want to subpoena the Trump administration’s documents around its Medicaid work requirement policy. HHS officials haven’t responded to their previous requests for information.

Healthcare reform issues

Senate Dems fail to block Trump’s policy on short-term health insurance: Wisconsin Democrat Sen. Tammy Baldwin’s forced vote to overturn the Trump administration’s plan for short-term health insurance failed in a tie, although the Democrats gained one Republican ally.

Senate Republicans in talks with Verma to expedite states’ 1332 waivers: The Senate’s two top GOP proponents for individual market exchange stabilization measures are in talks with CMS Administrator Seema Verma about making 1332 state innovation waivers easier to obtain.

Affordable Care Act:

Editorial: The midterm elections will decide the fate of the ACA: If the GOP maintains control of the entire government, the nation’s health insurance marketplace would look a lot like the one that existed before passage of the Affordable Care Act.

Judge skeptical of ACA’s standing without effective individual mandate penalty: In a U.S. district court Wednesday, a federal judge had hard questions for Democratic state attorneys general who argued that the ACA can stand even with a zeroed-out tax penalty.

ACA court case causing jitters in D.C. and beyond: A lawsuit aiming to overturn the Affordable Care Act goes before a conservative Texas judge Sept. 5. The health insurance industry and GOP lawmakers are bracing for the potential fallout.

Uncertainty could spook insurance markets as DOJ decides not to defend ACA: The Department of Justice has asked a federal court to invalidate three key Obamacare coverage mandates, siding with a red state lawsuit against the Affordable Care Act and spurring new uncertainty for the 2019 individual market.

Republicans weigh electoral calculus on reviving ACA repeal push: Both Republican and Democratic political observers see a narrow possibility for yet another Obamacare repeal drive this year, given intense pressure from conservatives and the urgent GOP need to fire up right-wing voters to maintain their control of Congress in this fall’s elections.

Pre-existing conditions:

Pre-existing conditions drive state attorney general campaigns: Democratic candidates in state attorney general races have leveraged their party’s national campaign strategy around coverage of pre-existing conditions. They’re trying to beat Republican incumbents who are suing to end Obamacare.

Will Republicans keep their new promises on pre-existing condition protections?: Despite congressional GOP candidates’ promises, health policy analysts doubt whether victorious Republicans would move to replace those ACA protections with equally strong measures to cover people with health conditions as part of repeal legislation.

Tight Iowa congressional races key on pre-existing condition protections: The battle over pre-existing condition protections has become particularly heated in two toss-up House races in Iowa, even as unregulated Farm Bureau health plans that can use medical underwriting will go on sale Nov. 1.

GOP senators propose new protections for challenged ACA provisions: As the country heads toward midterm elections and red states look to overturn Obamacare in the courts, Republican senators have introduced a bill to preserve some of the law’s most popular provisions.

Medicare for all:

Verma argues ‘Medicare for all’ would cause physician shortage: In a speech to insurers, CMS Administrator Seema Verma claimed patients would struggle to find a doctor if the U.S. implements “Medicare for all.”

‘Medicare for all’ proves to be a tricky issue for Democrats: Progressive Democrats want to wrestle “Medicare for all” into their party’s platform. But Democratic strategists and the results of recent primaries say the country isn’t ready for it yet.

Drug prices in America

Editorial: Drug price controls? A good idea, but don’t bet on it: Once the heat of the campaign dissipates, a majority in both parties will remain susceptible to their main argument that high prices are necessary to promote innovation.

The fate of Trump’s Part B drug cost plan may depend on the Dems winning House: Trump’s Medicare Part B drug cost plan could move forward, particularly if Democrats win control of the House.

New CMS pay model targets soaring drug prices: The Trump administration’s first mandatory CMS pay model is projected to save taxpayers and patients $17.2 billion over five years by shifting Medicare Part B drugs to price levels more closely aligned with what other countries pay.

340B showdown: Big pharma, hospitals squaring off in lobbying fight: Hospitals have adopted a take-no-prisoners approach in the fight with Big Pharma over the 340B drug discount program. Can this strategy hold as Congress, oversight agencies, the courts and the Trump administration ratchet up scrutiny of the program?

Midterms 2018 ballot measures

Editorial: Medicaid expansion, dialysis, staffing ratios get grassroots push: Grassroots activism is behind both good and bad trends in policy. Consumer coalitions are behind Medicaid expansion ballot measures in several states, while other coalitions are pinpointing dialysis policy and staffing ratios.

Nurse-to-patient staffing ratios in Massachusetts

Mandated nurse-to-patient ratios spark high costs, few savings: Massachusetts voters in November will determine whether mandated staffing ratios for registered nurses will go into effect Jan. 1. Implementing the ratios could cost providers $676 million to $949 million per year.

Data Points: A state-by-state look at nurse-to-patient staffing ratios: As nurse-to-patient ratios are debated on both coasts, projections show a few states may not be able to meet future demand for registered nurses.

Dialysis ballot measure in California:

Dialysis Cos. dole out more than $100M to beat Calif. ballot measure: With just a few weeks to go until November’s elections, the dialysis industry has raised more than $105 million to defeat a ballot measure that would cap their profits at 15% of direct patient-care costs.

Calif. governor vetoes dialysis reimbursement cap: Dialysis giants DaVita and Fresenius won a major victory in California as Democratic Gov. Jerry Brown vetoed a bill that would have slashed and capped their reimbursement rates.

Impact of immigration on healthcare

Children’s hospitals bear the largest brunt of Trump immigration crackdown: Children’s hospitals could see their revenue dip if increased anti-immigration sentiment from the Trump administration causes an exodus from Medicaid. Chronically ill children on Medicaid primarily go to these facilities for their hospital stays.

Clinics catering to immigrants take a hit from White House policy: Healthcare providers who care for refugees are faced with the financial strain of having fewer new patients as a result of the Trump administration’s limits on immigration.

Healthcare groups blast proposed rule penalizing immigrants for using public benefits: The Department of Homeland Security published a proposed rule that would allow immigration officials to consider legal immigrants’ use of public health insurance, nutrition and other programs as a strongly negative factor when applying for legal permanent residency.

Immigrant detention crisis could yield a profit for some providers and payers: The influx of immigrant children under HHS’ care translates into big contracts for providers charged with the children’s medical treatment.

Trump’s immigrant healthcare rule could hurt low-income populations: The Trump administration reportedly is nearing completion of a new immigration rule that health care providers and plans fear will harm public health and their ability to serve millions of low-income children and families.

What do U.S. immigration policies mean for the healthcare workforce?:

There’s been a drop in the number of foreign-born medical graduates applying for residencies in the U.S. at the same time that the country struggles with physician staffing shortages. Industry stakeholders worry the decline comes from recent efforts to stem immigration.

So, everybody hold your noses, do your research and VOTE! We’ll see what happens Tuesday!

Newt Gingrich predicted that Ignoring health care could spell disaster for Republicans in 2018 elections. Maybe, But What About the “ME-To” Wave And All Men Are Bad?

43066034_1731880880274897_8358288627561660416_nAs Newt Gingrich wrote, the U.S. economy has been growing and breaking records ever since President Trump first took office and Republicans took control of Congress.

Many in the GOP are hoping this success will help them get re-elected in November. Some consultants I’ve spoken with seem to think it will inoculate Republican candidates against most all Democratic attacks.

They are mostly right, except for one area – health care.

Here I have to modify his thoughts. I think that after this Judge Kavanaugh circus we are, no the Democrats are not finished with the “Me To”/sexual assault and “All Men Are Bad” push. They are going to mobilize the women and some of the crazy men who will listen to their leaders.

But let us continue with the health care issue.

No doubt, Republicans should be proud of the enormous success of the economy. But the economy won’t reach its full potential and the GOP will not win big in the 2018 elections unless Republicans deal with the cost of health care in America.

The reason is simple:

Health care represents nearly one-fifth of our country’s economy and is the largest driver of government spending. It is also such a huge slice of household budgets that many Americans don’t end up feeling the benefits of the 4.1 percent growth in the gross domestic product (GDP). In 2016, individual health care costs amounted to $10,328 per person (in 1960, that figure was $146).

As Dave Winston and Myra Miller at The Winston Group have noted, with nearly half of Americans saying they are living paycheck-to-paycheck (with no reserves for emergencies) it is hard for people to “feel the prosperity” implicit in a remarkably strong macroeconomy. Their individual micro-economies are too deeply impacted by the cost of health care.

Additionally, health care costs are outpacing income growth because businesses have had to eschew raises and promotions to afford more and more health care costs. According to a 2017 report by the Kaiser Family Foundation and the Health Research & Education Trust and federal income data, “premiums for an employer-provided family insurance plan have climbed 19 percent, while worker pay increased 12 percent.” The additional money Americans are receiving in their paycheck from the Tax Cut and Jobs Act helps, but lowering health care costs still needs to be a priority.

A Republican party that hides from the challenge of modernizing the health system is a party, which has conceded a huge part of the political playing field to the left.

Fortunately for Republicans – and for the country – we now have leadership capable of developing a serious strategy for a dramatically improved health care system. Secretary of Health and Human Services Alex Azar has the knowledge and the experience to help shape a new, profoundly better health system for all Americans.

Secretary Azar’s move this week to widen access to less expensive, short-duration health insurance plans was a step in the right direction. These plans will give Americans more options to buy the level of insurance they need for themselves – rather than being forced to buy more expensive coverage they don’t necessarily need.

President Trump’s earlier announced plan for reducing prescription drug prices will also be a huge help for families, and the administration’s support for the expansion of association health plans will provide more options for small businesses and self-employed individuals.

So, while there is still more work to be done, Republicans can point to positive steps that have been taken and progress that has been made — but they can’t shy away from talking about health care.

This reality of half the nation operating on the margin is what drives support for government-run health care, which is now sweeping large parts of the Democratic Party.  If Republicans refuse to articulate a better solution, a large portion of the American people will decide that government bureaucracy is better than constant economic anxiety about unknowable, increasing health costs.

As I have written before, if the left wins on health care and puts in place a single-payer system, it would be a disaster.

So, to truly win the economic argument, Republicans must think through and win the health care argument. The dynamics of the fall campaign give them no choice. The Democrats’ government-run health care system will fill the gap left by the absence of a serious Republican alternative.

There is a long tradition of Republicans trying to avoid health issues. Consultants assert “it isn’t our topic.” Incumbents find it hard to communicate a clear policy or plan for improving the health system. “Repeal and Replace” was largely about repeal because Republicans lacked a coherent plan to replace ObamaCare. This is why it failed.

A Republican party that hides from the challenge of modernizing the health system is a party which has conceded a huge part of the political playing field to the left.

Conversely, a Republican party that can explain common sense improvements that will empower Americans to have longer lives, better health, greater convenience, more choices, and lower costs in healthcare is a party that can easily demolish the left’s arguments.

Healthcare Is The No. 1 Issue For Voters; A New Poll Reveals Which Healthcare Issue Matters Most

And as Robert Pearl, M.D. stated, depending on which news outlet, politician or pundit you ask, American voters will soon participate in the most important midterm election “in many years,” “in our lifetime” or even “in our country’s history.”The stakes of the November 2018 elections are high for many reasons, but no issue is more important to voters than health care. In fact, NBC News and The Wall Street Journal found that healthcare was the No. 1 issue in a poll of potential voters.

What’s curious about that survey, however, is that the pollsters didn’t ask the next, most-logical question.

What Healthcare Issue, Specifically, Matters Most To Voters?                                          To answer this question, I surveyed readers of my monthly newsletter. Will the opioid crisis sway voters at the polls? What about abortion rights? The price of drugs? The cost of insurance?

See for yourself:

Untitled. mid-term.elections

To understand the significance of these results, look closely at the top four:

  1. Prescription drug pricing (58%)
  2. Universal/single-payer coverage (57%)
  3. Medicare funding (50%)
  4. Medicaid funding (40%)

Notice a pattern here? All of these healthcare issues come down to one thing: money.

Healthcare Affordability: The New American Anxiety                                               Because the majority of my newsletter readers operate in the field of healthcare, they’re well informed about the industry’s macroeconomics. They understand healthcare consumes 18% of the gross domestic product (GDP) and that national health care spending now exceeds $3.4 trillion annually. The readers also know that Americans aren’t getting what they pay for. The United States has the lowest life expectancy and highest childhood mortality rate among the 11 wealthiest nations, according to the Commonwealth Fund Report. But these macroeconomic issues and global metrics are not what keeps healthcare professionals or their patients up at night. Eight in 10 Americans live paycheck to paycheck. Most don’t have the savings to cover out-of-pocket expenses should they experience a serious or prolonged illness. In fact, half of U.S. adults say that one large medical bill would force them to borrow money. The reality is that a cancer diagnosis or an expensive, lifelong prescription could spell financial disaster for the majority of Americans. Today, 62% of bankruptcy filings are due to medical bills.

To understand how we’ve arrived at this healthcare affordability crisis, we need to examine the evolution of health care financing and accountability over the past decade.

The Recent History Of Healthcare’s Money Problems

Until the 21st century, the only Americans who worried about whether they could afford medical care were classified as poor or uninsured. Today, the middle class and insured are worried, too. How we got here is a story of evolving policies, poor financial planning and, ultimately, buck-passing.

A big part of the problem was the rate of health care cost inflation, which has averaged nearly twice the annual rate of GDP growth. But there are other contributing factors, as well.

Take the evolution of Medicare, for example, the federal insurance program for seniors. For most of the program’s history, the government reimbursed doctors and hospitals at (approximately) the same rate as commercial insurers. That started to change after a series of federal budget cuts and sequestration reduced provider payments. Today, Medicare reimburses only 90% of the costs its enrollees incur and commercial insurers are forced to make up the difference. As a result, businesses see their premiums rise each year, not only to offset the growth in their employee’s medical expenses but also to compensate hospitals and physicians for the unreimbursed portion of the cost of caring for Medicare patients.

Combine two high-cost factors: general health care inflation and price constraints imposed by Medicare and what you get are insurance premiums rising much faster than business revenues.

To compensate, companies are shifting much of the added expense to their employees. The most effective way to do so: Raise deductibles. By increasing the maximum deductible annually, the company reduces the magnitude of its expenses the following year, at least until that limit is reached. A decade ago, only 5% of workers were enrolled in a high-deductible health plan. That number soared to 39.4% by 2016 and jumped again to 43.2% the following year.

High-deductible coverage holds individual patients and their families responsible for a major portion of annual healthcare costs, anywhere from $1,350 to $6,650 per person or $2,700 to $13,3000 per family. This exceeds what the average available savings for most American families and helps to explain the growing financial angst in this country.

And it’s not just employees under the age of 65 who are anxious. Medicare enrollees also fear that the cost of care will drain their savings. As drug prices continue to soar, Medicare enrollees are hitting what has been labeled “the donut hole,” which means that once the cost of their “Part D” prescriptions reaches a certain threshold, patients are on the hook for a significant part of the cost. Now, more and more seniors find themselves having to pay thousands of dollars a year for essential medications.

When it comes to paying for health care, the United States is an anxious nation in search of relief. The fear of not being able to afford out-of-pocket requirements is the reason so many voters have made health care their No. 1 priority as they head to the polls this November. And it’s why both parties are scrambling to deliver the right campaign message.

On Healthcare, Each Party Is A House Divided

In the last presidential election, the Democratic Party chose a traditional candidate, Hilary Clinton, whose views on healthcare were closer to the center than her leading challenger, Bernie Sanders. Two years later, the party is divided by those who believe that (a) the only way to regain control of Congress is by fronting centrist candidates who support and want to strengthen the Affordable Care Act as the best way to attract undecided and independent voters, and (b) those who will accept nothing less than a government-run single payer system: Medicare for all. The primary election of New York congressional candidate Alexandria Ocasio-Cortez, a Sanders supporter, over long-time incumbent Joseph Crowley, represents this growing rift within the party.

The Republicans also face two competing ideologies on healthcare. Since his election in 2016, President Donald Trump has sought to dismantle the ACA. In addition, he and his political allies want to shift control of Medicaid (the insurance program for low-income Americans) from the federal government to the states—a move that would lower health care spending while eroding coverage protection. There are others in the Republican Party who worry that shrinking Medicaid or undermining the health exchanges will come back to bite them. Most of them live and campaign in states where voters support the ACA.

Do The Parties Agree On Anything?

Regardless of party, everyone, from the president to the most fervent single-payer advocate, understands that voters are angry about the cost of their medications and the associated out-of-pocket expenses. And, not surprisingly, each party blames the other for our current situation. Last week, the president gave the Medicare program greater ability to reign in costs for medications administered in a physician’s office. In addition, Trump has promised a major announcement this week to achieve other reductions in drug costs. Of course, generous campaign contributions may dim the enthusiasm either party has for change once the voting is over.

Playing “What If” With Healthcare’s Future

If both chambers remain Republican controlled, we can expect further erosion of the ACA with more exceptions to coverage mandates and progressively less enforcement of its provisions. For Republicans, a loss of either the Senate (a long-shot) or the House (more likely), would slow this process.

But regardless of what happens in the midterms, no one should expect Congress to solve healthcare’s cost challenge soon. Instead, patient anxiety will continue to escalate for three reasons.

First, none of the espoused legislative options will do much to address the inefficiencies in the current delivery system. Therefore, prices will continue to rise and businesses will have little choice but to shift more of the cost on to their workers. Second, the Fed will persist in limiting Medicare reimbursement to doctors and hospitals, further aggravating the economic problems of American businesses. whose premium rates will rise faster than overall health care inflation. Finally, compromise will prove even more elusive since so many leading candidates represent the extremes of the political spectrum.

Politics, the economy, and health care will all be deeply entangled this November and for years to come. I believe the safest path, relative to improving the nation’s health, is toward the center. Amending the more problematic parts of the ACA is better than either of the two extreme positions. If our nation progressively undermines the current coverage provisions, millions of Americans will see their access to care erode. And on the other end, a Medicare-for-all health care system will produce large increases in utilization and cost.

It’s anyone’s guess what will happen in three months. But, whatever the outcome, I can guarantee that two years from now healthcare will remain top-of-mind for voters.

The Memo: GOP to win Kavanaugh fight but Dems vow midterm revenge

Niall Stanage noted that Brett Kavanaugh is set to be confirmed to the Supreme Court on Saturday, notching a big victory for President Trump and the Republican Party — but one that carries sizable complications.

Democrats believe their voters are now more fired up than ever to deliver a rebuke to the GOP in the November midterm elections.

They vow that women’s anger at the judge’s near-certain confirmation, despite allegations of sexual assault and misconduct against him, will be a potent electoral force.

“What I have seen is anger and outrage from women in a way that I’ve never seen before,” said Karine Jean-Pierre, senior adviser and national spokeswoman for MoveOn, a progressive group. “I don’t think Republicans realize what they have unleashed.”

One national women’s group, UltraViolet Action, issued a stark two-sentence statement Friday from co-founder Shaunna Thomas.

“This doesn’t end tomorrow. It ends in November,” Thomas said.

Sen. Kamala Harris(D-Calif.), widely predicted to become a 2020 presidential candidate, made a broader argument that the GOP had disrespected women by backing Kavanaugh.

“To all survivors of sexual assault: We hear you. We see you. We will give you dignity. Don’t let this process bully you into silence,” Harris tweeted as the Kavanaugh drama neared its peak on Friday afternoon in the Senate.

Some Republicans had expressed concern earlier this week when Trump mocked Kavanaugh’s most prominent accuser, Christine Blasey Ford, during a rally in Mississippi. They worried that the president’s rhetoric seemed likely to cause deeper erosion of support for the GOP among suburban women in particular — a demographic that is already skeptical of the president.

An NPR/PBS/Marist poll conducted in late September showed Trump’s job approval rating to be very negative among college-educated white women. Fifty-seven percent within that group disapproved of Trump’s job performance, whereas only 38 percent approved.

At that time, GOP strategist Liz Mair told The Hill: “The party is already in trouble with suburban women. I just have a sneaking suspicion that the Republicans will find a way to mess this up. We are already in trouble with a group of voters we need to not totally hate us.”

But by Friday such concerns seemed to have been supplanted by satisfaction about getting Kavanaugh to the finish line.

Republicans believe they will be rewarded by conservative voters who might not have gone to the polls had GOP senators proved unable to confirm Kavanaugh, who’s spent the past 12 years as a judge on the U.S. Court of Appeals for the District of Columbia Circuit. Many social conservatives voted for Trump with a degree of ambivalence in 2016, given his colorful personal life, but did so in the hope that he would tilt the Supreme Court in their favor.

Kavanaugh’s confirmation would give the nine-member high court a solid 5-4 conservative majority.

“At the moment it appears that Republican voters, Trump voters, have re-engaged and are heading to the polls,” said GOP pollster John McLaughlin on Friday.

Had Kavanaugh plunged to defeat, McLaughlin asserted, “you would have a lot of angry Trump voters who would blame the Republicans and not show up” for the Nov. 6 midterms.

The Kavanaugh drama came to a head on Friday afternoon when Sen. Susan Collins(R-Maine), who had not previously declared her position, announced she would support him.

Moments after her announcement, Sen. Joe Manchin (D-W.Va.) became the only Democrat to cross party lines to back the judge. Manchin is seeking re-election this year in a state that Trump carried by 42 points in 2016 over Hillary Clinton.

The liberal dismay about those decisions was immediately evident on social media and elsewhere.

Susan Rice, who served as U.S. ambassador to the United Nations during former President Obama’s administration, suggested she would be willing to challenge Collins when she comes up for reelection in 2020. It was not clear if Rice was being serious.

Democracy for America, a progressive group, announced that it would work with “anyone we can to finish the job” of defeating Collins.

In a parallel development, former Alaska Gov. Sarah Palin (R) suggested she would consider challenging Sen. Lisa Murkowski(R-Alaska), who voted against Kavanaugh in a procedural vote Friday morning.

“Hey, @LisaMurkowski – I can see 2022 from my house…” Palin tweeted, referring to the year when Murkowski is up for reelection.

Beyond that, the sheer bitterness of the battle over Kavanaugh is striking to all sides.

“The starting gun for the 2020 election was fired with this confirmation fight,” said Ron Bonjean, a Republican who served as a communications strategist in the battle to confirm Trump’s first Supreme Court nominee, Neil Gorsuch, in 2017.

“This rollercoaster nomination has bonded both parties together in a way,” Bonjean added, “because of the intensity of it, how close this vote was and the unfair tactics both sides claimed the other party utilized.”

The president seemed to begin a victory lap on Friday. “Very proud of the U.S. Senate for voting ‘YES’ to advance the nomination of Judge Brett Kavanaugh!” he tweeted.

Democrats are hoping that air of celebration will be short-lived.

Who is correct? We will soon see!

 

Survey Shows that Worries about Healthcare​ Will Follow Voters into the Voting Booth, Waiting for Healthcare in Canada and Some Progress Finally!!

41715310_1709429559186696_758100051737182208_nIf anyone doubts the significance of our discussion regarding how important health care discussion is in the voters’ minds. Look at this survey! Oh, those greedy angry politicians and the mid-term elections!! The question is what are our politicians interested in?

I had an interesting conversation with a strategist for the Democratic party and she agreed with me that even if the Republicans in the House and the Senate came up with a solution to health care and or immigration that fulfilled their wants and needs, they wouldn’t approve or vote in favor of any bills until after the mid-term election to which they expected to declare their majority position.

Jenny Dean reviewed a survey, which showed that of the 37 percent of voters nationwide who planned to vote for President Donald Trump in the 2020 election, more than a third of Republicans and 37 percent of Independents said in a survey conducted by the Texas Medical Center that they would change their mind if his policies led to an increase in the uninsured. When the majority of voters across the country head to the voting booth in November and again in 2020, the politics of health care will not be far from their thoughts.

That’s the finding of the fourth annual Texas Medical Center’s national consumer survey, released Wednesday, which gauges attitudes on health issues, ranging from support of President Donald Trump’s policies to whether foods laden with fat and sugar should cost more.

“The Nation’s Pulse,” the survey questioned 5,038 people across 50 states, including 1,018 people in Texas. Respondents were both Democrats and Republicans but also included those who identified as Independent. Nearly two-thirds, or 61 percent, said they would be likely to only vote for candidates who promise to make fixing health care a priority. Additionally, the majority of voters said it was important that candidates share their views on such hot-button issues as the expansion of Medicaid. Those views held both in states that expanded Medicaid under the Affordable Care Act and in the 17 states, including Texas that did not.

Survey responses at a glance

Likelihood to only vote for a candidate who wants health care fixed:

Democrats: 68 percent

Republicans: 60 percent

Independent: 53 percent

Plan to vote for Donald Trump in 2020:

U.S (all parties).: 37 percent

Texas (all parties): 38 percent

2020 Trump voters who would change their mind if the uninsured rate rises:

Republicans: 35 percent

Independents: 37 percent

Democrats: 60 percent

Texans who support Medicaid expansion:

60 percent

Texans who support Medicare for all:

55 percent

Support lowering legal blood alcohol limit while driving to 0.0 percent:

U.S.: 46 percent

Texas: 48 percent

Think foods that lead to obesity should cost more:

U.S. 51 percent

Texas: 56 percent

Source: Texas Medical Center Health Policy Institute

Across all political parties, 60 percent of Texans favored a Medicaid expansion, according to the survey. This comes despite years of steadfast opposition from state leaders. It also closely mirrors a similar survey in June by Houston-based Episcopal Health Foundation and the Kaiser Family Foundation that found 64 percent of Texans wanted a Medicaid expansion.

But perhaps most striking was that “Medicare for All” health coverage — once politically unthinkable in Texas —found surprising favorability with 55 percent in the state saying they would support it. That compares with 59 percent nationwide, the survey found.

“With health care so expensive and increasingly unaffordable, the respondents told us that it is important to try to fix it,” said Dr. Arthur “Tim” Garson, director of the Texas Medical Center Health Policy Institute, which led the study.

While the bitter health care debate of a year ago has slipped mostly out of the headlines, it apparently has not slipped from people’s minds, political operatives from both parties said Tuesday.

Neither Glenn Smith, an Austin-based progressive consultant nor Jamie Bennett, vice president at Potomac Strategy Group, a right-leaning political consulting firm, were especially surprised when told of the survey results.

“I think (health care) is the most critical domestic issue that we face today,” said Smith, adding that worries about affordability and access are “ever-present” in people’s lives.

“Health care is a very important issue for our elected leaders to solve,” agreed Bennett in an email, “It makes up the majority of the federal budget and affects every American at some point in their lifetime. I think health care will continue to be a central issue in the mid-terms and 2020 presidential election — especially given the inaction from the federal level.”

Looking ahead to 2020, the survey zeroed in on Trump supporters. Of the 37 percent of voters nationwide who planned to vote for the president, more than a third of Republicans and 37 percent of Independents said they would change their mind if his policies led to an increase in the uninsured.

Such potential defection did not surprise Smith. “That is one of the things that could knock significant numbers from his base,” he said. Garson cautioned, though, the presidential race is still two years away. “You don’t know until Election Day what people will do,” he said,

There were differences, however, in how party affiliation affected priorities. While reducing costs was considered the highest priority across the board, Democrats listed universal coverage as next, while Republicans and Independents said affordability was the second highest priority.

In other issues, the survey found nearly half of Americans, including those in Texas, supported lowering the legal blood alcohol limit while driving to 0.0. It is currently .08 in Texas. Also, an overwhelming majority in all states wanted the age of buying tobacco products raised to 21, and more than half said that foods that lead to obesity should cost more.

The policymakers and politicians continue to point to the Canadian health care system as one that we should use as the model for our system here in the U.S.A. ’Canadians are one in a million — while waiting for medical treatment

Sally Pipes points out that Canada’s single-payer healthcare system forced over 1 million patients to wait for necessary medical treatments last year. That’s an all-time record.

Those long wait times were more than just a nuisance; they cost patients $1.9 billion in lost wages, according to a new report by the Fraser Institute, a Vancouver-based think-tank.

Lengthy treatment delays are the norm in Canada and other single-payer nations, which ration care to keep costs down. Yet more and more Democratic leaders are pushing for a single-payer system — and more and more voters are clamoring for one.

Indeed, three in four Americans now support a national health plan — and a new NBC/Wall Street Journal poll finds that health care is the most important issue for voters in the coming election.

The leading proponent of transitioning the United States to a single-payer system is Sen. Bernie Sanders, Vermont’s firebrand independent. If Sanders and his allies succeed, Americans will face the same delays and low-quality care as their neighbors to the north.

By his own admission, Sen. Sanders’ “Medicare for All” bill is modeled on Canada’s healthcare system. On a fact-finding trip to Canada last fall, Sanders praised the country for “guaranteeing health care to all people,” noting that “there is so much to be learned” from the Canadian system.

The only thing Canadian patients are “guaranteed” is a spot on a waitlist. As the Fraser report notes, in 2017, more than 173,000 patients waited for an ophthalmology procedure. Another 91,000 lined up for some form of general surgery, while more than 40,000 waited for a urology procedure.

All told, nearly 3 percent of Canada’s population was waiting for some kind of medical care at the end of last year.

Those delays were excruciatingly long. After receiving a referral from a general practitioner, the typical patient waited more than 21 weeks to receive treatment from a specialist. That was the longest average waiting period on record — and more than double the median wait in 1993.

Rural patients faced even longer delays. For instance, the average Canadian in need of orthopedic surgery waited almost 24 weeks for treatment — but the typical patient in rural Nova Scotia waited nearly 39 weeks for the same procedure.

One Ontario woman, Judy Congdon, learned that she needed a hip replacement in 2016, according to the Toronto Sun. Doctors initially scheduled the procedure for September 2017 — almost a year later. The surgery never happened on schedule. The hospital ran over budget, forcing physicians to postpone the operation for another year.

In the United States, suffering for a year or more before receiving a joint replacement is unheard of. In Canada, it’s normal.

Canadians lose a lot of money waiting for their “free” socialized medicine. On average, patients forfeit over $1,800 in lost wages. And that’s only counting the working hours they miss due to pain and immobility.

The Fraser Institute researchers also calculated the value of all the waking hours that patients lost because they couldn’t fully function. The toll was staggering — almost $5,600 per patient, totaling $5.8 billion nationally. And those calculations ignore the value of uncompensated care provided by family members, who often take time off work or quit their jobs to help ill loved ones.

Canada isn’t an anomaly. Every nation that offers government-funded, universal coverage features long wait times. When the government makes health care “free,” consumers’ demand for medical services surges. Patients have no incentive to limit their doctor visits or choose more cost-efficient providers.

To prevent expenses from ballooning, the government sets strict budget caps that only enable hospitals to hire a limited number of staff and purchase a meager amount of equipment. Demand inevitably outstrips supply. Shortages result.

Just look at the United Kingdom’s government enterprise, the National Health Service, which turns 70 this July. Today, British hospitals are so overcrowded that doctors regularly treat patients in hallways. The agency recently canceled tens of thousands of surgeries, including urgent cancer procedures, because of severe resource shortages. And this winter, nearly 17,000 patients waited in the backs of their ambulances — many for an hour or more — before hospital staff could clear space for them in the emergency room.

Most Americans would look at these conditions in horror. Yet Sen. Sanders and his fellow travelers continue to treat the healthcare systems in Canada and the UK as paragons to which America should aspire.

Sen. Sanders’s “Medicare for All” proposal would effectively ban private insurance and force all Americans into a single, government-funded healthcare plan. According to Sen. Sanders, this new insurance scheme would cover everything from regular check-ups to prescription drugs and specialty care, no referral needed — all at no charge to patients.

Americans shouldn’t fall for these rosy promises. As Canadians know all too well, when the government foots the bill for health care, patients are the ones who pay the biggest price.

Sanders was asked to respond to comments Schultz made about the plan in another interview.

Schultz recently announced that he would be leaving Starbucks and said he was considering “public service.” He said on CNBC he was concerned about the way “so many voices within the Democratic Party are going so far to the left.”

Sen. Bernie Sanders said Medicare-for-all is a “cost-effective” program.

“And I ask myself, how are we going to pay for all these things? In terms of things like single-payer or people espousing the fact that the government is going to give everyone a job, I don’t think that’s realistic,” he said.

CNN’s Chris Cuomo asked Sanders about the possibility of Schultz running as “the Left’s Trump” who may go up against the current president in 2020.

Sanders said he didn’t know Schultz but his comment was “dead wrong.”

“You have a guy who thinks that the United States apparently should remain the only major country on earth not to guarantee health care to all people,” Sanders said. “The truth of the matter is that I think study after study has indicated that Medicare for All is a much more cost-effective approach toward health care than our current, dysfunctional health care system, which is far and away the most expensive system per capita than any system on Earth.”

But there was progress made as evidenced in that the Senate finally Passes Historic Health Spending Bill and the Package includes funding for cancer, opioids, and maternal mortality

Shannon Firth a Washington Correspondent, for the MedPage, wrote that a spending bill that boosts funding for medical research while also taking aim at the opioid epidemic and maternal mortality passed the Senate on Thursday in a vote of 85-7.

The $857-billion “minibus” package bundled funding for Department of Health and Human Services (HHS) as well as for the Defense, Labor, and Education departments.

Senators Mike Lee (R-Utah), Jeff Flake (R-Ariz.), Rand Paul (R-Ky.), Bernie Sanders (I-Vt.), Pat Toomey (R-Pa.), Mike Crapo (R-Idaho) and James Risch (R-Idaho) voted against the bill.

Attention now turns to the House of Representatives, which has not yet acted on a bill to fund HHS. Congress faces a Sept. 30 deadline to enact a funding package to avoid a shutdown of the affected departments.

What’s in It?

The legislation provides $2 billion in additional funding for the National Institutes of Health (NIH), including $425 million for Alzheimer’s research and $190 million for cancer research. It also maintains current levels of CDC spending for cancer screening and early detection programs, as well as for the agency’s Office of Smoking and Health.

Also woven into the package: $3.7 billion for behavioral and mental health programs targeting opioid addiction — an increase of $145 million over the FY2018 budget — including $1.5 billion in State Opioid Response Grants from the Substance Abuse and Mental Health Services Administration; $200 million to increase prevention and treatment services in Community Health Centers; and $120 million to address the epidemic’s impact in rural areas through support for rural health centers. The bill also dedicates $50 million to programs aimed at tackling maternal mortality.

Sen. Patty Murray (D-Wash.) lauded the investment in ending maternal mortality in a press statement.

“It is completely inexcusable that mothers are more likely to die in childbirth in our country than any other country in the developed world, and long past time we treated this issue like the crisis it is,” she said.

New Push for Research

Sen. Roy Blunt (R-Mo.), speaking on the Senate floor Thursday, blasted the short shrift given to NIH from 2003 to 2015.

Should this bill become law, the agency will see a nearly 30% increase in its reserves — from $30 billion to $39 billion, he added.

Already, heightened funding since 2015 has driven efforts to develop new vaccines, rebuild a human heart using a patient’s own cells, and identify new nonaddictive painkillers — “the holy grail of dealing with the opioid crisis” — said Sen. Lamar Alexander (R-Tenn.), chairman of the Health Education Labor and Pensions Committee, during a committee hearing on Thursday.

In addition, NIH Director Francis Collins, MD, Ph.D., said at the hearing that the new monies will let the agency award 1,100 new grants to first-time investigators through the Next Generation Researchers Initiative — the largest number to date.

On the Senate floor, Sen. Ed Markey (D-Mass.) stressed the importance of NIH funding to curb the costs of health care, especially of Alzheimer’s disease.

“If we do not find the cure for Alzheimer’s by the time we reach the year 2050, the budget at Medicare and Medicaid for taking care of Alzheimer’s patients will be equal to the defense budget of our country,” he said.

“Obviously, that is non-sustainable,” Markey noted.

U.S. taxpayers currently spend $277 billion on patients with Alzheimer’s disease. By 2050, that figure is projected to grow to $1.1 trillion, Blunt noted.

Also Wrapped In… 

The minibus package also included the following:

  • $1 million for HHS to develop regulations stipulating that drug companies include the price of the drug in any direct-to-consumer advertisements — an idea supported by HHS Secretary Alex Azar
  • Full funding for the Childhood Cancer STAR Act which involves collecting medical specimens and other data from children with the hardest to treat cancers, and supports research on the challenges pediatric cancer survivors encounter within “minority or medically underserved populations”
  • The requirement that the HHS Secretary provide an update on rulemaking related to information-blocking, as mandated in the 21st Century Cures Act
  • Funds “Trevor’s Law,” which seeks to enhance collaboration among federal, state, and local agencies and the public in investigating possible cancer clusters
  • Mandates that CDC report on the Coal Workers Health Surveillance Program, which targets black lung disease among coal miners

An amendment from Paul aimed at defunding Planned Parenthood failed in a vote of 45-48.

Docs, Wonks Weigh In

Stakeholders in medicine applauded the Senate’s work.

“[T]his bill will enable the nation’s medical schools and teaching hospitals, which perform over half of NIH-funded extramural research, to continue to expand our knowledge, discover new cures and treatments, and deliver on the promise of hope for patients nationwide,” said Darrell Kirch, MD, president and CEO of the Association of American Medical Colleges, in a press statement.

These new NIH monies will also help support “well-paying jobs across the country, strengthen the economy … and make America more competitive in science and technology,” Kirch said; he urged the House to pass a similar measure as quickly as possible.

The American Heart Association also applauded the Senate’s bipartisan achievement.

“Sustained funding for the NIH is critical to ensuring the nation’s standing as a global leader in research. Even more importantly, it opens an abundance of possibilities in pioneering research that could help us conquer cardiovascular disease, the no. 1 killer in America and around the world,” said Ivor Benjamin, MD, president of the AHA.

Members of the right-leaning Heritage Foundation, however, were disappointed.

“The bill fails to make any program reforms or policy recommendations to address Obamacare. Congress still needs to provide relief to the millions suffering under Obamacare’s reduced choices and higher costs,” said a Heritage report issued Wednesday.

The departments to be funded by the minibus package account for more than 60% of discretionary federal spending for 2019, so there was some positive movement on the health care system despite our political dysfunction. Where do we go next?