Just a few points as everyone should be calling their House representatives right now.
First, Kaiser Family Foundation is looking at the implied deductibles of the AHCA compared to the ACA:
Deductibles would likely rise 61% under the GOP health care plan. New post from @DrewAltman on @axios w/ KFF #'s https://t.co/T0uki9bOAZ pic.twitter.com/Y37yAfFxDD
— Cynthia Cox (@cynthiaccox) March 22, 2017
Secondly, this is under-reported this week, we need to be aware that attempts to lower the cost of care in Medicare will be made much more difficult under this administration.
The CMS has delayed the expansion of a major bundled payment pilot, Comprehensive Care for Joint Replacement, and the implementation of its bundled payment initiatives for cardiac care from July 1 to Oct. 1, 2017, according to an interim final rule posted to the Federal Register. It also delayed, for a second time, the effective date of a final rule laying out the implementation of CJR and other bundled payment programs, from March 21 to May 20, 2017.
The agency also delayed its Cardiac Rehabilitation Incentive Payment Model and is also weighing whether to push back implementation of all bundled payment initiatives even further, until 2018. These programs are mandatory, and different from the voluntary Bundled Payments for Care Improvement initiative, which is not affected by the interim rule.
So get off of this blog, and start calling Congress.
Sab
We was commenting about your invaluable posts in an earlier thread in the middle of the night. Thanks for all you do. Not many comments, but many readers.
David Anderson
@Sab: Thank you, and I know what and how I write does not lead to too many comments, but that has never been my metric of personal success with Balloon Juice.
Barbara
Just called my represenative in midnight blue Arlington to thank him. I got through right away. His vote is not in doubt. Nor is Gerry Connolly’s, but if you live in VA-10 with Barbara Comstock, call, call, call. It won’t change her vote but you will be glad you did.
Barbara
@David Anderson: You get the best commenters!
Starfish
I called my representative in the House about this issue. I called my Democratic Senator about the Supreme Court nominee because he seems to want to support him because the nominee is from our state.
BC in Illinois
Have called or e-mailed my absolutely-dependable-Republican Congresswoman on a regular basis. [Ann Wagner, R – Financial Industry] Did it again this morning. I wonder how quickly one gets put into the category of “Oh, it’s him again.”
Congresswoman Wagner seems actually excited about two things: repealing the “disaster that is the ACA” and freeing financial advisors from being required to act in the best interest of their clients.
But I’ll keep calling and writing. Sigh.
BC in Illinois ( really Missouri )
Barbara
I also sent contact information to some people I know living in Republican districts and urged them to call. This is not like me, but I only contact people I know are reliably liberal and probably just as outraged as I am.
tobie
I’ve been calling Andy Harris (MD District 1) almost daily. He’s horrible, will vote for the AHCA but, yeah, it feels good to sound the alarm that the bill will really hurt his poor, rural district.
hedgehog mobile
Done. Diana DeGette (CO 1) is a solid no. I thanked the staffer and asked him to pass along my thanks to the Congresswoman.
JMG
@tobie: I believe Harris said he’s a no vote just yesterday. That doesn’t mean anything until he actually does it, but it indicates he’s feeling enough pressure to at least lie about it.
David Anderson
@JMG: The tell tomorrow is if they have the vote is if there are 23 GOP NO votes in the first few minutes — and then those 23+ leave the chamber and go get drunk. If they are still on the floor after casting NO votes, the issue will still be in doubt as arms can be twisted.
tobie
@JMG: Thanks for this update. Glad to know calls do count for something afterall!
Barbara
The person I contacted lives in PA-5, with Glenn Thompson and just looking at his website made me mad. Front and center is a suggestion that if you want young people to go into farming you should start by forgiving student loans for young farmers. Forget about everyone else, right, let’s focus on the less than 1% of college students who might otherwise go into farming but for their college loans. That’s the kind of identity politics that is being played out there and his district encompasses Penn State University, the largest residential university in the entire state. (U Pitt probably has more students, but most are part-time or commuting.)
germy
@Barbara:
But they went to college so they wouldn’t have to farm.
Mike J
@David Anderson: what you do is too important for our usual snark. Lack of comments is an excess of respect for what you have to say.
JMG
I am of the opinion that the bill will pass the House, perhaps not by as many as five votes, because if it doesn’t, the congressional Republicans will look like hopeless frauds. They can’t abide that. They will tell themselves that voters who lose insurance will forgive them because of “tax cuts” and “growth.” This could only be assumed by people whose own insurance is excellent. But it’d kick the consequences of their vote down the road for a year and eight months. These are not people given to long-term thinking.
About the Senate, I don’t know.
zhena gogolia
@BC in Illinois:
I don’t know which is more frustrating — having a jerk as a representative (your situation) or having a wonderful representative who has no power (my situation).
tobie
@Barbara: I’ve never met people who feel more entitled to govt aid than rural Americans. In my area, which is in the Chesapeake Bay watershed, the state of MD forks over as much as $50,000 for people to get new septic systems. You point this out to the Republican voters in the district and they always say that they paid for it with their taxes. They’re convinced they’re the salt of the earth and everyone else is a freeloader.
jonas
@germy:
Farming’s a business — and a complex one at that these days. I don’t see how you can really do it if you *don’t* have a degree. I ran into someone recently who was surprised that a dairy farmer here in CNY they were talking to one time had an advanced degree from Cornell. A lot of upstate farm kids planning to take over the family business go to Cornell. It’s the only land-grant/Ivy League college, and if you major in Ag Sciences, you pay the equivalent of in-state public school tuition.
tobie
@jonas:
No one’s denying that. It’s just that farmers shouldn’t be the only group that has its college loans forgiven.
CaseyL
@JMG: McConnell’s already said if the bill gets to the Senate they’ll take it straight to the floor for a vote: no hearings, no filibuster.
I know my Rep will vote against – Pramila Jayapal doesn’t need anyone’s encouragement to be a firebrand – and am reasonably sure about my Senators.
jonas
I’m in Claudia Tenney’s (NY-22) district, and she was on the fence, but is now leaning yes after the Buffalo Buyout scam was introduced. No guarantee that will go through, either, but her office got a (polite) earful from me on that this morning. As well as slashing the NEH/NEA.
I have to say, though, the fact that Tenney, a big Tea Party/Trump-supporting right winger, isn’t putting herself out there on the front page of the local papers posing with a chainsaw next to a sign with Obamacare written on it and was even leaning “no” at one point is a strong indication that she’s getting furious pushback on this. Her colleague John Katko (R-Syracuse) has come out dead-set against the AHCA. Having a huge public hospital that’s one of the major employers in your district tends to focus your mind on these issues.
germy
Quote from a thinkpiece over at WaPo
germy
https://www.washingtonpost.com/news/wonk/wp/2017/03/22/the-only-obamacare-replacement-that-will-work-is-obamacare/?hpid=hp_no-name_hp-in-the-news%3Apage%2Fin-the-news&utm_term=.f02da69d9e00
The only ObamaCare replacement that will work is ObamaCare.
AKA the Affordable Care Act.
tobie
@CaseyL:
And meanwhile Democrats are concerned about using the filibuster against Gorsuch. I’ve never said it before because I hate the sexism of the expression but, C’mon, grow some!
zhena gogolia
@germy:
They’re a very fit, health-conscious family, until their teenage son wipes out on his mountain bike and incurs brain damage.
JCJ
Wow. Bundled payments seem like one of the best ways to control costs. Surveys that compare how much a hip replacement can cost in one hospital vs another are amazing.
From the Philadelphia Business Journal:
http://www.bizjournals.com/philadelphia/morning_roundup/2015/06/knee-hip-replacement-surgery-charge-phc4-report.html
And in case anyone is concerned that this is a race to the bottom, this article is a good reference
http://archive.jsonline.com/business/payment-model-shows-potential-to-lower-costs-and-improve-quality-b99706511z1-375951591.html
germy
Gee. This isn’t how my local TV news station reported it this morning. The pretty lady reporter said “Manafort made some money working for an aluminum corporation but denies any wrongdoing.”
But my local TV news station is owned by the sinclairr fammily.
I turned my TV on this morning because I was looking for a weather report.
jonas
@tobie: Absolutely.
hedgehog the occasional commenter
@zhena gogolia: This. Or someone gets diagnosed with cancer, which does not care about your health or fitness. Or a car wreck…or…I am with schroedinger’s cat, I cannot even with these idjits.
schrodingers_cat
@germy: Again, the celebration of stupidity by the so-called watchdogs, the media. Its not a coincidence.
Barbara
@jonas: Thanks for saying that so I didn’t have to.
dlm
@Barbara: I’m in PA-06 with Ryan Costello-R. He’s all for killing ACA. I’ve called, I’ve written letters.
Toomey is the same. No problems killing human beings.
What do we do? Should we die in the hallways outside of their offices? Or should we show up at their houses and die on the front lawn.
I’m serious. I feel completely helpless.
germy
@zhena gogolia:
For some reason I see more and more of these “forego health insurance” stories on TV and online, and I suspect it’s because somebody wants me to feel ashamed about demanding affordable health insurance.
Mary G
@germy: So when Travis, his wife, or one of their kids gets hit by an uninsured drunk driver and the life flight helicopter alone is $20,000 and intensive care is $400,000 for the first couple of days, they’ll just take the money out of savings. Yeah, right.
JMG
@dlm: Let them know, repeatedly, you will vote against them and tell everyone else you know to do the same. It’s all you can do. It won’t change their votes, but you won’t feel quite as helpless.
Barbara
@hedgehog the occasional commenter: Or someone falls down the steps and injures their back and can’t walk in the morning. It happened to my husband, who among other things, is an expert skier and bikes to work and whose parents and grandparents lived into their 90s.
Barbara
@JMG: And if a lot of people like you are calling then they can’t say they didn’t know about opposition in their district, which is what they are inclined to say when they don’t get calls.
Barbara
@David Anderson: The model is Medicare Part D. The vote was left open for close to two hours while various House leaders roamed the chamber making unsubtle threats. I think there are rules about leaving the chamber so I don’t know if they can actually leave until the vote closes but I don’t actually know.
germy
@Barbara:
A suddenly discovered suspicious lump can change a family’s life forever. I speak from experience.
Sab
@germy: I remember a story 5 or 10 years ago that was all over the cable news. A 20 something woman was bitten by a copperhead snake when she got out of her car to hike or something. Her leg swelled up to twice it’s normal size. She spent a week in the hospital, and was facing about 50 grand in medical bills. The only one of the many news outlets that asked why the phuck didn’t she have health insurance was the Guardian in the UK. Youngsters also need insurance. Stuff happens, and any contact with medical care is expensive.
Barbara
@germy: The guy in the article said that he was willing to pay for catastrophic insurance. And the funniest part (for me) is that he is a personal injury attorney. Maybe he thinks that if something bad happens he will be able to sue someone for lots of money.
germy
@Sab:
And the 20 somethings pay much more for car insurance. Because the car insurance people know 20 somethings are more likely to get into an accident.
germy
@Barbara:
But I thought republicans were the “tort reform” party.
germy
Our Secretary Of State didn’t even want the job:
David Anderson
@JCJ: Charged rate is irrelevant. Contract rate is what matters.
David Anderson
@Barbara: Yeah, my collection of nerds has a pool on how long the vote is open (using Price is Right rules, I have 201 minutes as my bid)
Ella in New Mexico
@Barbara: @germy: @jonas:
I know, I know this is SOOO off track/topic but as a person who lives in a very rural state with a fantastic Land Grant university Agriculture College, just want to say a couple of things that came to mind about your interchange re: farmers/education/loans:
A. My nearby state university was founded under the Morrell Land Grants of 1862 and 1890 in this rural part of the state, and it has a fantastic bunch of programs in its College of Agricultural, Consumer and Environmental Sciences. Ag majors are GOOD for agriculture and ranching, period. We want people with solid science backgrounds, educated in sustainable agronomy, best practices in animal science, natural resource and wildlife conservaton doing the work of farming and resource management. . These educated agriculture folks have a good relationship with our state Departments of Agriculture and Extension outreach programs, which means they’re less likely to be doing stupid and dangerous things to harm the environment or create negative impacts on human safety. So YAAAAY for Ag Education!! I’ve got two Ag Natural Resource/Wildlife grads who are doing good things in the world because of their degrees, and farmers and ranchers are some of their best partners in protecting the environment.
B. If our country is to move towards sustainable farming and ranching, we really DO need to encourage more people to try and run small, family-based or independent farms who produce LOCAL produce, meat and dairy products using organic and/sustainable practices. Right now, if you work for a non-profit organization, a school or government program you can pay your student loans back based on income and then, after ten years, have the remainder forgiven. I would be all for the kinds of Agriculture degrees that fall into a category that improves our food supply and our environment having benefit of that program. It would literally change the way we feed the country, helping shift supply chains away from Big Corporate Ag production and back to communities.
For example, my daughter is dating a young man who want’s to go into business with his brother to run an aquaculture farm that essentially sets up a complex ecosystem with mutually beneficial interrelationships to produce food and plant products. He has a BS in Chem E, his brother in Agricultural Biology and Econ. The start up costs will be huge, and both have student loans. Why not encourage them to pursue that?
Barbara
@Ella in New Mexico: Sure, of course, those are good ideas, but why not work for a few years and save money? Why not make college cheaper? Singling out agriculture related degrees when SO MANY people have college loans just strikes me as unfair, not because farming is not worthwhile, it is, but because a lot of other things are also worthwhile and it is not clear to me that students with ag degrees have greater need for loan forgiveness.
Peter Moore
David,
Are there some incremental (i.e. not single payer) changes that Democrats could and should propose for ACA? To at least get us on record as actually trying to solve the problem.
For example, I’ve heard some pretty awful anecdotes about lower middle class families getting really squeezed between expensive high deductible plans and the tax penalty for no insurance. How real is this? Is it simply a competition issue in their state? Could/should this be handled by the hardship exemption? Or are there something relatively small tweaks that could be done to reduce the issue?
And are there other tweaks that would help? For example, as I remember Mario Rubio killed an adjustment risk corridors. Would undoing that help?
David Anderson
@Peter Moore: I will have more to say on this very good question next week.. but yes, there are plausible tweaks (extend CSR up income scale or do a single comprehensive subsidy, get rid of family glitch, max cap % of income for health without regard to income level etc) Big problem is all cost money.