Health Care Emergency:

  • 01/05/2017
  • Paul Rosenberg

Trump, GOP Threaten Obamacare, Medicare and Medicaid

By Paul Rosenberg, Senior Editor

“I am going to take care of everybody,” [getting health care],” Donald Trump told 60 Minutes correspondent Scott Pelley in September, 2016. “Everybody’s got to be covered. This is an un-Republican thing for me to say!”

Saying that—and other un-Republican things—is a very large part of why Trump was elected. But he lied. And Pelley, like so many others, let him lie.

Trump’s actual health care plan, “Healthcare Reform to Make America Great Again,” wouldn’t cover everybody. An analysis four months earlier by the non-partisan Committee for a Responsible Federal Budget found that Trump’s plan “would cause almost 21 million people to lose their insurance coverage, as the replacement health care policies would only cover 5 percent of the 22 million individuals who would lose coverage upon the repeal of the Obamacare. This would almost double the number of Americans without health insurance.”

Others pointed out that repealing the Affordable Care Act, also known as Obamacare, would also eliminate recent improvements to Medicare and make its trust fund less solvent. Additionally, Trump’s proposal to grant states fixed block grants rather than federally funding each Medicare recipient would significantly weaken the program, paving the way for future cuts. This means Trump’s plan is a lie with regard to his repeated campaign promise to protect Social Security, Medicare and Medicaid.

Trump knew what he was doing, even if Pelley did not. As far back as 2013, Trump told a gathering of conservative activists, “As Republicans, if you think you are going to change very substantially for the worse Medicare, Medicaid and Social Security in any substantial way, and at the same time you think you are going to win elections, it just really is not going to happen.”

With the election over, all bets are off.  Within days of Trump’s win, House Speaker Paul Ryan went on Fox News to renew his long-time push to privatize Medicare, accurately revealing that GOP attacks on Medicare, Medicaid and Obamacare are all interrelated, while falsely claiming that “because of Obamacare, Medicare is going broke.” (Actually, Obamacare extended Medicare’s financial stability.)

tom-price

Republican Rep. Tom Price is Donald Trump’s nominee to lead the Department of Health and Human Services. Price advocates privatizing Medicare. File photo

Trump followed up by nominating Ryan’s close ally, Rep. Tom Price, to head the Department of Health and Human Services. And the fight was on.

“Tom Price at HHS is someone who has advocated for privatizing Medicare in the past; there’s just no way that’s a good situation,” Brad Wright, a spokesman for the National Committee to Preserve Social Security and Medicare, told Random Lengths.

Price has also advocated slashing Medicaid and replacing Obamacare with a much weaker system that would dramatically increase the number of uninsured, leading groups like National Nurses United to lobby the Senate not to confirm him.

“If confirmed, it is clear that Rep. Price will pursue policies that substantially erode our nation’s health and security — eliminating health coverage, reducing access, shifting more costs to working people and their families and throwing our most sick and vulnerable fellow Americans at the mercy of the health care industry,” National Nurses United warned in a letter to Senators.

“The signal that is sent when you appoint someone like Tom Price doesn’t jibe with what the president-elect campaigned on, which is that he’s not going to cut Social Security or Medicare,” Wright chimed in.

The disconnect was vividly illustrated when National Public Radio, the Washington Post and others looked at hard-hit Kentucky voters after the election. The sub-head of Vox’s story summed it all up: “In Whitley County, Kentucky, the uninsured rate declined 60 percent under Obamacare. So why did 82 percent of voters there support Donald Trump?”

Sarah Kliff’s report included this:

“I guess I thought that, you know, he would not do this, he would not take health insurance away knowing it would affect so many people’s lives,” said Debbie Mills, an Obamacare enrollee who supported Trump. “I mean, what are you to do then if you cannot pay for insurance?”

A good question that should have been asked sooner.

Congressional Republicans are contemplating two budget reconciliation bills— the first in January to repeal Obamacare, another later in the year to slash Medicaid and begin privatizing Medicare, along with tax cuts concentrated on the rich.

Reconciliation bills aren’t subject to a filibuster, so they don’t require any Democratic votes. But they do require Republicans willing to risk voters’ wrath if they proceed, which is why folks are already furiously organizing. On Dec. 7, a coalition of groups delivered one million signatures demanding that Congress “keep its hands off of Medicare.”  On Dec. 20, MoveOn partnered with 45 local and national groups against repealing Obamacare to demonstrate outside 82 Republican House and Senate offices in 26 states, along with thousands of supporting phone calls.

With Obamacare repeal first on the GOP agenda, it’s important to understand how much else it would undermine.

“Right on the immediate horizon, the repeal of Obamacare has very significant implications for Medicare,” Wright said. “Most people who are Medicare beneficiaries don’t realize how the Medicare improvements of the past several years have been part of what is referred to as ‘Obamacare,’ the Affordable Care Act.  It’s not something they’re consciously aware of, and so that’s one of the messages that we’ve been trying to get out, is understand what’s at stake for Medicare if the Affordable Care Act is repealed.”

Perhaps most dramatic is “an enormous help in closing the donut hole.” [The gap in Medicare drug discounts.]

With Obamacare, “The discounts that Medicare beneficiaries get in their prescription drug discounts is very significant.  Nationwide, it’s probably $1000 per enrollee,” Wright said. “There are health screenings, screenings for chronic diseases that people who are 65 and over often suffer…. There are colonoscopies, there are mammograms, there are tests for diabetes. These are things that seniors get now, because of the Affordable Care Act, with no out-of-pocket cost. So you remove that co-pay barrier and more people will get the screenings…. When they get the screenings, if there is a problem, they’ve caught it early enough, in a lot of cases, to keep people healthier and therefore, less expensive to treat.”

There’s also been a dramatic reduction in hospital readmissions, driven by changes in reimbursement, which now encourage significantly better continuity of care.

“They’re down in every state in the union that we know of,” Wright said. “Down anywhere from 5 to 11 percent since the Affordable Care Act came into being…. We just are very concerned that people don’t understand that these benefits are at risk…. Information is power. If you understand what’s happening to Medicare with the repeal of the Affordable Care Act, then take action and get involved, get on the phone, because this is a real threat.”

In California, the impact of Obamacare repeal threatens to be particularly dire, according to a report from the Center for Labor Research and Education at the University of California Berkeley. Repeal could take away health insurance from millions of Californians, while also eliminating 209,000 jobs and costing the state economy $20.3 billion in gross domestic product, it said.

“Through the Affordable Care Act, we have 5 million people who are insured now who weren’t insured before; more than four million of those are through Medi-Cal, our Medicaid program,” said Chris Hoene, executive director of the California Budget and Policy Center, at a Dec. 13, 2016 presentation in Sacramento.

“Nationally, 11 million more people in the county are covered now by Medicaid than prior,  more than 4 million of those are Californians,” Hoene noted. “California more than anyplace else has a grand stake in what happens with this.”

At the same event, Edwin Park, vice president for Health Policy at the Center on Budget and Policy Priorities, explained the severity of what Republicans were planning.

“The Affordable Care Act repeal does not include a replacement plan, despite what congressional Republican leaders have promised, so it’s effectively [a] repeal,” Park said. “There’s no indication that there is a replacement plan. Congressional Republican leaders have had six years to put together such a plan, but there is no consensus plan, particularly among Senate Republicans…. The House budget plan from Republicans this [past] year talked about cutting federal Medicaid funding by another trillion dollars over 10 years, on top of repeal of the Medicaid expansion as part of an ACA repeal proposal.”

More than 5 million Californians could lose coverage.

“The cuts are so large that states have no choice but to dramatically scale back their programs, going well beyond losing the expansion,” Park said.

A Dec. 6, 2016 report from the Urban Institute added more detail to what such a bill might entail. These included:

  • The number of those uninsured would rise from 28.9 million to 58.7 million in 2019, an increase of 29.8 million people (103 percent).
  • The share of uninsured non-elderly people would increase from 11 to 21 percent, a higher rate of uninsurance than before the ACA.
  • Eighty-two percent of those becoming uninsured would be in working families.
  • Eighty percent of the adults becoming uninsured would not have college degrees.
  • Federal government spending on health care for the non-elderly would be reduced by $109 billion in 2019 and by $1.3 trillion from 2019 to 2028.
  • State spending on Medicaid and Children’s Health Insurance Program would fall by $76 billion between 2019 and 2028.
  • The newly uninsured will be seeking an additional $1.1 trillion in uncompensated care between 2019 and 2028.
  • Many, if not most, insurers are unlikely to participate in market places in 2018 if the individual mandate is not enforced starting in 2017, meaning millions more would lose their insurance.

“This scenario does not just move the country back to the situation before the ACA. It moves the country to a situation with higher uninsurance rates than was the case before the ACA’s reforms,” the report stated, echoing Park’s assessment.

The bottom line comes back to what Wright said: “Information is power; if you understand what’s happening… then take action and get involved, get on the phone, because this is a real threat.”

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