A federal appeals court in New Orleans has issued a split ruling in a challenge to the Affordable Care Act. The court says it is unconstitutional to force people to get healthcare coverage because Congress has gotten rid of the tax penalty on those who fail to get it.
Health Care Doom on the
Horizon
The relationship between Americans and
their health care delivery is about to make a dramatic change for the worse. Consumers
of health care are poised to vote for a federally managed
system. Why would they go down this predictably awful rabbit
hole? They'll do it because they are overwhelmed and frightened in
the current system. They'll do it because this may be the only
option that a typical voter understands. They'll do it because our
elected leaders do not have the courage to enact changes that could make things
work and don't want to give up power. And it will happen because the
media will demonize and target anyone who isn't on the socialist bandwagon.
Currently, we have a situation in America
where the insured among us are utilizing health care less than in the
past. This is because of the financial implications of
high-deductible insurance policies, most people's only affordable
option. As a result, it is arguable that the very people who bear
the financial burden for our medical care — namely, the minority among us who
are insured Americans — are among those getting the worst care in our
country. It is well known that Americans often live on the edge of
their finances. So when it comes to budgeting for our deductible
when health issues arise, we are frequently left with hard
decisions. This often results in the insured tolerating illness
rather than seeking appropriate, expensive care.
The result of this development will most
assuredly result in even conservative voters being swayed toward a federally
managed health delivery system. With the elderly freely using
Medicare and Medicaid participants getting treatment with seemingly no
debilitating financial consequences, it would be easy to desire something
similar for the rest of us. After all, what could be more messed up
than the current system, where a simple visit to the emergency room can lead to
bankruptcy?
The federal option for health care
delivery will undoubtedly be wretched. Ask any veteran or doctors
who trained at those hospitals about their experience with the V.A., the best
example of a federally run health delivery option. You'll hear
stories that will curl your toes. It is not possible for government
to provide quality care in a timely manner affordably, just as equality and
liberty can't coexist without one sacrificing itself to the
other. Add on the layers of bureaucracy in a federally run hospital
to the inefficiencies and redundancies they mandate, and the results are
predictable.
Yet the people may opt for it anyway,
because it is hard to imagine relying on the current system creating a more
affordable market. We are not using the economic tools that work to
bring down costs. There is no such thing as capitalism or a free
market in health care delivery. If a group of doctors think they can
provide better care at cheaper prices than your community hospital, they cannot
easily do so. Government regulations would not grant them
permission, because it is more "in the community's interest" to keep
the inefficient and expensive existing hospital afloat than to allow the
creative destruction that capitalism provides. Ending local government's
control over "certificate of need" would lower costs, but politics
keeps these laws going.
Additionally, hospitals are allowed to
charge much more for services than private practitioners of medicine and
surgery. This is because they have convinced local governments that
this is justifiable because they have to take care of the
indigent. A lot of the recent dramatic rise in health care costs is
a result of the incestuous relationship between hospital corporations and the
government. Doctors are getting absorbed into hospital employment
with the lure that their pay will not go down as precipitously if they are paid
the higher allowable fees that they can bill through the hospital.
You can add the insurance industry to the
hospital corporations and the government as the three players that keep the
system unaffordable and non-competitive. Many competitive options
for insurance coverage could decrease cost. But these are opposed by
the industry and are lobbied away. The laws that could make these
legal are unlikely to be enacted because power would shift from government and
insurance companies to the individual.
One such idea is insurance
pooling. Suppose that someone who would normally be almost
uninsurable, like a 33-year-old waitress with Crohn's disease, could join in
with other waitresses and shop as a group for policies across state
lines. This would put market forces to work and necessarily drive
down her costs. This is because most waitresses are young and fairly
healthy, and the actuaries in the insurance companies would jump to bid for
this business. For particularly difficult to insure populations,
there could even be federally subsidized pools. This could work for
the uninsured and unemployed.
For this concept to work, there would have
to be allowances for buying insurance across state
lines. Politicians have too many pet causes to allow this to
happen. Most insurance coverage in New York City mandates coverage
for transgender operations. Years ago in Connecticut, insurance had
to cover hair plugs. As you might suspect, insurance can run much
higher in these environments when compared to similar coverage (not including
these boondoggles) in the upper Midwest. If a resident of New York
or Connecticut could buy the Midwestern policy for similar coverage without the
local mandates, costs would go down.
Another priority would be transferring
ownership of insurance to individuals rather than through their
employers. But tax incentives encourage the
opposite. Policies that do not end when changing jobs or crossing
into other states would be preferable, but business tax deductions change the
game. If individuals could deduct insurance cost, as businesses have
traditionally done, it could work.
Tort reform would remove a lot of dysfunction
and wasteful spending. But most lawmakers are lawyers, so the
possibility of goring this cash cow is remote. (What will happen to
this sector if the federal government runs medicine?) Allowing
information technology to evolve naturally rather than instituting top-down,
central control to the medical records, billing, and other information systems
would result in savings, too. But I.T. is essential to maintaining
power, which makes any change non-negotiable.
Americans may have had enough, egged on by
progressive media. Plots to make medical care more affordable by
re-introducing the free market and capitalism through changes in the current
laws seem to have died off. The fawning hero-worship directed toward
former president Obama by the media glorified the idea of health care as a
human right, with support for this wrong-headed idea achieving his goal of
"fundamentally changing America." Medicare for all is
depicted in the press as a desirable idea despite common sense suspecting the
contrary. When it is shown that the cost of administering health
care through the existing system proves that insurance companies eat up around
a third of the health care dollar, it does seem ridiculous to maintain the
status quo. After all, the cost of administration in the Veterans
Administration is far less. But we know intuitively that care will
be worse. And, as anyone who knows history can tell you, giving them
power over our health care decision-making will be the final nail in the coffin
of our freedom.
Yet, when the simple idea of a Health
Savings Account, a necessary pillar of any health care reform, is above the
heads of many voters, we have lost. Because the media will shoot
down any politician brave enough to try anything but a federal option (remember
Tom Price, [R-GA]?), it is harder than ever to have any kind of inertia for
reasonable change. With the shortsightedness of insurance companies
and hospital corporations essentially pricing themselves out of existence for
access to more money today, it looks hopeless. And when federal debt
continues to be viewed as a "so what?" by politicians and citizens
alike, we are done.
It Pays to be Illegal in California
It certainly is a good time to be an illegal alien
in California. Democratic State Sen. Ricardo Lara last week pitched a bill to
permit illegal immigrants to serve on all state and local boards and commissions.
This week, lawmakers unveiled a $1
billion health care plan that would include spending
$250 million to extend health care coverage to all illegal alien adults.
“Currently, undocumented adults are explicitly and
unjustly locked out of healthcare due to their immigration status. In a matter
of weeks, California legislators will have a decisive opportunity to reverse
that cruel and counterproductive fact,” Assemblyman Joaquin Arambula said in
Monday’s Sacramento
Bee.
His legislation, Assembly
Bill 2965, would give as many as 114,000 uninsured illegal
aliens access to Medi-Cal programs. A companion bill has been sponsored by
State Sen. Richard Lara.
But that could just be a drop in the bucket. The
Democrats’ plan covers more than 100,000 illegal aliens with annual incomes
bless than $25,000, however an estimated 1.3 million might be eligible based on
their earnings.
In addition, it is estimated that 20 percent of
those living in California illegally are uninsured – the $250 million covers
just 11 percent.
So, will politicians soon be asking California
taxpayers once again to dip into their pockets to pay for the remaining 9
percent?
Before they ask for more, Democrats have to win the
approval of Gov. Jerry Brown, who cautioned against spending away the state’s
surplus when he introduced his $190 billion budget proposal in January.
Given Brown’s openness to expanding Medi-Cal
expansions in recent years, not to mention his proclivity for blindly
supporting any measure benefitting lawbreaking immigrants, the latest fiscal
irresponsibility may win approval.
And if he takes a pass, the two
Democrats most likely to succeed Brown – Lt. Gov. Gavin Newsom and former Los
Angeles Mayor Antonio Villaraigosa – favor excessive
social spending and are actively courting
illegal immigrant support.
COST to AMERICANS of the LA RAZA
MEXICAN OCCUPATION in CALIFORNIA ALONE: $2,370 per legal.
All that “cheap” labor is
staggeringly expensive!
"Most
Californians, who have seen their taxes increase while public services
deteriorate, already know the impact that mass illegal immigration is having on
their communities, but even they may be shocked when they learn just how much
of a drain illegal immigration has become." FAIR President Dan Stein.
Californians bear an enormous fiscal burden as a result of an illegal
alien population estimated at almost 3 million residents. The annual
expenditure of state and local tax dollars on services for that population is
$25.3 billion. That total amounts to a yearly burden of about $2,370 for a
household headed by a U.S. citizen.
Exclusive–Mo
Brooks: Healthcare for Illegal Aliens Latest Democrat Effort to Turn U.S. into
California
JOSH EDELSON/AFP/Getty Images
JOHN BINDER
5 Jul 201971
3:34
Providing free, American taxpayer-funded
healthcare to all illegal aliens is just the latest effort to use mass
immigration to turn the United States into the sanctuary state of California,
Rep. Mo Brooks (R-AL) says.
As Breitbart News reported, the majority of
2020 Democrat presidential candidates have endorsed a plan to force taxpayers
to pay for free healthcare for all 11 to 22 million illegal aliens living
across the country. The plan would cost taxpayers at least $660 billion a
decade.
Brooks told SiriusXM Patriot’s Breitbart News Tonight that
Democrats’ “primary motivation” behind offering healthcare to illegal aliens is
not compassion, but rather an effort to transform the U.S. into the state of
California through mass illegal and legal immigration.
LISTEN:
Brooks said:
The motivation for all for this is
even worse. They don’t have compassion for these illegal aliens. That’s not
their primary motivation. Their primary motivation is the desire to
acquire raw political power. That’s what it’s all about. [Emphasis added]
If you limit votes to American
citizens, Democrats do not fair to well with us. So what they’re trying to do
is import people who do not understand the foundational principles that have
combined to make America a great nation and who … are
much more likely to vote Democrat once Democrats give them voting rights.
[Emphasis added]
Brooks detailed how California, the
state where former President Ronald Reagan was governor, has been forever
changed due to the country’s mass illegal and legal immigration policy that
imports about 1.5 million foreign nationals a year.
“Let’s learn from history. California
used to be a purple state. Remember, Ronald Reagan came from there … the
Democrats have flooded California with noncitizens,” Brooks said. “And why do
noncitizens vote Democrat so often? Well, let’s look at illegal aliens. The
data shows that 70 percent of households that have an illegal alien in them are
on welfare. The data shows that 60 percent of households that have a lawful
immigrant in them are on welfare. So, you’ve got three different themes that
the Democrat Party now relies on: One is racism, two is sexism, and three is
socialism.”
“In California, what used to be a
purple state, now out of 53 congressional seats, only seven are Republican … 46
are Democrat and seven are Republican,” Brooks said. “So they have seen how
that strategy of importation of foreign voters has worked in California.
They’re trying to do it in Texas, Nevada, New Mexico, Arizona, in every state
where they can possibly do it. They want to flood the voting booths with people
who are dependent on welfare and who do not understand the principles that have
made us a great nation. That’s how they change the voter pool and they’re doing
it successfully.”
Health insurance expert Linda
Blumberg told the New York Times that any of the
Democrats’ plans that offer free health care to illegal aliens is could likely
to drive a mass migration of foreigners with “serious health problems to enter
the country or remain longer than their visas allow in order to get
government-funded care.”
Likely U.S. voters, by a majority,
said they oppose being forced to pay for the healthcare of millions of illegal
aliens living in the country, as Breitbart News reported. The latest
Rasmussen Reports poll found that 55 percent of voters said they opposed such a
plan, including 8-in-10 Republican voters, about 6-in-10 swing voters, and 62
percent of middle-class voters.
In the next two decades, should the
country’s legal immigration policy go unchanged, the U.S. is set to import about 15 million new foreign-born voters. About eight
million of these new foreign-born voters will have arrived through the process
known as “chain migration,” whereby newly naturalized citizens are allowed to
bring an unlimited number of foreign relatives to the country.
Some Big Health Care Policy Changes Are Hiding In The Federal Spending Package
Congress is set to pass a $1.4 trillion spending package this week, which President Trump has said he'll sign. The legislation includes policy changes and funding increases that public health advocates are celebrating, as well as the permanent repeal of three key taxes that were designed to pay for Obamacare — a win for industry groups.
Notably absent from the spending package: legislation to address surprise billing or prescription drug prices. The House passed a prescription drug price bill last week, but a bill that can get through the Senate may be a long way off. Surprise billing proposals had support from both parties in both chambers of Congress as well as in the White House. Still, such legislation have proven difficult to nail down. Lawmakers involved say it is a priority for next year.
Our health reporting team took a look at what is in the package and picked out notable highlights, including some surprising policy reverses for Congress.
Repeal of health taxes designed to pay for ACA
When President Barack Obama signed the Affordable Care Act into law in 2010, he said: "It is paid for. It is fiscally responsible." But many of the taxes designed to cover the cost of expanding health coverage to 20 million people have been derailed. Now, the so-called "Cadillac tax" on generous employer health plans is getting permanently nixed, as are taxes on health insurance companies and medical-device makers.
Insurance industry groups applaud the move. But the repeal of these taxes alarmed many health policy and budget watchers. It will contribute $373 billion to the deficit, according to an estimate from Congress' Joint Committee on Taxation.
"So we're cutting the funding out from under Obamacare, but still doing all the spending," says Marc Goldwein, of the nonpartisan Committee for a Responsible Federal Budget. "This whole bill is about reversing the few hard choices that we made to pay for Obamacare."
"Everybody seems to want lower deficit in the abstract, but when it comes time to actually cut spending or raise taxes, there doesn't seem to be the political will in either party at the moment," he adds. —Selena Simmons-Duffin, health policy reporter
Raising the age to buy tobacco products to 21
The measure raises the federal age limit from 18 to 21 and would apply to both cigarettes and e-cigarettes.
At least 16 states and Washington, D.C., have raised the minimum age to buy tobacco products to 21, according to the American Lung Association. The organization, which has long campaigned to raise the federal age limit, said the move "will significantly reduce youth tobacco use and save thousands of lives."
The national conversation around tobacco age limits gained new momentum thanks to the surging numbers of teenagers who are vaping. The Trump administration had signaled that it planned to introduce an age limit. Some major tobacco companies have backed the idea, such as Altria, which owns Philip Morris USA and partially owns JUUL.
Advocates against vaping are also pushing for a federal ban on flavors for e-cigarettes, to make them less appealing to kids. Earlier this year, Trump had pledged to impose a flavor ban but has appeared to walk that idea back since then. It's not clear whether further sweeping regulations of the industry are still in store. —Merrit Kennedy, news desk reporter
A foundation for President Trump's plan to end HIV
In his state of the union address in February, President Trump announced a plan to end the HIV epidemic in America by 2030. This year, not a whole lot has happened toward this goal because there hasn't been funding from Congress — until now. The president's budget had called for $291 million, and Congress will overshoot that slightly.
This past fall, the Department of Health and Human Services gave grants to 32 state and local health departments where there are HIV "hotspots" so that they could develop or update programs to reach the goal of ending the epidemic. With this federal funding coming through, the hope is that those places will be able to hit the ground running.
"This is just the foundation — it's the first year of funding," says Carl Schmid of the AIDS Institute and the President's Advisory Council on HIV/AIDS. "It's an excellent start, but to achieve the goal of ending the epidemic, we'll need a lot more money to scale it up for next year and the years to come." —Selena Simmons-Duffin, health policy reporter
Paving the way to develop more generic drugs
A bill intended to promote generic drug competition is also expected to get a ride in the budget. The Creating and Restoring Equal Access To Equivalent Samples Act — called the the CREATES Act, for short — aims to make sure branded manufacturers sell samples of their products to companies that want to use them to develop generic versions.
Brand-name companies have, at times, refused to sell samples to would-be generic competitors, citing a Food and Drug Administration program designed to keep potentially harmful drugs from being misused. The FDA says some brands have exploited this program to stall development of generics, maintain their monopolies and keep prices and profits high. With the passage of the CREATES Act, generic companies can sue if they think they've been wrongfully denied samples.
"It's not a panacea, but it's definitely an important step forward in providing relief for Americans struggling with high prescription drug costs," says Harvard Medical School instructor Ameet Sarpatwari. The bill has been introduced five times but never managed to pass despite bipartisan sponsorship. The Congressional Budget Office expects CREATES to save taxpayers $3.7 billion over 10 years. —Sydney Lupkin, pharmaceuticals correspondent
First funding for gun violence research since 1996
The budget provides $25 million for research on preventing deaths and injuries from guns, split equally between the National Institutes of Health and the Centers for Disease Control and Prevention.
"This is a very meaningful, small step in the right direction," says Christian Heyne, vice president of policy at Brady, an organization focused on ending gun violence. He notes that these are the nation's two preeminent public health agencies. The CDC has shied away from gun violence research since 1996, when legislation known as the Dickey Amendment first prohibited the agency from using federal funds to advocate or promote gun control. In 2018, language added to instructions accompanying a spending bill made it clear that the CDC was allowed to conduct research on the causes of gun violence. At that time, Congress provided no funding.
Now, lawmakers have not only allocated money, "they're actually naming that this money needs to be spent to research gun violence," says Heyne. —Nell Greenfieldboyce, correspondent
Shoring up suicide prevention efforts
The budget provides SAMHSA with $19 million for the Suicide Prevention Lifeline — this includes an increase of $7 million over last year. The additional funding is a "significant improvement," notes Lauren McGrath, the vice president of public policy at Centerstone, a behavioral health care provider working in several states.
Calls to the Lifeline are answered by a patchwork of about 165 local call centers that receive only about $1,500 to 2,000 per year of federal money. Most of the federal funds support the Lifeline's national infrastructure. The additional funding "will provide much needed resources to improve consumer access to the National Suicide Lifeline," McGrath wrote in an email. The funds will likely be used to identify areas where there are gaps in coverage and to find ways to fill in those gaps, she adds.
Still, she notes that the service is far from fully funded and centers struggle to keep pace with the rise in call volumes. As call volumes have increased, so have wait times and dropped calls. "We have a lot more work to do here," she adds.
The spending package also includes an increase of $7 million for the Zero Suicide Program, which provides a tools, training and outreach to help health care systems adopt effective suicide prevention approaches.
This budget doesn't address funding needs for transitioning to the new 988 number that's in the works. That might come in the next fiscal year, notes McGrath. —Rhitu Chatterjee, health correspondent
Medicaid in the territories, community health clinics, and other "extenders"
The U.S. territories had been facing a dramatic funding cliff this fall. The ACA gave the territories 10 years of additional money for Medicaid, but that ran out in September — causing a potential $1 billion shortfall in 2020. Guam and the Virgin Islands warned they would need to start cutting their Medicaid rolls, and Puerto Rico would have had to cut benefits to account for the funding cliff.
Now, they won't have to — the spending package restores funding to the territories' Medicaid for two years. In fact, as Politico first reported, the White House agreed to four years of funding, but Trump objected, a source familiar with the negotiations confirmed to NPR.
Also attached to the budget are several other health "extenders," including funding for community health centers and safety net hospitals. However, those only get funding until May, notes Edwin Park, a research professor and the Georgetown Center for Children and Families.
Park thinks the new May deadline might be designed to help push forward legislation on other health priorities like prescription drug prices or surprise billing.
"I hope that Congress will come back in the spring of 2020 and will provide a longer-term extension, as opposed to again kicking the can down the road and placing these provisions in limbo," Park says. —Selena Simmons-Duffin, health policy reporter
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