A Mile Wide, An Inch Deep

As January wraps up, it appears that Congress is still nowhere close to a deal on several major issues with significant implications for health policy. Four months into fiscal year 2018, Congress still can’t agree on FY 2018 funding levels or a budget deal to prevent sequestration — the deep, automatic, across-the-board cuts set to hit everything from the military to family planning and HIV/AIDS services to road and bridge safety. Hardline conservatives are happy to let sequestration hit non-defense priorities like health care, education, and infrastructure but are pushing for new spending for the Pentagon. Democrats have said that’s a non-starter. Meanwhile, there’s little evidence that Congress is any closer to a DACA deal for Dreamers, and there are significant concerns that, even if the Senate can pass something, Republican leadership in the House won’t bring it to a vote unless moderate Republicans face more public pressure. If there’s a silver lining to this madness ...

We drafted this for our interns based on a presentation I've been giving for years. Posting it here for anyone who might find it helpful while Congress debates the ACA's future. Health Insurance 101 Half of Americans get their health insurance through their employer The other half are insured through the government, through the individual market, or have no coverage at all You may have heard of terms like “socialized medicine” (Great Britain), “single payer” (Canada), and private health insurance. In the US, we have all three: Socialized health care: the government operates health care facilities and employs health care professionals. Examples include hospitals, clinics, and doctors that are owned, operated, or employed by the Indian Health Service, the Defense Department, and Veterans Affairs Single payer: health care services are provided by private businesses but paid for by the government. Examples include Medicare (seniors), Medicaid (low-income pati...

This week we’re on red alert in response to reports that Republican leadership is gearing up for a vote to repeal the Affordable Care Act (ACA) and gut Medicaid the week of September 25 , with a sham hearing possible before then. Now is the time to call, write, and rally to urge the Senate to reject this new threat and support a bipartisan package instead. The bill, known as Graham-Cassidy-Heller-Johnson for its sponsors Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), and Ron Johnson (R-WI), is being sold as a “compromise” and “non-partisan” solution—even though no Democrats support it. But not only is Graham-Cassidy not a compromise, it is the most radical proposal yet. And like the proposals that preceded it, the bill goes far beyond Republicans’ campaign pledge to repeal the ACA; it also attacks long-standing traditional Medicaid. Republicans only have two weeks to ram through repeal with just 50 senators and Vice President Mike Pence because on Sept...

Taking two full trash bags of supplies to the school on orientation day. The bags represented just part of each child's list. Every year our school supply list is 80% standard business supplies like copy paper, dry erase markers, paper towels, hand sanitizer, and one year, even toilet paper! There's no need to label most of the items we send because they won't belong to any individual child, but rather to the class or grade as a whole. These are the kinds of general operating supplies most employers are expected to simply provide. I've worked in for-profit, non-profit, public, and private sectors and I've never been asked to bring in my own copy paper, dry erase markers, or other basic business supplies. Maryland is the wealthiest state in the union (as measured by median household income, 3rd wealthiest by per capita income) so the only conclusion I can draw from these lists is that despite lofty rhetoric from politicians about children being the future...

Wondering what’s next after the Republican effort to repeal the Affordable Care Act (ACA) was dramatically stopped in its tracks last week ? This week has brought a new round of legislative threats and another promise from a petulant president to actively sabotage the law at the expense of millions of Americans who rely on it for their care. Radical bill from "moderate" senators This week, Senators Lindsey Graham (R-SC), Bill Cassidy (R-LA), and Dean Heller (R-NV) announced that they are working on yet another extreme GOP-only bill with the House Freedom Caucus to gut the ACA. The bill would repeal the ACA’s Medicaid expansion and its financial assistance to help low- and moderate-income households purchase private insurance. In their place, the bill would give states a block grant worth less than what the federal government would contribute under current law. Furthermore, the states that expanded Medicaid would be cut deeply while the 19 states that have refused to e...

I drafted this piece on behalf of our organization for publication in newspapers around the country. Check out a version in today's Sacramento Bee . The shortest answer to their prompt is simply: Hell no. Con: Millions lose health insurance to pay for tax The Affordable Care Act (ACA, or “Obamacare”) extended health insurance to 20 million people while closing loopholes in existing insurance for everyone. The GOP proposal would take health insurance away from 24 million people —and likely millions more —and re-open those loopholes. While it is marketed as an ACA repeal, the GOP proposal actually goes far beyond the ACA, attacking long-standing programs like Medicaid and long-standing health providers like Planned Parenthood. The bill does all of this in order to give the 400 wealthiest households in America an average tax cut of $7 million each . Doctors groups like the American Medical Association, seniors groups like the AARP, patient groups like the American Cancer Soci...

If you're confused by the news reports and you're wondering how the pieces fit together and where things stand, I'll try to keep this page updated as events unfold. ACA repeal: what happens next? Politico reporter Dan Diamond posted this ACA repeal checklist on Twitter. I've modified it slightly to better reflect the full scope of what's happening when. But don't forget, "ACA repeal" in this context is only a partial repeal, which will set up a "death spiral" in health insurance markets and raise costs for all of us. (Read my backgrounders on what the GOP can and can't do through reconciliation here and on the politics of their replacement plans here .)   ☑  Senate vote-a-rama on amendments to budget outline   ☑  Senate passes budget outline   ☑  House passes budget outline   ☐  House drafts reconciliation bill repealing parts of the ACA, cutting taxes on the .01% wealthiest Americans, and blocking women with Medicaid from g...