Monday, July 9, 2012

Monday Morning Memo

I hate Mondays as much as I love Fridays.  Oh, well.  Onward and upward.

The GOP-led House will vote to repeal health reform this week.  That means they would take your kids up to age 26 off of their parents' policies; they would reverse savings on prescription drugs for seniors; they would stop requiring insurers to spend 80-85 percent of premium dollars on health there, thereby reducing the amount premiums can be inflated for administrative costs, salaries, bonuses; they would stop requiring insurers to cover kids to age 19 with pre-existing conditions; they would eliminate the Pre-existing Condition Insurance Plan; they would reinstate lifetime and annual limits on benefits; they would eliminate external appeals. . . .  I could go on.  Of course, this is largely symbolic -- the Senate will not vote to repeal, and even if they did, the President would veto.  Enough political theater.  How about doing something to grow jobs.

As I've been saying since the Supreme Court decision, in states that opt out of the Medicaid expansion, there will be thousands of the very poor who are left with no health care.  This is so because subsidies start at 100% of federal poverty level, so those under 100% not only won't have Medicaid, but they won't be eligible for subsidies, so unless they are lucky enough to have employer-sponsored insurance, they will have nothing. 

Meanwhile, anti-reformers are preparing their next attack on the health reform law -- exchanges.  Well, subsidies, to be exact.  You see, the law says states create exchanges, marketplaces where people can shop for and buy insurance.  But if states don't create an exchange, the federal government will step in for them -- and the law doesn't expressly state that the subsidies are available through federally-run exchanges.  So the anti-reformers are developing a legal claim that, in fact, there are no subsidies in the federally-run exchanges.  And that would leave even more people out than opting out of the Medicaid expansion. 

Ask yourself why so many people don't want poor and middle-class people to be able to afford health care?

Since the Supreme Court decided that the penalty associated with the individual mandate should be considered a tax, anti-reformers have been screaming about the alleged tax increase on the middle class.  Turns out that, in fact, the biggest tax increase in the Affordable Care Act is the tax on Cadillac plans that starts in 2018

Meanwhile, if Republicans take a majority of the Senate, they are planning to repeal as much of health reform as they can through the budget reconciliation process -- the same process used to push through the law -- which requires a majority vote for passage rather than the usual 60 votes.   If you thought the Presidential election was the only key vote coming up for health reform, think again. But can they repeal parts of the law that don't deal with the budget, such as coverage of people with pre-existing conditions?  Hmmm.  Tom Daschle says the President must be re-elected for the ACA to survive.  It certainly would help if pro-reformers also held the Senate.  Mitch McConnell thinks the GOP has a 50/50 chance at winning a majorityBut even if the pro-reformers hold the Senate, there will be plenty a President Romney would be able to do to kill reform.

For those of you on disability, Allen West is here to tell you that it's a modern form of slavery.  That's right -- by fostering your dependence on Social Security disability, you are being robbed of your self-esteem and, thus, are being enslaved.  Is this kind of craziness even worth repeating?  For Mr. West to presume that your CHOICE to go on disability can be equated with the buying and selling of human beings into slavery -- wacko. 

The highest Medicare costs are those spent on a small percentage of challenging cases, often near the end of life. Often these are not the elderly; they are people under age 65 on disability.  How do we tackle the issue of health care costs without also tackling the moral issue of whether and when to withhold treatment?  Is this a decision we can make as a society, or do we just leave it to the patient and his/her family?

The current state of our knowledge about the risks and benefits of hormone therapy.  Whether to use it should be an individualized decision. 

New numbers in elder care -- in the past 3 months, 39.8 million people over age 15 assisted a person over age 65 due to a condition relating to age.  Most of them are middle-aged, caring for a parent, and 85% of them do not live in the same household as the elder.

New frontiers for cancer treatmentWhole genome sequencing.  It may provide us with new answers to treatment. 

Get this -- infants in households with dogs are less likely to get infections.  In general, they are healthier and need fewer antibiotics. 

And there you go, at least for this morning.  Have a great day!  Jennifer

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