health insurance

Terrific (Heroes and Villains)

#SomethingTerrific | #WhatTheyVotedFor

Photo by Kevin Lamarque/Reuters

“While the leaders of the ruling political party have convinced themselves that they are heroes, in reality they are villains and enemies of the American people.”

Chauncey DeVega

What? He’s got a point. Salon:

As the Republicans voted to steal away health insurance from the sick, children, pregnant women, the poor, elderly, babies and people with pre-existing medical conditions in order to give millionaires and billionaires like themselves more money, they reportedly played the theme song to the movie “Rocky” and found inspiration from George C. Scott’s Oscar-winning performance as Gen. George S. Patton. On one hand, these are just curious details that help to paint a picture of what happened that day in Congress. But they also tell us a great deal about how the Republicans who voted to overturn the Affordable Care Act see themselves in history.

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Image note: Photo by Kevin Lamarque/Reuters.

DeVega, Chauncey. “Despite their twisted fantasies, Republicans are nothing like Rocky or George Patton—they are political terrorists”. Salon. 8 May 2017

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Terrific (Nobody Dies)

#SomethingTerrific | #WhatTheyVotedFor

Rep. Raul Labrador (R-ID01). [Detail of photo by John Miller/Associated Press]

Let us try a compromise: Just don’t call him “pro-life”. Or, perhaps, we should begin in the moment, as Kristine Phillips tells it for the Washington Post:

A conservative Republican congressman from Idaho is drawing criticism for his response to a town-hall attendee’s concerns about how his party’s health-care bill would affect Medicaid recipients.

“You are mandating people on Medicaid to accept dying,” the woman said.

“That line is so indefensible,” said Rep. Raúl R. Labrador, a member of the influential House Freedom Caucus. “Nobody dies because they don’t have access to health care.”

The boos instantly drowned him out.

The congressman from Idaho’s First Congressional District and founding member of the House Freedom Caucus might have discovered a new apex for the absolute value of conservative political rhetoric. To the other, tempting as it seems to wonder if e’er so thoughtless bovine excrement was spoken, we do happen to be speaking both of Congress and conservatives, so, yeah, actually, lots. Still, though, Rep. Labrador reminds without question the challenge of abiding no integrity.

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The Republican Promise (MacArthur’s Exemption Remix)

#SomethingTerrific | #WhatTheyVotedFor

A portion of the U.S. Capitol dome. (Detail of photo by Win McNamee/Getty Images, 2013)

Sarah Kliff explains:

House Republicans appear to have included a provision that exempts Members of Congress and their staff from their latest health care plan.

The new Republican amendment, introduced Tuesday night, would allow states to waive out of Obamacare’s ban on pre-existing conditions. This means that insurers could once again, under certain circumstances, charge sick people higher premiums than healthy people.

Republican legislators liked this policy well enough to offer it in a new amendment. They do not, however, seem to like it enough to have it apply to themselves and their staff. A spokesperson for Rep. Tom MacArthur (R-N.J.) who authored this amendment confirmed this was the case: members of Congress and their staff would get the guarantee of keeping this Obamacare regulations. Health law expert Tim Jost flagged me to this particular issue.

Do we all understand, then, that when Republicans tell us government doesn’t work, they’re not arguing political theory but, rather, making a promise?

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#DimensionTrump (cryptic pipeline)

#DimensionTrump | #WhatTheyVotedFor

U.S. President-elect Donald Trump (left) meets with Speaker of the House Paul Ryan (R-WI01; center) and Vice President-elect Mike Pence on Capitol Hill in Washington, D.C., 10 November 2016. (Photo: Reuters/Joshua Roberts)

“The Trump executive order should be seen more as a mission statement, and less as a monarchical edict that can instantly change the law.”

Margot Sanger-Katz

As Republicans rally ’round their health care policy better known as, “Repeal and … y’know … whatever”, this is President Trump’s ante; Margot Sanger-Katz explains for the Upshot:

The order spells out the various ways that a Trump administration might fight the parts of the health law until new legislation comes: by writing new regulations and exercising discretion where allowed. Regulations can be changed, but, as the order notes, only through a legal process of “notice and comment” that can take months or years.

On matters of discretion, the administration can move faster, but there are limited places where current law gives the administration much power to quickly change course.

How much of the order is bluster and how much it signals a set of significant policy changes in the pipeline is unclear. The order was not specific and did not direct any particular actions.

“Right off the bat, what do they do―something incredibly cryptic that nobody understands,” said Rodney Whitlock, a vice president of M.L. Strategies, a Washington consulting firm. Mr. Whitlock was a longtime health policy aide to Senator Chuck Grassley, a Republican from Iowa.

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The Tale of Those Who Left

In southern Brazil, there still exists remnants of the American Confederacy. Each April, the Descendants of American Southerners don hoop skirts and the grey uniform to celebrate their shared history. Thousands of Southerners migrated to Central and South America after finding themselves on the losing side of the war and their relatives are called Confederados. (Photo by Paulo Whitaker/Reuters, 2015)

This seems worth mentioning:

Every April, the Fraternidade Descendencia Americana gather in the south of Brazil to celebrate a strange and incongruous shared history. “Stonewall Jackson’s Way” is piped out of speakers, chicken is fried, and girls in hoop skirts dance to old Dixie tunes. Men in Rebel-gray uniforms with yellow trim browse dozens of stands of Confederate memorabilia. The Confederados, as they’re known, are the descendants of Americans who fled after losing the Civil War. Now, 150 years later and 5,000 miles away, they continue to gather under the banner of the Stars and Bars to pay homage to their ancestry.

The setting for this festival is Santa Barbara d’Oeste, which abuts a 200,000-person municipality called Americana. It’s there that a long-forgotten enclave of Confederate descendants rebuilt their lives in the years after the War between the States. At a time when the Confederate flag has sparked tension and protests anew across the United States, this small community in South America still celebrates its controversial history with a fervor.

(Strohlic)

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The Ted Cruz Show (Hair-on-Fire Apoplexy)

Sen. Ted Cruz (R-TX) responds to the 2015 State of the Union address in an online video, 20 January 2015.

“As ridiculous as Cruz’s posturing seems, it’s important to remember the broader context: national GOP candidates have a built-in incentive to be as hysterical as possible right now, in the hopes of currying favor with the party’s base. Mild, reasoned disappointment with the court doesn’t impress far-right activists; unrestrained, hair-on-fire apoplexy does.”

Steve Benen

This is an obvious point, or, at least one might think.

Steve Benen points to his msnbc colleague Benjy Sarlin’s report Friday last detailing the 2016 GOP presidential reactions following the Supreme Court’s 5-4 decision in favor of same sex marriage:

Sen. Ted Cruz (R-Tex.) went so far as to call for a constitutional convention to overturn the court’s decision while campaigning in Iowa, according to CNN. In an interview with Sean Hannity he called the back-to-back rulings on health care and gay marriage “some of the darkest 24 hours in our nation’s history.”

While the Texas junior is hardly the only Republican presidential candidate opting to skip out on posturing his response within the realm of general dignity, Mr. Benen responded aptly:

Hannity, incidentally, found Cruz’s rhetoric quite compelling, responding, “I couldn’t say it more eloquently.”

For what it’s worth, it’s not hard to think of some genuinely tragic 24-hour periods in American history. The Lincoln assassination comes to mind. So does the time British troops burned the White House. There were days during the Civil War in which tens of thousands of Americans died on the battlefield. Just in the last century, we witnessed the JFK assassination, Pearl Harbor, and a corrupt president resign in disgrace.

For the Republican presidential hopeful, learning that Americans will have health benefits and loving couples will get married belongs on the same list.

The thing is that Mr. Cruz is not entirely wrong; the rest, as Benen points out, is a matter of perspective.

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King v. Burwell (Wingnutshell Party Mix)

U.S. Sen. Jeff Sessions (R-AL), January, 2014.  (AP Photo)

“Just once, I want to hear an ACA critic admit what is plainly true: King v. Burwell is a brazenly stupid con, but they’re playing along with the charade because they really hate the president and his signature domestic policy initiative.”

Steve Benen

Really, it is a reasonable suggestion.

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Benen, Steve. “The importance of setting Sessions straight”. msnbc. 5 June 2015.

Good News with an Asterisk

Transgender pride

This is important:

The largest group of internal medicine doctors in the U.S. came out Monday in support of policies it says will improve the health of the country’s lesbian, gay, bisexual and transgender (LGBT) people.

Those policies include support for civil marriage rights for same-sex couples, opposition to so-called conversion or reparative therapy and support for health insurance plans that include comprehensive transgender healthcare services.

“The LGBT community deserves the same high quality care that any community in the United States should be getting, but may not be getting,” said Dr. Wayne J. Riley, president of the American College of Physicians.

(Seaman)

This is the challenge: Prevention and risk identification. The Reuters report notes, for instance, that among the estimated 1.1 million HIV cases in the United States, one in six is not yet diagnosed. And think about that for a moment; that nearly seventeen percent works out to nearly one hundred eighty-four thousand people with unknown transmission potential likely in high risk profiles.

And this is a problem. First and foremost, doctors need to know these patients in order to help. But as a practical concern, this number also represents a tremendous gateway for potential further undiagnosed exposure, transmission, and contraction. Both individual and public health are at risk.

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Morbid Hilarity (King v. Burwell Throwback Mix)

That King v. Burwell has even made it to the Supreme Court becomes even more of a mystery; the cynicism of the case is plainly apparent; even Justice Scalia is reduced to cheap politicking.

Perhaps, then, we ought not be surprised at Ian Millhiser’s report for ThinkProgress, which runs under the lovely title, “The Lawyer Telling The Supreme Court To Gut Obamacare Explained Why He Should Lose In 2012”, should surprise nobody:

On Wednesday, a lawsuit seeking to defund much of the Affordable Care Act appeared to hit a roadblock when Justice Anthony Kennedy expressed concerns that the plaintiffs’ reading of the law is unconstitutional. Though Michael Carvin, the lead lawyer challenging the law, attempted to extract himself from this roadblock, he quickly ran into an entirely different obstacle — his own past writings.

Attorney Michael Carvin, who argued King v. Burwell before the Supreme Court of the United States, 3 March 2015, on behalf of plaintiffs hoping to overturn the Affordable Care Act, in an undated photo.  (Image credit: AP/Pablo Martinez Monsivais)Carvin claims, in a case called King v. Burwell, that Obamacare should be read to deny tax credits that enable millions of Americans to afford health insurance in states that elected not to set up their own health exchange (under the Affordable Care Act, states have “flexibility” to decide whether to set up their own exchange or to allow the federal government to do so). During oral arguments on Wednesday, however, several justices raised concerns about the catastrophic damage Carvin’s reading of the law could inflict on those states’ insurance markets ....

.... Carvin tried to downplay the risk that consumers would simply stop buying plans in the law’s health exchanges if the tax credits were cut off, claiming that these consumers would still be attracted to exchange plans by the fact that the exchanges offer “one-stop shopping” for people looking to buy insurance. He also claimed that Congress wasn’t worried about the risk of death spirals if the tax credits get cut off. According to Carvin, “there’s not a scintilla of legislative history suggesting that without subsidies, there will be a death spiral.”

But Carvin himself sang a very different tune three years ago. Indeed, Wednesday was not the first time he’s stood in the well of the Supreme Courtroom and asked the justices to gut the Affordable Care Act. Carvin was also one of the lead attorneys in NFIB v. Sebelius, the first Supreme Court case attacking the law.

In a brief filed in NFIB, Carvin explained that “[w]ithout the subsidies driving demand within the exchanges, insurance companies would have absolutely no reason to offer their products through exchanges, where they are subject to far greater restrictions.” And, contrary to his more recent suggestion that Congress never envisioned any danger if the tax credits are cut off, Carvin wrote in 2012 that “the insurance exchanges cannot operate as intended by Congress absent those provisions.”

In a subsequent brief, Carvin elaborated that “the federal subsidies are the incentive to participate in the exchanges, and without those subsidies, there will be no mechanism to sustain the exchanges.” He also seemed to contradict his central claim that different states are treated differently depending on whether their exchange is operated by a state or the federal government. The Affordable Care Act, according to the Michael Carvin of 2012, “enables uniform and acceptable federal premium subsidies”.

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More on King v. Burwell

The Supreme Court building in Washington, D.C.

A thematic question: At this point, how is it still a question?

There is a bit somewhere in a book about the Universe asserting what seems nearly circular, that we know what we know is right because it is what we know. That is, of course, an insufficient paraphrase, a memory of how the point felt, but it is also true that if what we think we know is that wrong, there would be no satellite communications. Try a simpler version. If you know a football coach, test a proposition; there is only so long one can hear people say a professional athlete “sucks”. Not a good day, maybe in a larger slump, but you don’t distill in the process and elevate to that valence if you suck. One might think similar things of, say top-tier electoral politics, but no, it doesn’t work that way. It is supposed to, or so we might imagine, except Sarah Palin was nominated to run for vice-president once upon a time, and we all watched Mitt Romney’s disastrously ill-executed campaign for the presidency in two years ago.α

Certes, such comparisons are notoriously vague, but here is the theme: At some point, we cannot maintain confidence if certain properties remain variable and unresolved; if questions of a particular nature and context remain in effect, how is the larger paradigm expected to function at a given valence?

Or perhaps we should simply start with standing. A juristic context. We considered the issue briefly, yesterday, but something about awestruck disbelief seems to have gotten the better of us.

Point being that one might wonder how standing could remain a potentially affecting question when a case reaches the Supreme Court.

Just sayin’.

However, Louise Radnofsky and Brent Kendall bring the question back to focus for The Wall Street Journal:

One of the plaintiffs in the Supreme Court case against the Affordable Care Act listed a short-term-stay motel as her address when she joined the lawsuit, potentially calling into question her basis for suing.

Rose Luck is among four plaintiffs suing the Obama administration to eliminate tax credits under the law that make health insurance cheaper for millions of Americans. They say the wording of the 2010 law allows consumers to tap the credits only in states that run their own insurance exchanges, and not their home state of Virginia, which is one of as many as 37 states that use the federal enrollment system.

And at this point it’s easy enough to make a point about how this sort of technicality shouldn’t matter; after all, the case has survived, anyway, and has achieved SCOTUS valence.

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