Ed Kilgore for New York Magazine had an article explaining how TrumpCare’s “mean” cuts to Medicaid will affect health care spending.

According to the Congressional Budget Office, TrumpCare will cut Medicaid spending $834 billion over ten years. The federal share of costs would be “capped” at a particular level per enrollee, with a fixed annual “growth rate” (basically the medical inflation rate).  The per capita cap reflects a long-standing GOP goal of ending Medicaid’s original status as an open-ended entitlement program in which the federal government would contribute a specified percentage of the costs incurred by states in covering eligible enrollees.

TrumpCare will also cut the Affordable Care Act’s federal subsidies for states (31 at this point) that choose to expand Medicaid eligibility to the universe of people (including able-bodied adults without children) with incomes under 138 percent of the federal poverty line.

‘Under ACA, the federal government initially covered 100 percent of the costs of covering the expansion population, a “super-match” that this year began declining toward a permanent level of 90 percent, still far above the usual match rate (which varies from state to state based on demographics, ranging from a minimum of 50 percent up into the 70s for a few really poor states). The House-passed AHCA would drop the super-match for new enrollees after 2020 (previous “expansion” enrollees would continue to receive the super-match so long as they had continuous coverage; in reality most would not meet that condition).”

The Senate version of the American Health Care Act institutes deeper Medicaid cuts than the House bill to help pay the cost of its expensive tax credits. The House version holds the program to the inflation rate plus one percent — which is historically lower than medical costs have risen, meaning that the program would have to curtail benefits for its beneficiaries, who tend to be poor and very sick. The Senate bill would cut growth down to the inflation rate, without the extra one percent.

The most important design feature is that the Senate bill retains all the tax cuts in the House bill. By eliminating nearly a trillion dollars in revenue, it necessarily creates a trillion dollars in cuts for coverage subsidies.

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The Madison-St. Clair Record reported the lawsuit filed against Integrity Healthcare of Alton; General Medicine, PC or in the alternative General Medicine of Illinois Physicians, PC; Senior  Healthcare Management, LLC; and Steve Blisco, alleging the defendants violated the Nursing Home Refort Act of 1987.

Jerome Bates, as administrator of the estate of Judith Bates, filed a complaint alleging neglect and failure to properly care for the decedent. On June 24, 2015, Judith Bates was a resident at the defendant’s nursing home and developed a urinary tract infection.  Judith Bates was also dehydrated, suffered from protein calorie malnutrition, had lost weight, suffered from urinary incontinence, could no longer eat and complained of abdominal pain. However, the plaintiff alleges no doctor was notified of her condition. The next day, Judith Bates died.

The plaintiff alleges the defendants failed to formulate and update a plan of care regarding hydration, weight loss, nutrition and diet, urinary incontinence and urinary tract infections and failed to provide appropriate hygiene and preventative measures to prevent recurrent urinary tract infections.

New York Magazine had an article about GOP moderates worried about TrumpCare’s health care cuts affecting the opiod crisis.  “During the worst year of the HIV/AIDS crisis, 43,000 Americans lost their lives to the virus. In 2015, 52,000 died of a drug overdose. Never in recorded history had opioids killed so many Americans in a single year; the drug-induced death toll was so staggering, it helped reduce life expectancy in the United States for the first time since 1993.”

The Medicaid cuts in TrumpCare will devastate addiction resources.  Medicaid expansion accounted for 61 percent of total Medicaid spending on substance abuse treatment in Kentucky, 47 percent in West Virginia, 56 percent in Michigan, 59 percent in Maryland, and 31 percent in Rhode Island. In Ohio, the expansion accounted for 43 percent of Medicaid spending in 2016 on behavioral health, a category that includes mental health and substance abuse.

As the New York Times reports:

Republican senators from states that have been hit hard by the opioid drug crisis have tried to cushion the Medicaid blow with a separate funding stream of $45 billion over 10 years for substance abuse treatment and prevention costs, now covered by the expansion of Medicaid under the Affordable Care Act.

But that, too, is running into opposition from conservatives. They have been tussling over the issue with moderate Republican senators like Rob Portman of Ohio, Shelley Moore Capito of West Virginia and Susan Collins of Maine.

Without some opioid funding, Mr. Portman cannot vote for the bill, he said, adding, “Any replacement is going to have to do something to address this opioid crisis that is gripping our country.”

Contagion Live had a discussion with Nicola Thompson, PhD, epidemiologist, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention who shared what is needed to estimate the burden of healthcare-associated infections in nursing homes.

Interview Transcript (slightly modified for readability):  “There has been a lot of work outside of the United States, in Europe, and also recently in the United States by the Centers for Disease Control and Prevention (CDC) to look at the prevalence of healthcare-associated infections in acute care hospitals. That data that has been collected has been used to translate the prevalence of infection into the burden over the course of the year. That has been done by a long-standing formula that has been out and has been published and used many times. That formula includes in it information on the average length of stay [for a patient].

Essentially the model that is used to estimate the burden of healthcare-associated infections from the prevalence takes into account the average length of hospital stay for people with a healthcare-associated infection, compared [with] the average length of hospital stay for people without a healthcare-associated infection. Those are the pieces for the inputs for the model. The differences between lengths of stay is used to estimate the national burden [of disease].

The concept of ‘length of stay’ does not really hold up when we think about the nursing home setting because the vast majority of people that are in a nursing home go there long-term to receive care and they are not anticipating a discharge. [Therefore,] we need to come up with a different approach to estimating the burden of [healthcare-associated] infections in nursing homes that does not rely on information, or take into account information on length of stay. That is really where the work that has been done by the European CDC (ECDC) to look at the burden estimation in nursing homes has been helpful to us.”

Salon had an interesting perspective on TrumpCare.  The new freedom is based on individual choice according to ideologues. “You’re free to be poor, free to be politically powerless or free to be ill and uncared for; it’s all a matter of decisions you freely make in life, and our larger society has no business interfering with your free will.” So that’s what Republicans’ Trumpcare is offering us, this “freedom” from health care.

“This is what passes for a philosophical framework behind many of the policies of today’s Republican congressional leaders. For example, they say their plan to eliminate health coverage for millions of Americans and do away with such essential health benefits as maternity care for millions more is just a matter of good old free-market consumerism. As explained by Jason Chaffetz, a Utah Tea Party Republican, “Americans have choices. And so maybe, rather than getting that new iPhone that they just love and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care.”

Paul Ryan: “Freedom is the ability to buy what you want to fit what you need.” Yes, apparently, you are as free as you can afford to be.

Sarah Kliff at Vox explains the Senate’s version of Trumpcare.  The overall theme is low- and middle-income Americans will spend significantly more for less coverage.

The bill would roll back the Affordable Care Act’s expansion of the Medicaid program, which currently covers millions of low-income Americans, and include additional cuts to Medicaid. It would rework the individual market so that enrollees get less financial help to purchase less generous health insurance with higher deductibles.

Here is how the Senate bill works:

  • The Senate bill begins to phase out the Medicaid expansion in 2021 — and cuts the rest of the program’s budget too. The Senate bill would end the Affordable Care Act’s expansion of Medicaid to millions of low-income Americans. This program has provided coverage to more Americans than the private marketplaces
  • It would also cut the rest of the public insurance program. Better Care would also limit government spending on the rest of the Medicaid program, giving states a set amount to spend per person rather than the insurance program’s currently open-ended funding commitment.
  • The Senate bill provides smaller subsidies for less generous health insurance plans with higher deductibles. The Affordable Care Act provides government help to anyone who earns less than 400 percent of the federal poverty line ($47,550 for an individual or $97,200 for a family of four). The people who earn the least get the most help. The Senate bill would make those subsidies much smaller for many people, and only provide the money to those earning less than 350 percent of the poverty line ($41,580 for individuals and $85,050 for a family of four). The Senate bill will tether the size of its tax credits to what it takes to purchase a skimpier health insurance plan than the type of plans Affordable Care Act subsidies were meant to buy. Essentially, these tax credits buy less health insurance.
  • The Senate bill seems to allow states to opt out of Obamacare’s marketplaces and essential health benefits requirement. A new waiver process would allow states to overhaul their insurance markets, including ending the essential health benefit requirement and specific subsidies that benefit low income Americans, so long as those changes do not increase the deficit.
  • The Senate bill repeals the individual mandate — and replaces it with nothing. The bill gets rid of the Affordable Care Act’s unpopular requirement that nearly all Americans carry health coverage or pay a fine. This could cause significant disruption in the individual market because it takes away a key incentive healthy people have to buy coverage, meaning only sick people may sign up.
  • The bill would cut taxes for the wealthy. Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion.
  • All in all, the replacement plan benefits people who are healthy and high-income, and disadvantages those who are sicker and lower-income. The replacement plan would make several changes to what health insurers can charge enrollees who purchase insurance on the individual market, as well as changing what benefits their plans must cover. In aggregate, these changes could be advantageous to younger and healthier enrollees who want skimpier (and cheaper) benefit packages. But they could be costly for older and sicker Obamacare enrollees who rely on the law’s current requirements, and would be asked to pay more for less generous coverage.

Illinois Public Media News reported that Champaign County Administrator Rick Snider says his nursing home is cooperating with an investigation into the death of a resident of the home. According to the News-Gazette, the county coroner and Illinois State Police are investigating the death of a 78-year-old woman who was discovered in the courtyard and may have been outside in high temperatures for as many as three hours.

The investigation comes as the county board looks to hire a management firm to run the nursing home and continues to discuss options for selling it. A majority of voters in April’s election backed a referendum in support of selling or closing the nursing home.

Vox had an interesting article about conservative Phillip Klein who disapproves of TrumpCare.  See published multiple pieces against it.  Klein favors a pure market-based system. His latest column for the Washington Examiner argues that Republicans have “already given up on repealing and replacing Obamacare” and are inching toward a cluster of half-measures that will be politically damaging and practically counterproductive.

His primary concern is that Republicans are being disingenuous about what their bill can do, and will pay a steep price when it fails.

“I think the Republicans are making a big mistake because their promises are just through the roof. I mean, President Trump promised at various times that he was going to cover everybody. It’s going to be more comprehensive insurance, that the deductibles will be lower, that there’s going to be less spending and lower taxes, and not all of these things can be possible simultaneously.

So whatever happens, it’s not going to live up to the promises made by Trump, and Democrats are going to run ads for years calling out Trump’s hypocrisy. You’re going to hear his famous line, “Everybody’s going to be covered and it’s going to be amazing” over and over and over again.”