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).”

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.”

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.”

Some 270 nursing home caregivers, members of 1199SEIU, who work as certified nursing assistants, licensed practical nurses, dietary aides, housekeepers, and activity aides are going on a 24-hour strike at 5 a.m., this Friday, June 23. because of the infamous Michael Konig.

Nursing home operator Konig, once dubbed “landlord from hell” by the New York Daily News and with a decades-long legal history—including payouts to resolve allegations of resident neglect and failure to abide by wage and hour laws—is now under fire for poor working conditions and unfair labor practices at three NJ facilities.

          Senate Majority Leader Loretta Weinberg has issued the following statement on the upcoming strike: “Nursing facilities which receive significant funding from public tax dollars have an obligation to use those resources with the utmost responsibility.  The women and men who do back-breaking work caring for our elderly loved ones deserve fair treatment and respect.  Michael Konig must bargain in good faith with his employees and reach a settlement that values these caregivers for their essential work.”

Nursing home workers who are members of 1199SEIU have announced a 24-hour strike at three facilities operated by Michael Konig, owner of Broadway Healthcare Management, to protest unfair labor practices and demand that their employer invest in better jobs and staffing levels for caregivers.

Each of the three nursing homes—Amboy Nursing and Rehabilitation Center in Perth Amboy, ManhattanView Nursing Home in Union City, and Teaneck Nursing Center in Teaneck—has staffing levels for certified nursing assistants (CNA) that fall below state averages on a majority of shifts, according to data from the NJ Department of Health.  CNAs are responsible for providing direct care at the bedside, including feeding, dressing, and bathing residents.  The overnight shifts are especially understaffed, with levels within the bottom fifth of all nursing homes in the state.  Caregivers say lack of sufficient staff makes it difficult to provide the type of quality, one-on-one care that residents need.

Residents want to get up at a certain time of day, but sometimes they’re stuck in bed because we’re so short-staffed and there’s no one available to assist them,” said Cerese Abraham, a certified nursing assistant at Teaneck. “Short staffing is becoming the norm.  A lot of us have high blood pressure from all the stress that brings—one CNA even passed out during a recent heat wave because she was so overworked.”

Earlier this year, the National Labor Relations Board (NLRB) issued complaints against all three facilities for failing to bargain in good faith with the workers’ union, 1199SEIU.  After a thorough investigation, the NLRB also charged the nursing homes with failing to make the required contributions into the employees’ education fund.  And at Amboy Nursing and Rehab, the NLRB has issued a complaint for the company’s failure to make the necessary contributions into the employees’ health benefit fund, which resulted in some workers being left without health insurance.  A similar investigation regarding employee health benefits is currently underway at ManhattanView.  All of the charges are being consolidated into a single case by the NLRB, for a trial slated to take place later this summer.

For months, nursing homes operated by Michael Konig have engaged in a pattern of unethical and illegal behavior that violates employees’ rights and jeopardizes their ability to deliver quality care to their patients,” said Milly Silva, Executive Vice President of 1199SEIU.  “It is incredibly irresponsible for Mr. Konig to force caregivers into a position where striking is the last option they have.  We do not want to strike, but we cannot allow this employer to undermine job standards in nursing homes.”

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1199SEIU United Healthcare Workers East is the largest and fastest-growing healthcare union in New Jersey and nationwide. We represent over 16,000 healthcare families in New Jersey and over 400,000 total members throughout New Jersey, New York, Massachusetts, Maryland, Florida, and Washington, D.C.   Our mission is to achieve quality care and good jobs for all.

POLITICO/Morning Consult polling indicates TrumpCare has become less popular since the House advanced it in early May. As the GOP Senate prepares to vote, only 35 percent of voters surveyed approve of the bill passed by the House last month. Nearly half of voters, 49 percent, disapprove of the bill. The other 16 percent don’t know or don’t have an opinion, the poll shows.

Among Republican voters, 30 percent disapprove of the GOP health care bill. That is up from 15 percent of Republicans disapproving in early May.  Independent swing voters– 53% disapprove of the bill: only 26 % approve.

FiveThirtyEight analyzed who TrumpCare’s tax cuts would benefit. One such tax is a 0.9 percent payroll tax on individuals earning more than $200,000 a year, often referred to as the Medicare surcharge. The other is a 3.8 percent tax on net investment income, also for people who earn more than $200,000.1 These taxes largely affect the top 5 percent of earners, with the majority of the money collected coming from the top 1 percent of earners.

The final bill will include hundreds of billions of dollars in tax cuts for the richest 1% of Americans. The cuts would go disproportionately to Democratic-leaning states.  The eight states that paid the most in 2014, six voted for Hillary Clinton in last year’s presidential election.  Those six states collectively accounted for 47 percent of all the money raised by the taxes in 2014.  Only the top 1.4% of South Carolina citizens pay the tax.

That pattern holds when we look at all states and the District of Columbia, too: These taxes as a whole — both in terms of dollar amounts paid and the share of people paying them — are largely coming from states that leaned Democratic in the 2016 election.  In all, states that voted for Clinton paid $17.3 billion, which is 59.9 percent of the combined ACA-related taxes. In short, in repealing these taxes, Republican senators would be giving tax breaks predominantly to states that favor their Democratic opponents.

One way to think about the tradeoffs of the ACA is to look at how many of a state’s residents directly benefited from the law (via tax credits or the Medicaid expansion) relative to how many paid the investment tax. That ratio shows that in certain red states, many more people are receiving financial support from the law than paying for it. In 2014, the three states with the highest ratio of beneficiaries to investment-tax payers were all won by Trump: West Virginia, Kentucky and Arkansas. In those three states, for every person who paid the investment tax, more than 16 people benefited directly from either the Medicaid expansion or the tax credit that subsidizes premiums on private plans.

The Advocate reported on the shenanigans in Louisiana.  A House bill intended to create a safety net for the mentally ill got an unexpected rider that would limit competition for Louisiana nursing homes.

Sens. Fred Mills, R-Parks, and Jay Luneau, D-Alexandria, asked the Senate to approve the amendment for House Bill 402, which had already passed the House floor and a Senate health committee.  The amendment, which is totally unrelated to the original bill, was written to extend a 5-year moratorium on “Level 4” assisted living facilities that provide a more independent level of care for people with higher medical needs.  The moratorium effectively blocks private-pay assisted living facilities from entering the market.

Mills, who owns a stake in a nursing home, said he asked for the amendment at the behest of the Louisiana Nursing Home Association. He said he agreed with the association that the moratorium was needed.

Rep. Jay Morris, R-Monroe, said he completely opposed the concept of a moratorium, believing the intention was to eliminate businesses that compete with nursing homes.

“I believe that because it was the nursing home industry that lobbied for the amendment,” he said.

Meanwhile, another Advocate article states that the AARP Foundation released its national scorecard for elderly services, cementing Louisiana’s status as one of the worst places in the nation to grow old. Overall, Louisiana ranked 40th in the nation for long-term care services, a drop from 37th from 2014, when the report was last updated. And in two of the categories that address nursing homes, Louisiana couldn’t get much worse: It ranked 50th for “quality of life and quality of care,” and 51st — behind every other state plus Washington D.C. — in how effectively people are transitioned out of nursing homes into their preferred communities.

The newest scorecard noted disapprovingly that Louisiana had the highest percentage of nursing-home residents receiving anti-psychotic medication. More than 21 percent of nursing home residents received the medication, compared to a national median of 16.8 percent.

Louisiana nursing homes were also among the worst — 49th in the nation — for high-risk residents with bed sores. Louisiana also ranked near the bottom for the proportion of new nursing-home stays that last 100 days or more, and the percentage of nursing-home residents who are hospitalized.