Less than a third of Americans support the GOP health care bill aimed at repealing the Affordable Care Act that passed the House last week, according to a new poll.

While 31% of Americans said they support the bill, 44% of respondents said they oppose it and a quarter said they were unsure, according to the HuffPost/YouGov survey.

More of those surveyed (39%) said the American Health Care Act would likely be worse than the Affordable Care Act than said it would be better (26%).

The GOP bill passed narrowly in the House and now faces consideration in the Senate.

The poll, conducted online on May 6, surveyed 1,000 adults and had a margin of error of +/- 4.5%.

The Advocate had a great editorial.

“The ongoing debate about government’s role in health care involves a compelling reality – namely, that when elected officials are charged with guiding help for the sick and the elderly, political expedience can trump policy choices that do the most good for the most people.

Louisiana offers a vivid case study of such cynical gamesmanship in the way that lawmakers and governors have steered patients and money toward nursing homes over the years when cheaper and more effective options such as community and home-based care are available. It’s no secret why nursing homes remain favored at the state Capitol, as a three-part Advocate special report that concludes today makes clear. The industry contributes lavishly to political campaigns, virtually ensuring that when governors and legislators decide how lucrative Medicaid dollars get spent, nursing home operators stand at the head of the line.

It’s a nice deal for the nursing homes and the politicos who feed at the industry’s campaign trough, but the losers, of course, are the frail and physically impaired Louisiana citizens who depend on state government to be their champion. Taxpayers at large get the shaft, too. Louisiana could, by one estimate, eventually save up to $200 million a year by guiding patients toward other kinds of care beyond nursing homes. As the state continues to hemorrhage red ink, such a wrong-headed fiscal policy should be a public scandal.

Nursing homes will always be needed for those who require specialized, around-the-clock care. But The Advocate’s investigation revealed that patients who seem ideal candidates for cheaper, less extensive assistance are often driven into nursing homes because state policy is stacked against them.

Nursing homes now get 77 cents of every Medicaid dollar Louisiana spends on care for the elderly and physically disabled, while home- and community-based programs get the rest. That ratio, among the highest in the country, has been increasing steadily since 2013.

On average, a nursing home costs the state $47,331 per resident per year. By comparison, it costs the state between $13,758 a year and $33,117 a year to care for an elderly or disabled person at home, depending on the level of care they require.

 As most states have shifted away from institutionalized care, Louisiana has gone in the opposite direction – a dubious distinction that’s been a boondoggle of bipartisan design. Former Gov. Bobby Jindal, a Republican, made a nod towards reforming the system, then abruptly ditched it after the nursing home industry, which had contributed hundreds of thousands of dollars to his political ambitions, raised objections. His successor, Democratic Gov. John Bel Edwards, also seems to be backing off his own promises about reform. Nursing home interests have written him big campaign checks, too, and the industry’s influence in the Legislature also crosses party lines.

In Louisiana, where so many residents trumpet family values, self-sufficiency, and fiscal discipline, state leaders should embrace health care alternatives that keep people at home with their loved ones, allow them to do what they can for themselves, and save as many tax dollars as possible.

As The Advocate’s special report demonstrated, our present Medicaid policies do exactly the opposite.”

Politico had an article on Republicans’ blatant hypocrisy.  “For seven years, Republicans campaigned on a single message: Obamacare was rammed through Congress by power-hungry Democrats who rushed a hastily written bill riddled with backroom kickbacks.”  Republicans are doing the exact same thing — or worse — that they blasted Democrats for repeatedly. Here’s how:

1. No CBO score: With all the last-minute changes to Republicans’ original repeal plan, the Congressional Budget Office won’t have an estimate of the potential impact for several days, if not weeks. That means lawmakers voted on a bill with no idea whether it will still lead to 24 million people uninsured — like the first proposal — or cause premiums to skyrocket.

House Speaker Paul Ryan, then ranking member on the Budget Committee, railed against the prospect of voting without a CBO report during the Obamacare debate. I don’t think we should pass bills that we haven’t read, that we don’t know what they cost,” Ryan said on MSNBC in 2009. And in fact, the Democratic-led House only voted on the bill after it received a CBO analysis.

2. Voting on a bill they haven’t read: Republicans blasted Democrats for years for voting on a bill without fully understanding the consequences.  “Have you read the bill? Have you read the reconciliation bill? Have you read the manager’s amendment? Hell no you haven’t!” then-House Minority Leader John Boehner (R-Ohio) said in a fiery floor speech shortly before the Affordable Care Act passed the House.

But some GOP lawmakers readily admitted they would back a bill that they hadn’t even read. “I don’t think any individual has read the whole bill,” Rep. Thomas Garrett (R-Va.) said on MSNBC Thursday. “That’s why we have staff.”

3. Congressional carve out: The initial compromise released last week by House Freedom Caucus Chairman Mark Meadows (R-N.C.) and moderate Rep. Tom MacArthur (R-N.J.) included an exemption for lawmakers and their staff. House Democrats’ campaign arm quickly seized on the provision, saying Republicans’ repeal plan was so bad, even they didn’t want to be affected by it.

4. No committee hearings: The revised repeal plan lawmakers voted on Thursday had significant changes and was considered on the House floor without a single hearing by the main committees of jurisdiction. The bill did go through the Rules Committee, which governs floor debate.

A bill — finalized yesterday, has not been scored, amendments not allowed, and 3 hours final debate — should be viewed with caution,” Sen. Lindsey Graham (R-S.C.) tweeted Thursday.

5. Partisan vote: House Republicans eagerly point out that Democrats passed Obamacare in 2010 without a single GOP vote. Democrats counter that one of the main tenets of Obamacare — the individual mandate — was inspired by Republican Gov. Mitt Romney’s health care plan in Massachusetts.

Democrats also point out that as Obamacare moved through the committee process, several Republican amendments were considered and adopted. Senate Democrats also spent months negotiating with Republicans to try to win bipartisan support.

“Rank hypocrisy [and] situational ethics,” House Minority Whip Steny Hoyer (D-Md.) said in an interview. “It’s okay if we do it, it wasn’t okay if you do it. It’s phony and they know it’s phony.”

The Advocate has had a series of articles about the failed and corrupt system of long term care in Louisiana.  One article explained how lobbyists and campaign contributions control the legislation passed by the politicians.

A team of government experts and industry stakeholders spent more than two years painstakingly crafting a plan that would have reduced Louisiana’s expensive and unpopular reliance on nursing homes to house the state’s most helpless residents.

But it took just one email from the head of the industry’s powerful Louisiana lobby to kill the reform even though estimates show the state could save more than $100 million a year while improving patient outcomes.  Months before he pulled the plug on the long-term care overhaul, Jindal received a pile of checks from nursing home interests in support of his quixotic presidential campaign. The stack added up to about $370,000 — roughly 5 percent of the total he raised. The industry had long been stuffing Jindal’s coffers: As governor, he had taken in nearly $800,000 from the industry.

050117 Nursing homes contributions.jpg

Over many decades, industry leaders have made themselves perhaps the state’s most powerful lobby, enjoying unfettered access to the state’s policymakers and protecting their profit margins even in the worst of budgetary climates. The Louisiana nursing home industry is a juggernaut in Louisiana’s political fundraising arena, with much of the muscle provided by three prominent owners: Ronnie Goux, Elton Beebe and Teddy Ray Price.

This year, the 259 nursing homes in Louisiana that accept Medicaid are slated to take in more than $1 billion in public funds. That’s roughly 4 percent of the overall state budget and about 10 percent of the state’s Medicaid budget — a bigger slice than any other sector, including hospitals and physicians.

House Republican passed Zombie TrumpCare with no hearings, no studies, no Congressional Budget Office analysis; not even the text of a bill circulated the day before the vote.

The bill is the same one that was polling at under 20 percent and failed two months ago: a near-trillion dollar tax cut for wealthy investors, financed by cuts to insurance subsidies for the poor and middle class; waivers for states to allow insurers to charge higher rates to people with preexisting conditions and to avoid covering essential health benefits. It is stuffed with unpopular provisions — cuts to special education, elimination of funding for Planned Parenthood, threats to coverage for people who have employer-sponsored insurance.

According to studies of the last version of their bill, premiums in the individual market are projected to increase by 13 percent, and deductibles would rise by 60 percent. President Trump repeatedly vowed not to cut Medicaid, and has smashed that promise.

They are rushing a bill reorganizing one-fifth of the economy, without attempts to determine the consequences. Its budgetary impact and increase in deficit is unknown. Millions of Americans will lose access to medical care, and tens of thousands of them will die.

A website called EverythingZoomer had an interesting article on why violence persists in nursing homes. The author used the tragic case of James Acker as an example. Acker was viciously attacked by another resident with dementia at at St. Joseph’s Villa nursing home. The beating left him black and blue and bleeding from the head; his family was told he only had a 50 per cent chance of surviving.

A CNN study found that between 2013 and 2016, more than 1,000 nursing homes in the United States were cited for failing to report or mishandling allegations of rape, sexual abuse or sexual assault. According to the report, three-quarters of those cases involved residents abusing other residents.

 

Paul Bland from Public Justice wrote an article on the DailyKos about Trump’s plan to revoke the rule prohibiting mandatory pre-suit arbitration clauses in nursing home contracts. Bland wrote:

Some of the most heart-wrenching stories of abuse, mistreatment and neglect you’re likely to hear involve nursing homes. As America’s baby boomers age, and nursing home populations continue to grow, big corporations have, not surprisingly, started to take note. In fact, the vast majority of nursing homes in the United States – 70%, according to the Centers for Disease Control and Prevention – are run by for-profit corporations, and an increasing number of homes are being snapped up by Wall Street investment firms.

And that, in turn, can often mean that high quality care takes a backseat to high profits.

Increasingly, these giant corporations are using forced arbitration clauses — contract terms that say that people cannot sue them, no matter what laws they break, and instead people harmed by illegal acts can only bring cases before private arbitrators who are generally beholden to the corporations. These clauses make it far harder for the victims of mistreatment to hold a facility accountable where there’s abuse or serious negligence, and they minimize the incentive to provide the highest quality of care.  The secretive arbitration system also effectively lets homes sweep the facts about problems under the rug, so that the public and regulators never learn about widespread or egregious abuses.

That’s why, in 2016, the Centers for Medicare and Medicaid Services said nursing homes should no longer receive federal funding if they use arbitration clauses in their contracts. It was a commonsense proposal that would ensure families can hold nursing homes accountable for abuse and neglect. The government essentially said – and rightly so – that protecting desperately vulnerable people is more important than squeezing out an extra percentage of profit for hedge fund owners.

But that was 2016. Now, the Trump Administration appears to be gearing up to kill the proposal.

Senator Al Franken (D-MN), a fierce opponent of arbitration who has fought corporate lobbyists to protect Americans’ right to their day in court, said on Tuesday that “the Trump Administration is planning to lift the ban on nursing home arbitration clauses.”

So the White House, it appears, is ready to deliver another gift to hedge funds and banks – the corporate entities that increasingly control the nursing home industry – at the expense of the sick and elderly and their families.

It’s no wonder why corporate lobbyists working for the nursing home industry have made killing the CMS proposal a top priority: unlike the public court system (where trials are open to the public, press and regulators), nursing homes benefit enormously from the secretive system of arbitration, where the facts about abuses can be (and often are) buried. “Confidentiality” provisions – which really translate into gag orders – and non-transparent, non-public handling make it easier for systemic problems to stay hidden, and to continue.

If nursing homes are permitted to continue opting out of the civil justice system, we can expect to see lower levels of care, and higher numbers of preventable injuries and deaths. If they succeed in keeping families out of court, the potential savings to their bottom line are enormous when you consider that abuse is very widespread (according to the government’s own study).  Public Justice, our national public interest law firm and advocacy organization, set forth an extensive factual and legal case in support of the CMS proposal, where a great deal more background is available.

Consider just a handful of the plaintiffs who were able to successfully challenge nursing homes in court:

  • A 90-year-old woman allowed to languish with a festering pressure sore, acute appendicitis, and a urinary tract infection so severe it has entered her blood.
  • A diabetic patient injected with the incorrect dose of insulin, sending them into hypoglycemic shock and causing brain damage.
  • An 81-year-old man who was viciously beaten by a roommate who’d been involved in 30 assaults prior to moving in with the victim.
  • An 87-year-old woman whose calls for help were ignored after she fell and broke her hip.

Had any of those patients been subject to an arbitration clause – as no doubt many future cases would be if the Administration folds to pressure from for-profit homes – they likely would have never had a chance to have their case heard by a jury.

Nursing homes have complete control over some of the most vulnerable and fragile people in the entire country: people who are gravely ill, who are often cognitively impaired in ways that make it hard for them to protect themselves, are completely at the mercy of these institutions.

Now, rather than working to give those patients some small measure of protection and security, the Trump Administration is poised to give them the shaft. It’s unconscionable back-pedaling that would leave millions with little recourse when they, or their loved ones, are mistreated or abused.

McKnight’s reported that the Trump Administration is trying to roll back protections for nursing home residents by reversing a federal ban on pre-dispute arbitration agreements in nursing homes.   Sen. Al Franken (D-MN) said the proposal was a “misguided decision” on the part of the administration.

Until last year, many long-term care contracts were riddled with fine print that prevented residents and families who were wronged from seeking justice in court,” Franken, an outspoken opponent of arbitration agreements, said in a statement released last Thursday. “But now the Trump Administration is planning to lift the ban on nursing home arbitration clauses, which would be terrible for consumers,” Franken said.

He authored a bill introduced in March that would ban any arbitration agreements made before employment, consumer or civil rights disputes arise.

The nonpartisan Congressional Budget Office (CBO) “scoring” of the original American Health Care Act was clearly an important contributor to the bill’s steadily declining popularity in both Washington and around the country. In particular, Republican House members could all too easily imagine attack ads based on CBO’s finding that the bill would eliminate health coverage for 24 million Americans. CBO’s follow-up “scoring” of a tweaked version of the original bill made things worse, as it significantly reduced its estimate of deficit savings without changing the projection of lost health coverage.

So, instead House Republicans passed the legislation before the CBO was able to score the modified TrumpCare.  Previously, House Republicans refused to vote on repealing ObamaCare until Congress’s budget scorekeeper weighs in.

Republicans are clearly terrified of their Members and the American people seeing the full consequences of their plan to gut critical protections for Americans with pre-existing conditions,” Pelosi said in a statement.

What will CBO say about Zombie Trumpcare? The provisions allowing states to waive essential benefit and nondiscrimination provisions will make coverage losses even worse. And the last-minute subsidy boosts could also further erode deficit savings.

Eventually, of course, the CBO score will arrive, certainly before anything happens in the Senate. So, the House Republicans just threw Senate Republicans under the bus.

New York Magazine had an interesting article about “Zombie Trumpcare”. “Republicans say they’re on the verge of rounding up the votes to pass the American Health Care Act. They sounded the alarm before they headed home for Easter recess, and again before President Trump’s 100th day in office, but each time Zombie Trumpcare stumbled before it could eat the brains of the American health-care system.”

Republicans are relying on a process called reconciliation that will let them pass the bill with a simple majority, not 60 votes. That window closes when they wrap up the budget for fiscal year 2017, and on Sunday night Congress reached a bipartisan spending agreement that’s likely to pass this week. Despite reaching a compromise last week that House Freedom Caucus members actually like — though it would make the AHCA even worse for the poor, sick, and elderly – Republicans were unable to muster the support to hold a vote last week. Plus, as Politico notes:

The House is scheduled to leave town for a one-week recess on Thursday, and some senior Republicans worry that failing to get it done by then would fritter away critical momentum. Skittish Republicans would return home to face a barrage of pressure from Democrats and progressive outside groups.

“This is it,” an administration official told Politico. “We get it done now, or we don’t get it done ever.”