“We Are Marching Steadily To An Uninsurable Future”

The following is part of an article by Todd C. Frankel in The Washington Post: 

A growing number of homeowners nationwide are being dropped by insurance companies as firms and regulators struggle to deal with the unpredictable and costly risks of climate disasters.

Nonrenewal notices surged by nearly 30 percent from 2018 to 2022 to more than 620,000 a year, according to a Treasury report released Thursday that examined 246 million policies nationwide. Nonrenewal rates were nearly 80 percent higher in Zip codes that faced the highest risk from insurance perils such as strong winds and wildfires compared with the lowest risk areas.

The rise of nonrenewal notices, as they are called, has attracted attention and criticism during the ongoing Los Angeles wildfires, where some major insurance companies had said last year they were dropping thousands of homes that ended up burning down in the raging fires.

But it’s not just a California thing. Florida, Louisiana and North Carolina all posted nonrenewal rates higher than the Golden State in 2023, according to a Senate report released in December. Florida’s rate was nearly 3 percent, compared with California’s rate of about 1.8 percent. That report also found an increased rate of nonrenewals nationwide.

The spike in nonrenewals is being driven by the increasing severity of extreme weather events, higher inflation pushing up the cost of rebuilding and stiff regulations that make it harder for insurance companies to raise prices to cover their costs, according to industry officials and consumer advocates. . . .

Insurers also have struggled to accurately price in the risk of promising to rebuild homes in the many parts of the country vulnerable to wildfires, hurricanes and wind storms. The computer models used to identify the riskiest areas, built on historical weather patterns, have been upended by climate change. . . .

Homeowners have seen insurance premiums soar — up 33 percent from 2020 to 2023, according to a National Bureau of Economic Research report. Insurance is required in most cases on properties with mortgages.

As prices rise, some have turned to state-run insurance pools as a last resort to find coverage. But others have opted to drop insurance entirely — what’s known in the industry as “going bare.” The number of homes without insurance has nearly tripled since before the pandemic, according to survey estimates. . . .

Insurers have been hit with big losses in their homeowners policies in recent years. The U.S. homeowner’s insurance market paid out $15.2 billion more in claims and costs than it collected from policyholders in 2023, the worst result this century and double the loss in 2022, according to AM Best, a credit-rating agency focused on the insurance industry.

The numbers for 2024 are not expected to look any better. . . .

The problems for homeowners are expected to continue. The cost of insurance will continue to rise as companies try to price in the risk from a rising number of climate threats — potentially leading to some homes and locations becoming unaffordable.

“We are marching steadily to an uninsurable future,” said Davis, the former California regulator.

Climate Change Causes Insurance To Cut Coverage

 The following is part of an op-ed by Jacob Bogage in The Washington Post:

In the aftermath of extreme weather events, major insurers are increasingly no longer offering coverage that homeowners in areas vulnerable to those disasters need most.

At least five large U.S. property insurers — including Allstate, American Family, Nationwide, Erie Insurance Group and Berkshire Hathaway — have told regulators that extreme weather patterns caused by climate change have led them to stop writing coverages in some regions, exclude protections from various weather events and raise monthly premiums and deductibles.

Major insurers say they will cut out damage caused by hurricanes, wind and hail from policies underwriting property along coastlines and in wildfire country, according to a voluntary survey conducted by the National Association of Insurance Commissioners, a group of state officials that regulates rates and policy forms.

Insurance providers are also more willing to drop existing policies in some locales as they become more vulnerable to natural disasters. Most home insurance coverages are annual terms, so providers are not bound to them for more than one year.

That means individuals and families in places once considered safe from natural catastrophes could lose crucial insurance protections while their natural disaster exposure expands or intensifies as global temperatures rise.

“The same risks that are making insurance more important are making it harder to get,” Carolyn Kousky, associate vice president at the Environmental Defense Fund and nonresident scholar at the Insurance Information Institute, told The Washington Post. . . .

Typical home insurance policies cover damage from all manner of perils, including fire and smoke, wind and hail, plumbing issues, snow and ice, and vandalism and theft. Floods are generally covered by a separate federally administered program.

Under the policy changes many large insurers are reporting to regulators, firms will continue to offer baseline policies to clients in disaster-prone areas, but without protections for damage caused by those disasters. For example, a policy in a region afflicted by hurricanes may exclude coverage for wind or hail damage, or in wildfire country, a policy without fire and smoke protection. . . .

Insurance markets, especially those that serve many regions across the country, rely on relatively stable risk projections when it comes to natural disasters. By balancing wildfire risk during the late spring in the Pacific Northwest with hurricanes in the early fall in the Southeast and winter storms in the Upper Midwest, insurers can spread risk across constituencies. In theory, providers can collect monthly premiums from a broad clientele without paying out claims on too many large-scale disasters at once.

But weather patterns are changing as the planet warms.

57% Say Gov. Responsible For Citizen's Health Coverage

The charts above are from a Gallup Poll -- done between November 9th and December 2nd of a nationwide sample of 1,020 adults, with a 4 point margin of error.

It shows that 57% of American adults believe that the federal government has the responsibility to make sure that all Americans have health care coverage.

That does not mean that a majority wants a government-run system (like Medicare For All). About 53% say they would still like the system to be based on private insurance.

Most still haven't realized that a government-run system would be cheaper, because it would cut out the profits for the middle men (private insurance companies).

Having Insurance Doesn't Mean You Can Afford Health Care

The United States spends more for health care than any other developed nation and yet still has millions without any health insurance. But even having health insurance doesn't necessarily mean a person can afford to get the health care they need.

The above chart is from Parma.com. 

We can -- we must -- do better!!!

A Public Insurance Option Is The Path To Universal Coverage

(This graphic image is from phsi.org.)

The United States is the only developed nation that doesn't recognize the right of every human to decent health care. In this country, health care has always been a product sold only to those who can afford it, and because of that many thousands die every year unnecessarily because they cannot afford the insurance that would save their lives.

The Republicans in our government think that's the way it should be. They talk about universal coverage, but vote against every effort to actually initiate it. They still believe health care is a product -- not a right.

Democrats believe differently. They believe health care is a right, and every citizen should have decent and affordable health care available to them. They want universal health care in this country, but aren't sure how to achieve it.

Some are calling for a single-payer, government-run insurance system (something like Medicare For All). This is not a bad idea, and I believe it will finally be the solution. The problem is that it still scares many Americans (because it would be a radical change, and they aren't sure how it would be paid for). Until a significantly bigger portion of the public wants it, our politicians are unlikely to even seriously discuss it.

What should we do then? It's obvious that our current system is broken. It doesn't cover everyone and it does nothing to control the sharply rising costs of health care. How can we fix it?

I believe the answer is the creation of a Public Option for health insurance.

* Medicaid should be eliminated, and the new Public Option should cover everything that the current Medicare program covers. This new program should be available to all citizens under the age of 65.

* This Public Option should be available to all Americans. Families and individuals making less than 100% to 150% of the poverty level should be immediately covered by the Public Option at no cost. The Public Option should be available to everyone else on a sliding scale of cost.

* The Public Option would be less expensive than private insurance, because by law it should be allowed to negotiate prices with drug companies and health care providers. It also would not have any profits to inflate the price (or enormous executive salaries, like private companies do).

* Open enrollment in the Public Option to businesses to cover their employees. Once many businesses and corporations understand they will save a significant amount of money by enrolling employees in the Public Option, they will do so (because it will increase their profits). We could even debate requiring businesses to cover all employees with insurance or pay a penalty (which will go to help fund the Public Option).

* Require all citizens to have health insurance, or pay a penalty equal to the cost of the Public Option.

Once a significant portion of individuals and businesses are participating in the Public Option, it will then be a small step to instituting a single-payer system for everyone.

I don't believe Medicare For All is achievable right now, but a Public Option is -- and that is the path we must take to universal health care.

GOP View On Health Care Is Not Popular With The Public

The Republicans have made their views on health care very clear. They do not believe health care is a right of all citizens. They view it only as a product to be sold to those who can afford it -- and they really don't care that this leaves millions of Americans without the preventative care that could save or extend their lives.

And their actions have matched their words. After gaining full control of both Congress and the White House, they immediately set about to destroy the Affordable Care Act (Obamacare), without giving Americans anything to replace it. Their actions have left millions more Americans with any kind of health insurance, and caused insurance premiums to skyrocket for others. And they've done nothing to curtail the rapidly rising cost of medical care in the United States.

They have tried to pose their odious actions as doing what the American people wanted them to do, but that is simply not true. Americans think health care should be a right and available to every citizen. And 63% believe it is the federal government's responsibility to make sure all Americans have access to decent and affordable health care.

Many progressives are pushing for a single-payer government-run health system (something like Medicare-for-all). Thanks to the Republican incompetence regarding health care, that idea is becoming more popular with the general public. Currently, close to half of Americans (46%) say they would support such a system, while only about 31% say they would oppose it.

Republicans hate the Medicare-for-all idea. They call it socialism. But unless they can come up with a different way to provide decent and affordable health care for all citizens, that is where the U.S. is heading. Call it what you will, but denying health care to American citizens is just morally and medically wrong.

The charts above don't come from  some left-wing survey. They represent the results from the latest Fox News Poll -- done between August 19th and 21st of a national sample of 1,009 registered voters, with a margin of error of 3 points.

Trump/GOP Efforts Already Causing Uninsured % To Rise

The efforts by the GOP to repeal Obamacare, and the threats to stop insurance subsidies to help cover the cost of insuring working and middle class people, have already had a negative effect on the percentage of uninsured Americans. Because of that insecurity about what will happen, insurance companies have raised premiums. That is causing some to be unable to afford insurance -- the the percentage of uninsured Americans has risen from 10.9% to 12.3%. That may not sound like much, but remember that each percentage point represents about 3 million people.

Now that Trump has stopped those insurance subsidies, and it is unsure what Congress will do about that, we can expect the number of uninsured to continue to rise. Trump is gloating over damaging Obamacare -- and that shows he really doesn't care about making insurance unaffordable for millions of Americans. He only cares about the rich (who don't need Obamacare).

The chart above is from the Gallup Poll, and it was done in the third quarter of this year (July-August-September) of a random national sample of 45,743 adults, with a 1 point margin of error.

Trump Is Still Acting Against What The Public Wants

Trump recently overruled Obama's directive that employer-based health plans must contain a provision for free contraceptions. As with most of his actions since being sworn in, that goes against the wishes of a majority of Americans. Americans, by a 19 point margin, think those plans should provide women coverage for contraception.

The chart represents the results of a new Rasmussen Poll -- done between October 12th and 15th of a random national sample of 1,000 likely voters, with a 3 point margin of error.

Trump Committed A $17 Million Insurance Fraud

(Caricature of Donald Trump is by DonkeyHotey.)

The following is some of a revealing article on Donald Trump -- written by Caleb P. Newton at the Bipartisan Report:

As it turns out, there is an even more personal side to the issue of Trump and dealing with natural disasters. While not previously unknown, an issue over storm damage to Trump’s Florida Mar-A-Lago resort that reportedly was made up has made its way back to the front of the nation’s political conversation in light of Harvey.

In October of last year, as the nation was gearing up for the general election, the Associated Press got wind of insurance claims that Trump had filed after the 2005 hurricane season, claiming massive damage to Mar-A-Lago.

There was just one problem — the damage doesn’t seem to have actually existed.

To start out with, “Mar-a-Lago members, staff and preservation officials do not recall significant damage.” Obviously, personal testimony can be hit-or-miss, but there’s more.

Palm Beach city records show that Trump never took out a permit for any major repairs to the property, even though the magnanimity of the damage that would have underlined $17 million in insurance claims would have no doubt required work that needed permits, as former city officials explained to the AP. . . .

Trump’s former butler, Anthony Senecal, who said that “Hurricane Wilma, the last of a string of storms that barreled through in 2004 and 2005, flattened trees behind Mar-a-Lago, but the house itself only lost some roof tiles.” . . .

Confirming what we could all guess is going on here, Trump admitted at one point to having deposited “some” of the money into his own accounts.

Hank Stein, the insurance agent who assessed Trump’s claims at the time they were filed, says that he can’t remember details of the breakdown of the supposed $17 million in damage.

The (Really Bad) Numbers For Senate's "Health" Plan

Senate Majority Leader McConnell is still trying to convince enough of his fellow Republicans to vote for the Senate's version of Trumpcare (BCRA). Most Republicans claim the bill is a health care plan, will not throw millions of people off the insurance rolls, and will lower insurance premiums. None of those things are true. It is much more a tax plan, takes health care away from at least 22 million Americans, and will actually increase insurance premiums for plans with current benefits.

Honest Republicans know this, and that's why McConnell is having so much trouble rounding up 50 votes for his version of Trumpcare. Here is how NBC News describes what the Senate plan will do:

As frustrated GOP senators are discovering, their bill is much less generous than Obamacare because it spends hundreds of billions of dollars less on people’s health care. And the main reason it spends so much less is that its savings are used to cut taxes for wealthy Americans and for medical companies. 

How close is the relationship? When it comes to Medicaid, it’s almost 1:1. The Senate bill slashes tax revenues by $701 billion over a decade, while reducing Medicaid spending by $772 billion versus current law. Overall, the Senate bill reduces federal health care spending by $1 trillion. 

The result: More Americans without insurance. According to the nonpartisan Congressional Budget Office, the bill would cover about 22 million fewer people by 2026 than Obamacare.

It might be easier to make this tradeoff if the Americans losing aid for health care were the ones benefiting from the tax cuts. But unless you’re paying a penalty under Obamacare's individual mandate for deciding to go without insurance, you’re unlikely to notice the difference in your return. 

Instead, the biggest gains from the bill, by far, go to the top 1 percent of earners and especially the top 0.1 percent. The individual taxes the Senate would eliminate, a 3.8 percent surtax on investment income and a 0.9 percent payroll tax, only apply to single filers making over $200,000 and families making over $250,000.

The cost of including these tax cuts, even for small numbers of high earners, is not chump change either. The Center for Budget and Policy Priorities estimatesthe bill’s tax benefits for the 400 highest earning households in America alone are equal to the cost of keeping Obamacare's Medicaid expansion in four states that cover 726,000 people.

On the spending side, the bill requires people to pay higher premiums to buy a private plan similar to what's available under Obamacare. It accomplishes this by reducing spending on subsidies and distributing them in a way that encourages people to purchase higher deductible plans with lower premiums. At the same time, it eliminates Obamacare subsidies that help low-income people pay their deductibles.

Here, too, the lower end of the economic spectrum fares worse than the higher end. The nonpartisan Kaiser Family Foundation projected premiums for people making over and under 200 percent of the federal poverty line (about $24,000 a year for an individual) and found the biggest spikes came for older low-income customers. The CBO also found this group would have the hardest time finding affordable insurance under the Senate bill.

Revised Estimate Shows Senate Bill Worse Than Thought

The Congressional Budget Office (CBO) predicted that the Senate bill (BCRA) would cost about 22 million Americans their health insurance. Some would come from individuals no longer buying plans (many because they could no longer afford them), and some would come from employers no longer providing insurance for employees -- but most would come from the 26% in cuts to Medicaid in the 10 year projection.

Well, it turns out the Senate bill is even worse than the CBO first projected. That's because the cuts to Medicaid don't stop at 2026. They grow even larger in later years -- growing to 35% by 2036. Those cuts past 2026, combined with the expected growth in medical care costs, would mean that millions more people would be dumped from Medicaid roles -- raising the number of people losing health coverage far beyond the 22 million projected.

The BCRA (i.e., Trumpcare) is a very mean-spirited bill. It would deny health coverage to a huge hunk of the American population. The Republicans have once again shown they simply don't care for their fellow Americans -- unless they are rich.

New England Journal Of Medicine Opposes The Senate Bill

The widely respected New England Journal of Medicine has joined the AMA, AARP, and many other organizations in opposing the Republican's "health" bill. NEJM writes:

The Better Care Reconciliation Act (BCRA), as the U.S. Senate calls the health care bill released by a small working group of Republican senators last week, is not designed to lead to better care for Americans. Like the House bill that was passed in early May, the American Health Care Act (AHCA), it would actually do the opposite: reduce the number of people with health insurance by about 22 million, raise insurance costs for millions more, and give states the option to allow insurers to omit coverage for many critical health care services so that patients with costly illnesses, preexisting or otherwise, would be substantially underinsured and saddled with choking out-of-pocket payments — all with predictably devastating effects on the health and lives of Americans. What would get “better” under the BCRA is the tax bill faced by wealthy individuals, which would be reduced by hundreds of billions of dollars over the next decade — about $5,000 per year for families making over $200,000 per year and $50,000 or more for those making over $1 million, according to analysis of the AHCA, which included a similar set of tax provisions.1 We believe that that trade-off is not one to which we — physicians, patients, or American society — should be reconciled.

Under the BCRA, states could easily receive waivers to drop many of the insurance regulations created by the Affordable Care Act (ACA). Although the ACA requirement that insurers take all comers would nominally remain intact, states could reject the ACA’s mandated essential benefits, allowing insurers to refuse to cover such critical services as emergency care, mental health care, maternity care, chemotherapy, and prescription drugs, among others. In some states, health plans could become largely worthless, particularly for patients with preexisting conditions (a group that includes 23 to 51 percent of nonelderly Americans, depending on the criteria used2). By redefining essential health benefits, states would also restore insurers’ ability to place annual and lifetime limits on enrollees’ coverage, since the ACA protections against such limits apply only to benefits designated as essential.3 Older Americans all over the country could be charged five times as much as younger ones for coverage, whereas the ACA limited age-based variation to a 3:1 ratio. And the BCRA would repeal cost-sharing reductions for low-income persons as of the end of 2019, leaving them with unaffordable deductibles and coinsurance after that. As Americans know all too well from the pre-ACA era, many underinsured and uninsured people would risk being bankrupted by health care costs3 — or would die for lack of access to needed care.

Perhaps in a nod to pleas for a reform less “mean” than the AHCA, the Senate bill would phase down federal funding for the ACA’s Medicaid expansion more slowly than House Republicans proposed to do — but it would impose the same cuts in the long run, and it would implement an even more draconian version of the House’s proposal to cap federal Medicaid funding per enrollee or turn the program into block grants. All told, the bill would cut more than $700 billion from the program over the next decade. The poorest Americans, those requiring nursing home care, and those with disabilities or mental illness would suffer. These attacks on Medicaid would undercut health care for the 74 million Americans who rely on it.

Women’s health care would also suffer major blows under the BCRA. In states that chose to stop mandating coverage of maternity care, women of child-bearing age could be forced to pay unaffordably high rates for basic pregnancy coverage. Planned Parenthood would be defunded for a year, severely restricting access not just to family planning services but to an array of important preventive care services, including cancer screenings, for millions of low-income women. Another provision would prohibit the use of tax credits for any individual insurance plan that covered abortion services (with exceptions for rape, incest, and risk to the woman’s life).

And at a time when about 60,000 Americans are dying each year from opioid overdoses, the Senate bill would drastically reduce the funds available for confronting this massive crisis and providing affected people the help they need to become functioning, contributing members of society. In addition to removing many people with opioid use disorder from the Medicaid or individual-insurance rolls, the BCRA would provide a mere $2 billion over 10 years for efforts that experts estimate would cost $183 billion.4

The public response to the very similar House bill indicates that the GOP’s approach to health care reform is deeply unpopular throughout the country, with an approval rating below 20%5 — and for good reason. Like many U.S. physician and hospital organizations that are speaking out against the BCRA, we whole-heartedly oppose sacrificing Americans’ health care and health to further enrichment of the wealthy. The future of our health care system and the lives of our patients are at stake.

Defeating GOP "Health" Bill Is Not Enough - More Is Needed

(Cartoon image is by Chan Lowe in the South Florida Sun-Sentinel.)

The Republicans in the Senate have put off voting on their health care reform bill (tax cut bill?) because the CBO estimate showed it to be a very bad bill. It would cost at least 22 million Americans their health insurance by 2026 (and even more in years after 2026). And it's only premium cost saving measure was to allow insurance companies to sell policies that covered far less and had much higher deductibles.

It was not reform, because reform should help more Americans to afford health care -- not less. The Republican bill needs to be defeated. But even if it is defeated, it should not be a reason to celebrate. That's because Obamacare (the Affordable Care Act) does need some reforms.

Don't get me wrong. Obamacare was a big improvement over the terrible health care situation that existed before it was passed. It did a lot of good -- covering about 20 million more with health insurance, stopping insurance companies from denying insurance (or charging prohibitive prices) for pre-existing conditions, covering contraceptives, stopping insurance companies from charging women more than men, eliminating the caps on how much an insurance company would pay for medical care, and allowing children to stay on their parents insurance until age 26.

But while Obamacare improved health care in this country, it did NOT fix all the problems of our health care system. There are some counties and states where health insurance is not offered (or is too expensive). Much of this has been caused by the uncertainty of the system due to Republican efforts to damage Obamacare -- but not all of it.

The fact is that Obamacare had some deficiencies when it was passed. First, it did not cover all Americans. If nothing is done, at least 28 million people will still be without health insurance by 2026. That's inexcusable. Other developed countries cover all of their citizens with health care or health insurance, and they do it at a much lower per capita cost.

Second, Obamacare did virtually nothing to control the rapidly rising cost of medical care in this country. Measures must be put in place to control those costs. At the very least, the government should be able to negotiate prices with doctors, hospitals, and drug companies.

Third, Obamacare did not mandate that insurance companies participate in all states and counties. This has resulted in many insurance companies cherry-picking the places they will sell insurance (picking only those places where they can make the biggest profit). If we are going to stick with a private insurance system, then any company wanting to sell health insurance in this country should be required to sell in every state and county -- and should be required to participate in the Obama subsidy program.

Obamacare is not the best of all solutions for health care in this country -- a single-payer system would, in my opinion, be better. But our politicians are not ready to do that, and the public is probably not ready to accept a change that radical (at least, not yet). But Obamacare could be fixed to work much better than it currently does -- and that should be done as quickly as possible.

Warren Says GOP Bill Would Bankrupt Many - Kill Others

Here is the latest e-mail from Senator Elizabeth Warren to her supporters about the "health care" plan the Senate Republicans have come up with.

Before I ran for the Senate, I was a bankruptcy law professor. I spent decades studying why working families were going broke.

Back when I got started, most experts believed that people went broke because of wasteful spending – running up credit card bills at the mall. But for most people, that wasn’t the case at all.

At the time, nearly nine out of every ten families listed just three reasons for their bankruptcies: job loss, family breakup (death or divorce), and medical problems. Half reported two of those problems. One in 13 was hit by all three.

Nobody was talking about medical bankruptcy, but my coauthors and I showed what was right in front of our faces: At the time, medical problems were pushing about 750,000 solid, middle-class families into bankruptcy each year.

No, the Affordable Care Act didn’t end medical bankruptcies or instantly solve America’s health care crisis. But it did end the annual and lifetime caps on many people’s insurance plans. It allowed people with pre-existing conditions to get insurance. And it gave states the resources to expand Medicaid – so seniors who needed nursing homes and babies born early could get the care they needed.

The so-called “health care plan” that Senate Republicans want to jam in the next few days before they skip town for the 4th of July ends that progress.

It lets insurance companies sell skimpier plans for higher out-of-pocket costs. It lets private insurance plans reinstate annual and lifetime caps on benefits for people who get really sick. And it guts Medicaid for the sick, for the elderly, for people with disabilities – for people who have nowhere else to turn.

If the Republicans rip health care away from 22 million Americans this week in order to give billionaires a tax break, people are still going to get diagnosed with cancer. Seniors are still going to have strokes and heart attacks. People are still going to get hit by drunk drivers. Babies are still going to be born with lungs and hearts that don’t work.

I’ve studied this heartbreaking problem for decades. I know that if the Republicans pass this bill, more people – even the most hard-working, responsible people – will go bankrupt. Some will die.

Please: Now is the time to make calls. Now is the time to call your friends and family with Republican senators and tell them what’s on the line – even your FOX News-loving uncle. Now is the time to share your story, share your photo, share your video on Facebook, Twitter, Instagram, or Snapchat. Now is the time to share your friends’ stories. Now is the time to join a group and get connected – because two voices are more than twice as powerful as one.   

This fight is personal for me. When I was 12, my daddy had a heart attack. He was out of work for a long time, and the medical bills piled up. We lost our family station wagon, and we were about an inch away from losing our home.

Today, our family probably wouldn’t have made it.

We all know someone – a cancer survivor, a mom who went into early labor, or a parent or grandparent who got Alzheimer’s or Parkinson’s and needed help. Any of us could get bad news from a doctor that our insurance plans wouldn’t cover.

I’m in this fight all the way – I’ll give it everything I’ve got. But if we’re going to win, we need every single one of us in this fight. We need to fight like people’s lives depend on it – because people’s lives will depend on what happens next.

Thanks for being a part of this,

Elizabeth

CBO Says Senate Bill Will Take Insurance From 22 Million

The Congressional Budget Office (CBO) has released its analysis of the Better Care Reconciliation Act of 2017 (BCRA) -- the Senate Republican bill to cut taxes for the rich disguised as a health care bill. And it's just as bad as we expected.

The bill would cause about 22 million people to lose their health insurance by 2026 -- raising the number of uninsured to 48 million Americans by that year. While that's a million fewer than the House bill (AHCA), the Senate cuts to Medicaid would continue after 2026 -- and that means the number of uninsured Americans would continue to rise after 2026.

While some of the rise in the uninsured would come from those currently purchasing their own policies or from employers no longer being required to purchase insurance for employees, most of those losing insurance would be people currently getting insurance help through Medicaid. The Medicaid program would be devastated.

The CBO also projected that insurance premiums would rise by 20% in 2018 and another 10% in 2019. After that, the average premium cost would go down. But that is not a cause for celebration. Current policies (under Obamacare) are required to pay about 70% of medical costs. But in 2020, they expect policies to cover only about 58% of costs -- meaning those policies will have fewer benefits and higher deductibles.

This means those buying individual plans might pay less for premiums, but if they get sick, they'll pay a lot more out of their own pockets for medical care. And it probably won't just be those who buy individual policies. We can expect a lot of employers to start buying plans for their employees that have fewer benefits and much higher deductibles.

The BCRA will do what it was intended to do -- give the richest Americans a huge tax cut. But to do that, the Senate Republicans will throw the poor, the working class, and even many in the middle class under the bus. It's a truly bad plan, and we can only hope it's defeated.

Senate GOP Releases Its "Health" Bill - And It's Really Bad

(Cartoon image is by Bill Day at cagle.com.)

When the House of Representatives passed their "repeal and replace" of Obamacare -- the AHCA -- many Republican senators said it was dead on arrival. They were not telling the truth.

Majority Leader McConnell and a few of his closest henchmen took that House bill behind closed doors -- and they resuscitated it. They brought it back to life, and then they made it even worse. The House bill would have taken insurance away from at least 23 million Americans -- primarily through huge cuts to Medicaid, and severely cutting insurance subsidies. That wasn't good enough for the hard-hearted Senate Republicans. The cut the number of people who can get a subsidy by lowering eligibility from 400% of poverty level to 350%. Then they made even deeper cuts to Medicaid.

That wasn't enough though. They then gave states the right to waive the benefits required in insurance policies sold to the public. This means that we'll again see cheap policies sold that won't cover most of the things people need insurance for (emergency rooms, long-term care, drug/alcohol treatment, medical care without a cap, etc). Those policies will be cheaper -- util the consumer tries to use them.

For those who want to keep their essential benefits, this GOP bill will insure their premiums continue to go up. They'll go up because Americans will no longer be required to have health insurance, and employers will no longer be required to provide insurance for their employees. This means there will be less people with insurance -- and insurance companies will have to raise premium prices to compensate for that. They'll also have to raise premiums because this bill does nothing to control the fast-rising cost of medical care in the United States.

But this was never about providing decent health care for Americans anyway. The Republicans don't believe health care is a right. They think it's just another product to be sold to those who can afford it. This was a tax cut for the rich bill -- not a health care bill. The taxes that funded Obamacare were all repealed, and some of the rich will even get a refund of those taxes. And the Republicans didn't mind throwing 80% of Americans under the bus to achieve those tax cuts for the rich (their real constituency).

I could go on with my rant, but I think President Obama probably said it better with his Facebook post. He wrote:

Our politics are divided. They have been for a long time. And while I know that division makes it difficult to listen to Americans with whom we disagree, that’s what we need to do today.

I recognize that repealing and replacing the Affordable Care Act has become a core tenet of the Republican Party. Still, I hope that our Senators, many of whom I know well, step back and measure what’s really at stake, and consider that the rationale for action, on health care or any other issue, must be something more than simply undoing something that Democrats did. 

We didn’t fight for the Affordable Care Act for more than a year in the public square for any personal or political gain – we fought for it because we knew it would save lives, prevent financial misery, and ultimately set this country we love on a better, healthier course. 

Nor did we fight for it alone. Thousands upon thousands of Americans, including Republicans, threw themselves into that collective effort, not for political reasons, but for intensely personal ones – a sick child, a parent lost to cancer, the memory of medical bills that threatened to derail their dreams.

And you made a difference. For the first time, more than ninety percent of Americans know the security of health insurance. Health care costs, while still rising, have been rising at the slowest pace in fifty years. Women can’t be charged more for their insurance, young adults can stay on their parents’ plan until they turn 26, contraceptive care and preventive care are now free. Paying more, or being denied insurance altogether due to a preexisting condition – we made that a thing of the past. 

We did these things together. So many of you made that change possible.

At the same time, I was careful to say again and again that while the Affordable Care Act represented a significant step forward for America, it was not perfect, nor could it be the end of our efforts – and that if Republicans could put together a plan that is demonstrably better than the improvements we made to our health care system, that covers as many people at less cost, I would gladly and publicly support it. 

That remains true. So I still hope that there are enough Republicans in Congress who remember that public service is not about sport or notching a political win, that there’s a reason we all chose to serve in the first place, and that hopefully, it’s to make people’s lives better, not worse. 

But right now, after eight years, the legislation rushed through the House and the Senate without public hearings or debate would do the opposite. It would raise costs, reduce coverage, roll back protections, and ruin Medicaid as we know it. That’s not my opinion, but rather the conclusion of all objective analyses, from the nonpartisan Congressional Budget Office, which found that 23 million Americans would lose insurance, to America’s doctors, nurses, and hospitals on the front lines of our health care system.

The Senate bill, unveiled today, is not a health care bill. It’s a massive transfer of wealth from middle-class and poor families to the richest people in America. It hands enormous tax cuts to the rich and to the drug and insurance industries, paid for by cutting health care for everybody else. Those with private insurance will experience higher premiums and higher deductibles, with lower tax credits to help working families cover the costs, even as their plans might no longer cover pregnancy, mental health care, or expensive prescriptions. Discrimination based on pre-existing conditions could become the norm again. Millions of families will lose coverage entirely. 

Simply put, if there’s a chance you might get sick, get old, or start a family – this bill will do you harm. And small tweaks over the course of the next couple weeks, under the guise of making these bills easier to stomach, cannot change the fundamental meanness at the core of this legislation.

I hope our Senators ask themselves – what will happen to the Americans grappling with opioid addiction who suddenly lose their coverage? What will happen to pregnant mothers, children with disabilities, poor adults and seniors who need long-term care once they can no longer count on Medicaid? What will happen if you have a medical emergency when insurance companies are once again allowed to exclude the benefits you need, send you unlimited bills, or set unaffordable deductibles? What impossible choices will working parents be forced to make if their child’s cancer treatment costs them more than their life savings?

To put the American people through that pain – while giving billionaires and corporations a massive tax cut in return – that’s tough to fathom. But it’s what’s at stake right now. So it remains my fervent hope that we step back and try to deliver on what the American people need. 

That might take some time and compromise between Democrats and Republicans. But I believe that’s what people want to see. I believe it would demonstrate the kind of leadership that appeals to Americans across party lines. And I believe that it’s possible – if you are willing to make a difference again. If you’re willing to call your members of Congress. If you are willing to visit their offices. If you are willing to speak out, let them and the country know, in very real terms, what this means for you and your family.

After all, this debate has always been about something bigger than politics. It’s about the character of our country – who we are, and who we aspire to be. And that’s always worth fighting for.

Charts Shows How Bad The GOP "Plan" Really Is

Paul Ryan and Donald Trump continue to lie to Americans about how good their health care "plan" for all citizens. That would be laughable if it did not hurt so many people.

Before the Affordable Care Act (Obamacare) went into effect, nearly 20% of all Americans did not have any kind of health insurance (most because they could not afford to pay the high private insurance premiums, and could not meet the strict qualifications for a government program like Medicaid). Obamacare reduced that percentage to about 10%, and could have reduced it even further of multiple GOP-controlled states had not refused to expand Medicaid.

Obamacare was not perfect, because it didn't cover all Americans (and did not lower the high costs of medical care). But it could have been fixed.

But instead of fixing Obamacare, the Republicans have chosen to destroy it, and replace it with their own (extremely inadequate) plan. How inadequate? The chart above shows that clearly. If their plan is enacted, the percentage of uninsured people in this country will rise back to pre-Obamacare levels (close to 20% of the population).

The Republicans say their plan will give all Americans "access" to health insurance. That is a LIE! Millions of Americans will be unable to afford to purchase private insurance, and will not be able to qualify for Medicaid (which is being cut). If you cannot afford insurance, then it is disingenuous to claim that you have access to insurance. The truth is that nearly 20% of the population will have neither coverage nor access.

And then we have the situation illustrated in the chart below. The United States continues to spend far more (per capita) for health care than any other developed nation. Obamacare did not solve that problem, and neither does the proposed Republican plan. Not only will the GOP plan throw millions off the health insurance rolls, but it will also insure that the U.S. continues to pay a higher price for health care than any other developed nation. It's crazy that Congress is even considering this boondoggle.

There is a better way -- single-payer insurance (Medicare for all). It would not only cover all citizens, but would lower the amount spent on health care in this country. Isn't it time we considered this?

Obamacare Has Insured 20 Million More Americans

The chart above was made from information provided by the Department of Health And Human Services. It shows that, while Obamacare (the Affordable Care Act) has not been perfect, it has been pretty effective in helping more Americans to get health insurance. The percentage of uninsured Americans has been cut from 20.3% in 2013 to 11.5% in 2016 (and the drop has been evident among all demographic groups). It could be cut even more if the Republican-controlled states would expand Medicaid. This is a good result, but not good enough.

Here is the conclusion of DHHS on Obamacare's effect:

We estimate that the provisions of the ACA have resulted in gains in health insurance coverage for 20.0 million nonelderly adults (ages 18 to 64). This estimate comprises 17.7 million nonelderly adults who gained coverage due to the coverage expansions that began in the fourth quarter of 2013 and 2.3 million young adults (ages 19 to 25) who gained coverage between 2010 and 2013 due to the ACA’s provision allowing young adults to stay on a parents’ plan until the age of 26. In total, 6.1 million previously uninsured young adults have gained coverage due to the ACA. This is especially important because this population were particularly likely to be uninsured prior to the enactment of the ACA. The gains in coverage have been shared widely across racial and ethnic groups, with the rate of being uninsured decreasing by 11.8 percentage points among Black non-Hispanics, by 11.3 percentage points among Hispanics, and by 7.3 among White non-Hispanics.

This is a good result, but not good enough. All Americans should be covered by good health insurance (as the other developed nations have done). Both Democratic presidential presidents have this as their goal. Hillary Clinton wants to improve on Obamacare -- something a clear majority of Americans also want (according to Kaiser Family Foundation health polls). Bernie Sanders wants to institute a "Medicare for all" single-payer system. I think that would be the best answer, but polls have shown that Americans are just not ready for that drastic a change.

All of the Republican presidential candidates have said they would do away with Obamacare, and replace it with a better plan (although none of them have come up with any kind of plan at all). According to the Kaiser polls, only about a third of Americans agree with this approach. That idea may appeal to the Republican base, but it would take health insurance away from 20 million Americans -- which seems to be a mistake in an election year.

Obamacare Is Working - But We Need More

The chart above is from a recent survey by the Gallup Poll. Between July 1st and September 30th, they questioned a random national sample of 45,615 adults, and because of the huge sample the poll has a margin of error of only 1 point.

The chart shows that the Affordable Care Act (Obamacare) has been pretty successful in its primary goal -- to lower the number of uninsured Americans (thus assuring they can get the healthcare, especially preventative care, that they need). In the last seven quarters, the percentage of uninsured Americans has been reduced fro 17.1% to 11.6% (a reduction in the uninsured of about 32%).

That's good, and I applaud the law for that reduction. But we need to get that number much lower -- all the way down to 0%. Obamacare could be even more successful if the Republican state legislatures would stop playing politics, and expand Medicaid (which currently about half of the states are refusing to do). That 22.2% of uninsured making less than $36,000 could be significantly reduced by that.

But while Obamacare has significantly reduced the number of uninsured Americans, and with GOP cooperation could do even more, the truth is that Obamacare alone will never eliminate the uninsured citizens in the U.S. -- and was never designed to do that. Obamacare was a significant step forward in many ways, but it has not completely fixed the health care system in this country. More needs to be done.

While there is not the political will for it right now, if Americans are to accept that healthcare is a right (and not just a product to be sold), then we are eventually going to have to go to a better system. I believe what is necessary is a government-run, single-payer health insurance system -- like most other developed countries have done (including our neighbor to the north).

This would be something like a Medicare-for-all -- which would have the advantage of covering all citizens with health insurance, and would reduce the amount of money spent on health care in the U.S. (which is much higher than in any other developed nation). It has to come. The only question is how long it will take to finally do it.

The United States Is Still The Only Rich/Developed Nation Without Universal Health Care For Its Citizens

The list at the left shows the nations that have accepted health care as a human right, and established some kind of universal health care system. The citizens in these nations all have access to decent health care -- no matter how rich or poor they may be. The earliest nation to do this was Norway in 1912, and the latest was Israel in 1995 -- but they have all done it.

Reading through that list, you may notice that one nation, the richest nation in the world, is conspicuously absent -- the United States. Although health care costs more per capita in the United States than in any other country (more than twice as much as most of the countries on this list), there are still tens of millions of people in the United States that do not have any access to adequate health care.

They don't have it, because in the U.S. health care is not a right, but a product that is sold to those who can afford it -- and to afford it you either have to be rich, or at least able to afford to purchase a health insurance policy. That leaves many millions of poor people out in the cold.

Obamacare (the Affordable Care Act) was supposed to fix this problem -- by giving subsidies to working and middle class workers to help them buy private insurance, and by expanding Medicaid to cover the poor (who don't make enough money to qualify for a subsidy).

If Obamacare could have been fully implemented, then most (but not all) Americans would have health insurance -- and hopefully the politicians would have found a way to cover the tiny percentage that would have been left out. But it didn't work out that way. Seizing upon a misguided Supreme Court decision, Republican state government in about half of the country's states have refused to expand Medicaid (even though the federal government would have paid for 100% of the expansion for the first 10 years, and 90% after that).

This refusal to expand Medicaid was a purely political decision by the Republicans -- done out of their hatred for having an African-American president in the White House, and their lack of respect for the millions of poor and underprivileged Americans. And it is not likely to change anytime soon. The Republicans simply don't care, and they consider their hatred of the president to be more important than the health and lives of the millions of people to whom they have denied access to health care.

Obamacare is a big improvement over the broken system we had before, and repealing it would be a big mistake. But it has not accomplished the two things it needed to do -- provide access to health care for all Americans, and bring down the cost of health care in the U.S. (to a more reasonable level like that enjoyed by other countries). It has reduced the number of uninsured people and slowed the growth of health care costs -- but that is just not good enough. Costs must be reduced, and ALL citizens must have access to decent health care.

There is a way to accomplish both goals. We need to go to a single-payer, government-run health insurance system that covers all American citizens (something like Medicare for all). This would not just cover everyone -- but would also take the profit margin out of health insurance. Further reductions could be done by negotiating with health care givers and pharmaceutical companies.

I know the Republicans will whine that we could not afford to do that, but they are lying. Other countries have done it, and we could do it too. It could easily be paid for with a small payroll tax on workers combined with a tax on employers (which would be less than they currently pay for employee insurance), and if necessary, supplemented by a small cut to our bloated defense budget (because we don't need to be spending 45% of the entire world's defense spending -- and more than the next 15 biggest spenders combined).

This is imminently doable. We would just need to make the reasonable political decision that the health and lives of all American citizens is more important than the bloated profits of the military-industrial complex (or the politics of hate). It is time for universal health care in this country, and failing to accomplish that shows a lack of moral and political courage.