May 6, 2017

Who Knew This Could Be So Confusing?

Darn it all, just when I think I have this health care stuff figured out, those pesky Republicans go and confuse the HDHP out of me.

Take access to care, for example. Some people believe that TrumpCare, or RyanCare, or the American Health Care Act-- actually, I think I will refer to it as WeDontCare - will take away access for people who are covered under plans paid for with Medicaid.  And according to the bill summary  published on GovTrack, if you are on Medicaid
  • The ACA expanded Medicaid eligibility in 32 states that opted into it. (WeDontCare) would reverse the eligibility expansion beginning in 2020 (anyone enrolled by then would remain enrolled) and it would reduce federal support for Medicaid with caps on coverage. And, if you have a gap in coverage for more than one month after the end of December 2019, you won't be able to re-enroll unless you live in a state that wants to pick up the cost. 
  • The ACA expanded required benefits under Medicaid, such as mental health and addiction services, which would not longer be required. 
You should recall the president promised - he PROMISED! - he would not cut Medicaid, so it's a little confusing why WeDontCare was estimated by the Congressional Budget Office (well, the early versions of the bill - we don't have an estimate on the one that passed) - to drop some $880B from Medicaid. 

And, to the second bullet above, the president promised - he PROMISED! - to end the opioid epidemic. 
Our terrible drug epidemic will slow down, and ultimately stop.
Not only that, but he announced this plan when he was a candidate which, in addition to building The Big, Beautiful, Busty, Bodacious Border Wall and closing shipping loopholes, would
  • Fix the misguided rules and regulations that have made this problem worse: Speed up the approval and availability of abuse-deterring drugs; lift the cap on the number of patients that doctors can treat with recovery medications, provided they follow safe prescribing practices and proper treatment supervision; and reduce the amount of Schedule II opioids (drugs like oxycodone, methadone and fentanyl) that can be made and sold in the US, and 
  • Get people struggling with addiction the help they need: Support the Comprehensive Addiction and Recovery Act; expand incentives to use drug courts and mandated treatment; expand access to treatment slots and end Medicaid policies that obstruct inpatient treatment; and distribute widely naloxone/narcan (opioid antidote to treat OD) to first responders and caregivers.
So it seems a bit surprising that he would so strongly support (and celebrate the passage of) a bill that chops a limb or three off Medicaid, and allows coverage for substance abuse treatment under Medicaid to be eliminated, doesn't it? Or is it just me?

And we learned, a long time ago, that people were appalled with conditions at the Veterans Administration, when people were dying waiting for care. You remember that, right?
Those are just a few of the headlines letting us know that people do die waiting for healthcare, and it's a horrible situation, whether it's a veteran or anyone else. It's a situation we all should be concerned about - folks like you and me, and politicians too. Really concerned, not fake concerned or politically expediently concerned. 

So then, what's wrong with this guy, Idaho Congressman Raul Labrador, that he doesn't understand this? When an attendee at Labrador's town hall mentioned her concern that the cuts in Medicare benefits might result in people dying, Labrador disagreed.
That line is do indefensible. Nobody dies because they don't have access to health care.
Well, I guess someone should tell that to all those veterans the Republicans told us about?

No wonder I'm so confused. Am I supposed to believe the Republicans, or the Republicans? Do I believe the promises of the president, and his indignation or do I just throw that all aside?

Of course, for clarity, there's always this interpretation of things.
It is hardly indefensible to say that people don't die from lack of access to healthcare. It is, rather, a basic fact of life. So perhaps Raul should just be honest and say "Sure, some people are going to die, but look at all the money we'd save rich people who don't like paying taxes? Isn't that worth it? They should be proud of their sacrifice! This country would hardly exist were it not for the poor nobly sacrificing their lives to that rich people can be slightly more rich than they would be otherwise!"
Yeah, that seems to help.