What The Senate GOP Plan Would Mean For Health Insurance

https://goo.gl/f6VKVL

Senate Republicans released the text of their bill to repeal and replace the Affordable Care Act today, and like the House bill before it, the measure would give big tax cuts to the wealthiest Americans and roll back Medicaid, the health insurance program for the poor. It also would get rid of the unpopular mandate that most people have insurance or pay a fine.

The draft bill, called the Better Care Reconciliation Act, would repeal most taxes in the Affordable Care Act, including two on the wealthiest individuals, a medical device tax, a tax on tanning salons and a tax on the insurance industry. It would also restrict Medicaid reimbursements to Planned Parenthood clinics for a year.

The measure also includes a host of details that would affect how millions of Americans get their health insurance, how much they pay for it and what it covers. The measure would cut back subsidies that help defray the cost of insurance for people who don’t get it from their employer or a public program. And it would loosen regulations on the insurance markets, likely meaning lower premiums but for more limited health insurance coverage.

But how much this bill would affect a person largely depends on how she gets her insurance. The 142-page bill is complex, and it will take some time to fully understand what it would mean for the health care landscape. Still, there are some clear initial takeaways for different groups:1

The 20 percent2 of the population with Medicaid:

The cuts, which are even steeper than those in the bill that passed the House in May, essentially shift more of the cost of Medicaid back to states. States, in turn, are likely to react in a variety of ways. Some could look for the money to pay for enrollees, but the expense would be substantial. Others will likely limit eligibility or the care that is covered. Some could eliminate the expansion program altogether.

The bill does fix one problem with the ACA that arose after the Supreme Court ruling on Medicaid expansion. About 2.6 million people in 19 states that didn’t expand Medicaid landed in a health insurance gap: They earned too little to be eligible for subsidies (the ACA assumed everyone with incomes below the federal poverty line would be on Medicaid, so they weren’t eligible for subsidies), but they earned too much to qualify for Medicaid. These people would be eligible for subsidies under the Senate bill. They would have to spend about 2 percent of their already small incomes on premiums, however.

The 7 percent who buy private insurance:

For starters, insurance companies would have to pay a smaller portion of an enrollee’s costs each year than they currently do. That probably means that the insurance plans eligible for subsidies would have higher co-pays and higher deductibles.

But the bill also would change how the subsidies are calculated. Under the Senate plan, subsidies are tied to income and cost (if you make less and live in a place with expensive coverage, you get a larger subsidy), as is the case with the ACA. But they would apply only to people making up to 350 percent of the federal poverty line, about $42,000 this year; the cutoff under the ACA is 400 percent. And the bill would raise the amount that some people are expected to contribute to their insurance. A 60-year-old earning about $24,120 a year (about 200 percent of the federal poverty line) is currently expected to pay about $1,550 in premiums. Under the Senate bill, that would be $2,412. A 30-year-old earning that amount, however, would be expected to pay slightly less, about $1,400 under the Senate bill, compared with $1,550 under current law.

The 49 percent who get insurance through their employer:

Employers will no longer be required to offer health insurance, which could affect people who are insured through their employers. But the Senate bill also keeps a tax that’s generally loved by economists and unpopular with the public: the “Cadillac tax.” Currently, people with employer-sponsored insurance get a tax break on money they spend on their coverage. The Cadillac tax essentially would cap that tax break, charging a 40 percent tax on insurance premiums paid beyond a cutoff (the tax wouldn’t start until 2020, but it would affect plans costing more than $10,200 in 2018 dollars).

The 9 percent who are uninsured:

The fate of this group is the question looming over the Senate as it prepares for a report from the Congressional Budget Office, which will assess the bill’s impact. As with the House bill, the number of uninsured will likely be projected to grow under the Senate bill. Some could join the ranks of the uninsured by choice if the individual requirement to buy insurance were to go away. But others would be priced out of the market. A pending report from the CBO, due by early next week, will help clarify who might be uninsured under the Senate bill. But there would likely be an increase among at least three groups: 1. low-income people who currently qualify for Medicaid but would be cut from the program, 2. older adults, because insurers would be allowed to charge them higher premiums under the Senate bill than they can under current law, and 3. young and healthy adults who might have less incentive to buy insurance in the absence of the individual mandate.

The country as a whole:

the main outcomes are clear. The wealthiest people would get a large tax cut. The poorest would be the most likely to lose their insurance. The cost of insurance would go down for some, particularly younger adults. For middle-income, older adults who aren’t yet eligible for Medicare, premiums would go up. But, as with the ACA, the bill would do little to curb overall spending on health insurance, which means someone will be stuck with the bill. The Affordable Care Act was a redistribution of wealth that took money from the highest earners and used it to pay for coverage for the poorest. The government also foots a larger share of the bill. Under the GOP Senate bill, many of those costs would revert to individuals with low incomes.


When politicians say what many are thinking about autistic students.

https://goo.gl/sLDRWF

I wasn’t surprised to read Australian Senator Pauline Hanson’s comments supporting the segregation of autistic students yesterday,

“I think that we have more autistic children, yet we are not providing the special classrooms or the schools for these autistic children.

“It is no good saying that we have to allow these kids to feel good about themselves and that we do not want to upset them and make them feel hurt.

“I understand that, but we have to be realistic at times and consider the impact this is having on other children in the classroom.”

I wasn’t surprised because I have heard exactly those words from friends and acquaintances. People who in theory support human rights, and have publicly and privately supported my work in disability rights. People who I know to be good people and good parents.

Sadly, when it comes down to their own child in their classroom, the same people tell me they are frustrated that their child isn’t getting the attention they want them to have. They are frustrated that the teacher seems to be spending more time on Mary or Johnny, the autistic kid, the disabled kid, the ADHD kid, the kid with challenging behaviours. In theory they support inclusion. In practice, they are complaining about Mary and Johnny, and wanting them gone from their classrooms and schools.

When I hear this, coming from people I know, it angers me. I am a parent of three autistic children. My children could be those very children they want out of their children’s classrooms.

I wonder, why isn’t information reaching parents about the clear benefits of children growing up and going to school with students with disabilities? 

Power Causes Brain Damage

We all knew this was happening, we just didn't know it was brain damage.....

https://goo.gl/cteuqN

f power were a prescription drug, it would come with a long list of known side effects. It can intoxicate. It can corrupt. It can even make Henry Kissinger believe that he’s sexually magnetic. But can it cause brain damage?

When various lawmakers lit into John Stumpf at a congressional hearing last fall, each seemed to find a fresh way to flay the now-former CEO of Wells Fargo for failing to stop some 5,000 employees from setting up phony accounts for customers. But it was Stumpf’s performance that stood out. Here was a man who had risen to the top of the world’s most valuable bank, yet he seemed utterly unable to read a room. Although he apologized, he didn’t appear chastened or remorseful. Nor did he seem defiant or smug or even insincere. He looked disoriented, like a jet-lagged space traveler just arrived from Planet Stumpf, where deference to him is a natural law and 5,000 a commendably small number. Even the most direct barbs—“You have got to be kidding me” (Sean Duffy of Wisconsin); “I can’t believe some of what I’m hearing here” (Gregory Meeks of New York)—failed to shake him awake.

What was going through Stumpf’s head? New research suggests that the better question may be: What wasn’t going through it?

The historian Henry Adams was being metaphorical, not medical, when he described power as “a sort of tumor that ends by killing the victim’s sympathies.” But that’s not far from where Dacher Keltner, a psychology professor at UC Berkeley, ended up after years of lab and field experiments. Subjects under the influence of power, he found in studies spanning two decades, acted as if they had suffered a traumatic brain injury—becoming more impulsive, less risk-aware, and, crucially, less adept at seeing things from other people’s point of view.

Sukhvinder Obhi, a neuroscientist at McMaster University, in Ontario, recently described something similar. Unlike Keltner, who studies behaviors, Obhi studies brains. And when he put the heads of the powerful and the not-so-powerful under a transcranial-magnetic-stimulation machine, he found that power, in fact, impairs a specific neural process, “mirroring,” that may be a cornerstone of empathy. Which gives a neurological basis to what Keltner has termed the “power paradox”: Once we have power, we lose some of the capacities we needed to gain it in the first place.

A Visit to the Psychiatric Hospital Made Me Sick

I had a similar experience while visiting a friend in an inpatient unit.....

https://goo.gl/Bexp62 

I thought then that the place was a dying remnant of an old system, and an old consciousness. Our mental health system was surely moving in the direction of creating treatment environments and models that would actually help vulnerable patients stabilize, recover, and heal.

Many years have gone by since then during which I had no further involvement with the inpatient psychiatric hospital system. But recently, a close relative of mine suffered a psychotic episode that landed her in the locked unit of a Midwestern private psychiatric hospital. I therefore had a chance, through visits to the hospital and through conversations with her, other visitors, and some of the staff, to revisit the inpatient hospital environment.

It was a shocking and disturbing experience. In fundamental ways, nothing has changed. In fact, in some ways, things appear to have gotten worse.

My relative, I’ll call her Claire, was brought to the hospital from the emergency room after she had a scary hallucination earlier in the day following a period of intense stress and anxiety. After she was admitted, she was examined (apparently to make a record of any marks on her body to ensure the hospital couldn’t be blamed for existing bruises) and then left in her room. She did not receive any orientation, was not told where the nurses were, and was not given a schedule, a welcome pack, or information on the rules, whom to talk to—nothing. Neither Claire nor her family received instructions about the hospital’s discharge procedures. She wasn’t told when she would see a doctor, nor was she given any medication (until she asked for some), or any other advice or assistance.

The next day, Claire later told me, was mostly spent waiting, with not much to do except watch junk TV, play cards, or lie in bed. There was one TV set receiving few stations, a few puzzles, Pictionary, two decks of cards, and four books on the unit. The nursing staff mostly stayed in their office and interacted little with the patients. A few rudimentary group sessions run by Techs were offered, including a group “art therapy” session, which consisted of being offered coloring books to fill in. For reasons that were not explained to her (or her family), Claire was placed in the Dual Diagnosis unit for addicts even though she is not a substance user.