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"content": "\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>[contextly_sidebar id=\"3xCHRB83RCegO5eCE9I9b7XUGYrDBx2J\"]\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uvPSgszQseNfQlpVIo48aD8k0r8xaCVy\"]\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "Republican senators are warming to the idea of a scaled-back plan that would delete the ACA's individual and employer mandates.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Betting that thin is in — and might be the only way forward — Senate Republicans are eyeing a \"skinny repeal\" that would roll back an unpopular portion of the federal health law. But health policy analysts warn that the idea has been tried before, and with little success.\u003c/p>\n\u003cp>Senators are reportedly considering a narrow bill that would eliminate the Affordable Care Act's \"individual mandate,\" which assesses a tax on Americans who don't have insurance. The bill would also eliminate the ACA's penalties for some businesses -- those that have 50 or more workers and fail to offer their employees health coverage.\u003c/p>\n\u003cp>Details aren't clear, but it appears that — at least initially — much of the rest of the 2010 health law would remain, under this strategy, including the rule that says insurers must cover people who have pre-existing medical problems.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In remarks on the Senate floor Wednesday, Sen. Minority Leader Charles Schumer, D-N.Y., said that \"we just heard from the nonpartisan Congressional Budget Office that under such a plan ... 16 million Americans would lose their health insurance, and millions more would pay a 20 percent increase in their premiums.\" The CBO \u003ca href=\"https://www.cbo.gov/publication/52977\" target=\"_blank\" rel=\"noopener noreferrer\">posted its evaluation\u003c/a> of the GOP's proposed plan Wednesday evening.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Earlier in the day, some Republicans seemed determined to find some way to keep the health care debate alive.\u003c/p>\n\u003cp>\"We need an outcome, and if a so-called skinny repeal is the first step, that's a good first step,\" said Sen. Thom Tillis, R-N.C.\u003c/p>\n\u003cp>Several Republican senators, including Dean Heller of Nevada and Jeff Flake of Arizona, appear to back this approach, according to \u003ca href=\"http://www.politico.com/story/2017/07/26/obamacare-repeal-republicans-minimum-240982\" target=\"_blank\" rel=\"noopener noreferrer\">published reports\u003c/a>. It is, at least for now, being viewed as a step along the way to Republican health reform.\u003c/p>\n\u003cp>\"I think that most people would understand that what you're really voting on is trying to keep the conversation alive,\" said Sen. Bob Corker, R-Tenn. \"It's not the policy itself ... it's about trying to create a bigger discussion about repeal between the House and Senate.\"\u003c/p>\n\u003cp>But what if, during these strange legislative times, the skinny repeal were to be passed by the Senate and then go on to become law? States' experiences with insurance market reforms and rollbacks highlight the possible trouble spots.\u003c/p>\n\u003ch3>Considering the Parallels\u003c/h3>\n\u003cp>By the late 1990s, states such as Washington, Kentucky and Massachusetts felt a backlash when some of the coverage requirement rules they'd previously put on the individual market were lifted. \"Things went badly,\" said \u003ca href=\"http://law.wfu.edu/faculty/profile/hallma/\" target=\"_blank\" rel=\"noopener noreferrer\">Mark Hall\u003c/a>, director of the health law and policy program at Wake Forest University.\u003c/p>\n\u003cp>Premiums rose and insurers fled these states, leaving consumers who buy their own coverage (usually because they don't get it through their jobs) with fewer choices and higher prices.\u003c/p>\n\u003cp>That's because — like the Senate plan — the states generally kept popular parts of their laws, including protections for people with pre-existing conditions. At the same time, they didn't include mandates that consumers carry coverage.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>That goes to a basic concept about any kind of insurance: People who don't file claims in any given year subsidize those who do. Also, those healthy people are less likely to sign up, insurers said, and that leaves insurance companies with only the more costly policyholders.\u003c/p>\n\u003cp>Bottom line: Insurers end up \"less willing to participate in the market,\" said Hall.\u003c/p>\n\u003cp>It's not an exact comparison, though, he added, because the current federal health law offers something most states did not: significant subsidies to help some people buy coverage. Those subsidies could blunt the effect of not having a mandate.\u003c/p>\n\u003cp>During the debate that led to passage of the federal ACA, insurers flat-out said the plan would fail without an individual mandate. On Wednesday, the Blue Cross Blue Shield Association weighed in again, saying that if there is no longer a coverage requirement, there should be \"strong incentives for people to obtain health insurance and keep it year-round.\"\u003c/p>\n\u003ch3>Individual Mandate Is Still Unpopular in Voter Polls\u003c/h3>\n\u003cp>About 6.5 million Americans \u003ca href=\"http://www.cnbc.com/2017/01/11/fewer-people-paid-obamacare-tax-penalties-as-more-got-obamacare-aid.html\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> owing penalties for not having coverage in 2015.\u003c/p>\n\u003cp>Polls consistently show, though, that the individual mandate is unpopular with the public. Indeed, when asked about nine provisions in the ACA, registered voters in a recent Politico/Morning Consult \u003ca href=\"http://www.cnbc.com/2017/02/22/obamacare-getting-more-popular-with-voters-in-trumps-presidency-poll.html\">poll\u003c/a> said they want the Senate to keep eight, rejecting only the individual mandate.\u003c/p>\n\u003cp>Even though the mandate's penalty is often criticized as not strong enough, removing it would still affect the individual market.\u003c/p>\n\u003cp>\"Insurers would react conservatively and increase rates substantially to cover their risk,\" said insurance industry consultant \u003ca href=\"http://www.healthpol.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Robert Laszewski\u003c/a>.\u003c/p>\n\u003cp>That's what happened after Washington state lawmakers rolled back rules in 1995 legislation. Insurers requested significant rate increases, which were then rejected by the state's insurance commissioner. By 1998, the state's largest insurer — Premera Blue Cross — said it was losing so much money that it would stop selling new individual policies, \"precipitating a sense of crisis,\" according to a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/10804476\" target=\"_blank\" rel=\"noopener noreferrer\">published\u003c/a> in 2000 in the \u003cem>Journal of Health Politics, Policy and Law\u003c/em>.\u003c/p>\n\u003cp>\"When one pulled out, the others followed,\" said current Washington Insurance Commissioner \u003ca href=\"https://www.insurance.wa.gov/about-mike-kreidler\" target=\"_blank\" rel=\"noopener noreferrer\">Mike Kreidler\u003c/a>, who was then a regional director in the federal department of Health and Human Services.\u003c/p>\n\u003cp>The state's individual market was volatile and difficult for years after. Insurers did come back, but won a concession: For a time, the insurance commissioner lost the power to reject rate increases. Kreidler, first elected in 2000, reclaimed that authority.\u003c/p>\n\u003cp>Predicting the effect of removing the individual mandate is difficult, although Kreidler said he expects the impact would be modest, at least initially. Subsidies that help people purchase insurance coverage — if they remain as they are under current law — could help blunt the impact. But if those subsidies are reduced — or other changes are made that further drive healthy people out of the market — the impact could be greater.\u003c/p>\n\u003cp>\"Few markets can go bad on you as fast as a health insurance market,\" said Kreidler.\u003c/p>\n\u003cp>As for employers, dropping the requirement that those with 50 or more workers must offer health insurance or face a financial penalty could mean some workers would lose coverage. But their jobs might be more secure, said \u003ca href=\"http://www.aei.org/scholar/joseph-antos/\" target=\"_blank\" rel=\"noopener noreferrer\">Joseph Antos\u003c/a>, a health care economist and resident scholar at the American Enterprise Institute.\u003c/p>\n\u003cp>That's because the requirement under the ACA meant that some smaller firms didn't hire people or give workers more than 30 hours a week — the minimum needed under the ACA to be considered a full-time worker who qualified for health insurance.\u003c/p>\n\u003cp>The individual mandate, he added, may not be as much of a factor in getting people to enroll in coverage as some think, because the Trump administration has indicated it might not enforce it anyway — and the penalty amount is far less than most people would have to pay for health insurance.\u003c/p>\n\u003cp>However, the individual market could be roiled by other factors, Antos said.\u003c/p>\n\u003cp>\"The real impact would come if feds stopped promoting enrollment and did other things to make the exchanges the state and federal markets through which insurance is offered] work more poorly.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://khn.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Kaiser Health News\u003c/em>\u003c/a>\u003cem> is a nonprofit health newsroom, an editorially independent part of the Kaiser Family Foundation. You can follow KHN senior correspondent Julie Appleby on Twitter \u003c/em>\u003ca href=\"http://twitter.com/Julie_Appleby\">\u003cem>\u003cstrong>@Julie_Appleby\u003c/strong>\u003c/em>\u003c/a>\u003cem> Congressional reporter \u003c/em>\u003ca href=\"https://twitter.com/RachelHBluth\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Rachel Bluth\u003c/em>\u003c/a>\u003cem> also contributed to this report. \u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 Kaiser Health News. To see more, visit \u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Kaiser Health News\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=States+Have+Already+Tried+Versions+Of+%27Skinny+Repeal.%27+It+Didn%27t+Go+Well&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients",
"title": "On Precipice of Senate Vote, East Bay Health Clinic Fears for Thousands of Patients",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">U.S. senators voted 51-50 on Tuesday to begin debate on a controversial health care bill that could unwind the 7-year-old Affordable Care Act, and possibly revamp the way Medicaid has been funded for the past 52 years. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The GOP leaders have not determined exactly \u003ca href=\"https://www.vox.com/policy-and-politics/2017/7/25/16027526/senate-health-care-bill-debate-explained\" target=\"_blank\" rel=\"noopener noreferrer\">what version\u003c/a> of the bill will be brought up for a vote after 20 hours of scheduled debate. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But two of the bills being considered would cut federal funding for Medicaid, the insurance program for low-income adults and children, pregnant women and people with disabilities. Since 1965, Medicaid has been administered by the states, but paid for through a combination of state and federal funds. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In California, the program is called Medi-Cal, and it covers one in three Californians. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Doctors, nurses and staff members at \u003c/span>\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">Tiburcio Vasquez Health Center\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> (TVHC) in Hayward have been speaking with KQED over the past month about how the proposed cuts of billions of dollars for Medi-Cal would affect the clinic's work as the safety-net provider of last resort for vulnerable patients. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Both [bills] would be just terrible for our patients,\" said Chief Medical Officer Dr. Porshia Mack, after Tuesday's \"motion to proceed\" vote. \"If it’s 'repeal and delay,' there’s no guarantee that they’d come up with a bill to cover those people that would lose insurance.”\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>'Less people will have coverage. Bottom line.' \u003c/strong>\u003c/p>\n\u003cfigure id=\"attachment_358426\" class=\"wp-caption alignleft\" style=\"max-width: 300px\">\u003cimg class=\"wp-image-358426\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg\" alt=\"David B. Vliet is the Chief Executive Officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, less people will have health coverage.\" width=\"300\" height=\"322\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1020x1096.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-160x172.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-800x860.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-768x825.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-1180x1268.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-960x1032.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-240x258.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-375x403.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/07/RS26075_David-B-Vliet-NCB-pic-qut-520x559.jpg 520w\" sizes=\"(max-width: 300px) 100vw, 300px\">\u003cfigcaption class=\"wp-caption-text\">David B. Vliet is the chief executive officer of Tiburcio Vasquez Health Center. He says if Obamacare is dismantled, fewer people will have health coverage.\u003c/figcaption>\u003c/figure>\n\u003cp>Recently, KQED health reporter Laura Klivans sat down with TVHC’s CEO to learn more about the day-to-day work of a large urban community health center and how potential cuts to Medi-Cal could affect that.\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This interview was edited for brevity and clarity.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Name:\u003c/strong> David B. Vliet\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>Title:\u003c/strong> Chief executive officer at Tiburcio Vasquez Health Center, a federally supported clinic with locations in Hayward, Union City and Fremont. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Tell me a bit about the scope of the programs here.\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We are pretty much a typical, run-of-the-mill community health center. We are \u003c/span>\u003ca href=\"https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">federally qualified\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, which essentially compels us to take care of any member of the community that needs health care without regard to their ability to pay. We have pediatrics, internal medicine, family practice, women's health and dental. We also have a very large WIC — \u003c/span>\u003cspan style=\"font-weight: 400\">\u003ca href=\"https://www.fns.usda.gov/wic/women-infants-and-children-wic\" target=\"_blank\" rel=\"noopener noreferrer\">Women, Infants, and Children\u003c/a> —\u003c/span>\u003cspan style=\"font-weight: 400\"> program. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Can you tell me a little bit about your own background and how you ended up as the CEO of Tiburcio Vasquez Health Center?\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> This is a movement that goes back to the civil rights movement. So we have a large number of people who have been in this work for a long time. I'm relatively new to the community health center world. I have about 16 years.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">I got here because having lived in Mexico as a younger man, I saw a very desperate need for health care. I wanted to actually have my own mobile clinic that would go into the rural areas of Florida to deliver health care, like a bus that was outfitted. And very long story short, I decided that if I was going to raise money to do that I’d have to get an undergraduate degree in that area. I sort of slipstreamed into health administration in Florida. Then I moved to Texas, where I was introduced in 2002 to the community health center model, and fell in love with it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In Austin, Texas, I ran the \u003c/span>\u003ca href=\"http://communitycaretx.org/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">community health centers\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> for about 10 years. I learned that this is really important, rewarding work because we get to impact the health outcomes of the community and see people be well. A lot of people will walk around with their diabetes out of control or slight depression or a toothache. And the fact that we're able to address that in a systematic way, to me is very exciting. \u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: Coming from Texas to a state like California, what are some of the things you've noticed about how health care is different at a community clinic level? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> Similar to Travis County [where Austin, Texas, is located], Alameda County is also very progressive. And the community’s very committed to serving people even without documentation, because there is a return on investment when you do that. The overall cost of care longitudinally is reduced when you take care of people \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">when\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\"> they need to be taken care of. So I think there are a lot of similarities, but the political atmosphere certainly is much different in Texas.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: What do you find to be unique about Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A:\u003c/strong> We began our health care journey back in the early '70s taking care of families that were busy making America great in agriculture, in the fields. As their families grew and they got ill, we were there in a very simple form. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">[Community Health Centers] take care of around \u003c/span>\u003ca href=\"http://www.kff.org/report-section/community-health-centers-recent-growth-and-the-role-of-the-aca-issue-brief/\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan style=\"font-weight: 400\">24 million\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> patients across the United States. We're a significant safety-net model and we've enjoyed bipartisan support for many years.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: How have the additional dollars from the Medi-Cal expansion helped Tiburcio Vasquez?\u003c/b>\u003c/p>\n\u003cp>\u003cstrong>A:\u003c/strong> We opened up a new health center in San Leandro. We're able to add exam rooms, and add dental chairs, and hire staff, and then see more patients. But there were dollars that did other things, [for example], the conversion to the electronic health record so that we're no longer on paper charts.\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">If those [Medi-Cal dollars] go away, we will continue to have to take care of communities whether the funding is there or not. Those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs because of that.\u003c/span>\u003c/p>\n\u003cp>\u003cb>Q: If the ACA gets dismantled, what's the impact going to be for Tiburcio Vasquez? \u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003cstrong>A: \u003c/strong>Less people will have coverage. Bottom line. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Health centers are here, and have been for 50-odd years. We have funding from the federal government and have enjoyed bipartisan support. But that has not always been enough. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The Medicaid expansion assures -- particularly for adults who were not covered previously, working adults -- they're able to come in here and get preventive care. If there is a reduction in Medicaid, some of those folks in our county could be pushed off Medicaid and will probably go back on some sort of county plan. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At our health center, roughly 5,000 folks that did not have coverage before currently have Medicaid. That number will go away under the contraction of Medicaid under the proposed new bill. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain’s decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the “failures” of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it’s still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>NPR’s health and politics teams have been doing our best to shed some light on what’s a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here’s our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says “nope”?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won’t get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That’s \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people’s health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"excerpt": "The president called on the Senate to repeal and replace the ACA this week. Here's what they would vote on.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate is expected to vote Tuesday on whether to advance health care legislation to the Senate floor. That would open up debate on an Obamacare repeal and/or replacement plan.\u003c/p>\n\u003cp>The importance of the vote was highlighted by \u003ca href=\"https://twitter.com/SenJohnMcCain/status/889652943791824897\" target=\"_blank\" rel=\"noopener noreferrer\">Sen. John McCain’s decision\u003c/a> to return to Washington to take part. He announced last week that he had been diagnosed with brain cancer.\u003c/p>\n\u003cp>At a White House event Monday, President Trump highlighted what he called the “failures” of the Affordable Care Act, also known as Obamacare, and called on senators to pass a bill that both repeals and replaces the ACA. Last week, Trump \u003ca href=\"https://twitter.com/realDonaldTrump/status/887134287350439936\" target=\"_blank\" rel=\"noopener noreferrer\">urged an approach\u003c/a> that would repeal the law over two years, giving lawmakers more time to craft new health care legislation. Several days later \u003ca href=\"http://www.npr.org/2017/07/20/538171317/fact-check-trumps-confusing-remarks-to-senate-republicans-on-health-care\" target=\"_blank\" rel=\"noopener noreferrer\">at a lunch\u003c/a> with lawmakers, he advocated repeal and replace.\u003c/p>\n\u003cp>But it’s still not clear what the Senate will be voting on. There are \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">multiple bills\u003c/a> in play.\u003c/p>\n\u003cp>The Senate hopes it can muster the 51 votes needed to pass a bill, but some Republicans are wavering, both in the center and on the right.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>NPR’s health and politics teams have been doing our best to shed some light on what’s a very confusing situation, even by health policy standards.\u003c/p>\n\u003cp>\u003cstrong>What are they voting on?\u003c/strong>\u003c/p>\n\u003cp>There are at least four bills that could advance to the Senate floor. \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/20/538360550/with-so-many-obamacare-repeal-options-in-play-confusion-reigns\" target=\"_blank\" rel=\"noopener noreferrer\">Here’s our summary\u003c/a>, with a chart comparing House and Senate bills to the Affordable Care Act, and links to stories that dive into the implications of the legislation.\u003c/p>\n\u003cp>\u003cstrong>Who wins? Who loses?\u003c/strong>\u003c/p>\n\u003cp>We worked with NPR member station reporters and editors to create an interactive \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/10/535851043/faq-how-would-the-republican-health-care-bills-affect-you\" target=\"_blank\" rel=\"noopener noreferrer\">Q&A\u003c/a> on how key elements of the bills would affect people in different states.\u003c/p>\n\u003cp>\u003cstrong>What if the Senate parliamentarian says “nope”?\u003c/strong>\u003c/p>\n\u003cp>Another \u003ca href=\"http://khn.org/news/ruling-by-senate-parliamentarian-upends-gop-hopes-for-health-care-bill/\" target=\"_blank\" rel=\"noopener noreferrer\">potential wrinkle\u003c/a> came up late Friday. Julie Rovner with Kaiser Health News reports that the Senate rule-keeper has advised that some key parts of some of the bills could need 60 votes to proceed. They include defunding Planned Parenthood and incentives to have people keep health insurance. Getting 60 votes would require Democratic support, which they won’t get.\u003c/p>\n\u003cp>\u003cstrong>And if Obamacare remains the law of the land?\u003c/strong>\u003c/p>\n\u003cp>For now, the Affordable Care Act is still the law, and insurers are trying to plan for next year. That’s \u003ca href=\"http://www.npr.org/2017/07/21/538399298/even-talking-about-weakening-obamacare-provisions-weakens-the-exchanges\" target=\"_blank\" rel=\"noopener noreferrer\">proving to be difficult\u003c/a> and might \u003ca href=\"http://www.npr.org/templates/transcript/transcript.php?storyId=538099050\" target=\"_blank\" rel=\"noopener noreferrer\">drive up costs\u003c/a> for \u003ca href=\"http://www.npr.org/sections/health-shots/2017/07/22/538396570/rural-californians-want-price-relief-from-gop-health-bill-but-most-won-t-get-it\" target=\"_blank\" rel=\"noopener noreferrer\">consumers\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Congressional action could have an enormous impact on people’s health insurance. But the U.S. Department of Health and Human Services has some wide berth in interpreting the law and could make a lot of changes without congressional action. Here are some \u003ca href=\"http://www.npr.org/sections/health-shots/2017/03/29/521713002/even-without-congress-the-trump-administration-can-still-redo-obamacare\" target=\"_blank\" rel=\"noopener noreferrer\">key actions\u003c/a> and regulations that could affect the exchanges and Medicaid (and more).\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=The+Senate+Health+Care+Vote%2C+Simplified&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Sighs of Relief From Health Safety-Net Providers in California After Senate Bill Collapses",
"title": "Sighs of Relief From Health Safety-Net Providers in California After Senate Bill Collapses",
"headTitle": "State of Health | KQED News",
"content": "\u003cp>\u003cspan style=\"font-weight: 400\">Health care workers at California hospitals and clinics that serve low-income patients are relieved but still wary after the collapse of the Senate Republican health care bill earlier this week.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">The bill proposed deep funding cuts to Medicaid, which is called Medi-Cal in California and covers one out of three state residents. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.cbo.gov/publication/52941\" target=\"_blank\" rel=\"noopener noreferrer\">Congressional Budget Office (CBO) analysis\u003c/a> predicted the latest version of the Senate bill\u003c/span>\u003cspan style=\"font-weight: 400\"> would result in 15 million people losing insurance coverage next year and 22 million by 2026. But it would reduce the federal deficit by $420 billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There has also been discussion of reviving a bill to repeal the Affordable Care Act (ACA) outright, without a plan to replace it. But that could be difficult because the \u003ca href=\"https://www.cbo.gov/publication/52939\" target=\"_blank\" rel=\"noopener noreferrer\">CBO estimated\u003c/a> that “repeal only” would lead to a whopping 32 million Americans without insurance by 2026.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal in California\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since the implementation of the ACA and the subsequent expansion of who qualifies for Medi-Cal, safety-net providers across the state have increased their capacity to treat more patients, and have hired more staff and improved outreach programs and infrastructure. This growth is possible because clinics are getting more reimbursements for their work treating people who were uninsured before the ACA.\u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>When the ACA was implemented, states were given the choice to expand Medicaid eligibility to those making less than 138 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\" rel=\"noopener noreferrer\">federal poverty level\u003c/a>. California, along with 30 other states, adopted this expansion.\u003c/p>\n\u003cp>\u003cb>Here's How it Affects Real Californians:\u003c/b>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cul>\n\u003cli>The number of people on Medi-Cal is \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">13.5 million as of January 2017\u003c/a>. Of those, 3.8 million got this coverage through the ACA expansion.\u003c/li>\n\u003cli>\u003ca href=\"http://calbudgetcenter.org/resources/republican-plans-end-medicaid-know-threaten-medi-cal-coverage-benefits-millions-californians/\" target=\"_blank\" rel=\"noopener noreferrer\">Half\u003c/a> of \u003ca href=\"http://www.dof.ca.gov/Forecasting/Demographics/Projections/documents/P_PressRelease.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">California's kids\u003c/a> are on Medi-Cal.\u003c/li>\n\u003cli>\u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">One out of three California residents\u003c/a> is on Medi-Cal.\u003c/li>\n\u003cli>Medi-Cal covers \u003ca href=\"http://www.kff.org/infographic/medicaids-role-in-nursing-home-care/\" target=\"_blank\" rel=\"noopener noreferrer\">62 percent of seniors in nursing homes\u003c/a>.\u003c/li>\n\u003cli>The uninsured rate has dropped sharply. Before the ACA, \u003ca href=\"http://www.chcf.org/publications/2016/12/californias-uninsured\" target=\"_blank\" rel=\"noopener noreferrer\">16 percent\u003c/a> of Californians had no coverage. As of 2016, that number shrunk to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.4 percent\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What Was on the Chopping Block\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Both the House of Representatives' American Health Care Act (AHCA) and the Senate Republicans' Better Care Reconciliation Act (BCRA) proposed a hard annual limit on the amount of federal dollars Medi-Cal recipients would get, no matter how much treatment they would need.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Since Medi-Cal is funded by both the state and federal government, less federal money \u003c/span>\u003cspan style=\"font-weight: 400\">would compel states to either make up those dollars or make cuts to current programs. With the collapse of the BCRA, states won't need to think about those difficult decisions for the time being.\u003c/span>\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/RDnews/2017/07/ACHAcollapsereax.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/RS26032_IMG_67441-qut.jpg\" Title=\"Breathing Sigh of Relief, Safety-Net Providers Hold onto Gains for Now\" program=\"State of Health\"]\u003c/p>\n\u003cp>\u003cb>'The threat is still there for our patients'\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Tiburcio Vasquez Health Center\u003c/a> (TVHC) in Hayward and Union City, and \u003ca href=\"http://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Zuckerberg San Francisco General Hospital\u003c/a> have traditionally served low-income patients, regardless of their ability to pay. Before the ACA, the majority of their patients were uninsured, but now that’s reversed, and most patients arrive with Medi-Cal coverage or private insurance purchased with ACA subsidies on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California.\u003c/a>\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those additional insurance dollars have been the difference between scraping by and being able to make significant improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Safety-net delivery systems are traditionally very poorly resourced,\" said Dr. Alice Chen, chief medical officer for the \u003ca href=\"http://www.sfhealthnetwork.org/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Health Network\u003c/a>, an affiliate of Zuckerberg SF General. \"We've invested the new revenues that have come in for Medicaid patients into improving our systems of care.\" She says her network has brought in $150 million in new revenues from the Medicaid expansion.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">With those dollars, Chen says SF General, where she is based, has been implementing a new electronic health record system, and is working on initiatives to integrate mental and medical health and improve the patient's overall experience. Work like this, she says, wouldn't be possible without the additional resources from Medicaid dollars.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Medical students and residents at the University of California, San Francisco also said they were tentatively happy that it appears the ACA will remain in place. Dr. Emily Thomas is a UCSF resident who has been politically active since the 2016 election. She’s fighting to keep her patients insured through the ACA. She spoke to a crowd of doctors at SF General on Tuesday, explaining why she wanted the advocacy to continue. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Even though the BCRA has collapsed at the Senate, the threat is still there for our patients,” Thomas said. “Our patients are still relying on everyone in this room to continue to advocate for their expanded access to care.”\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Across the bay, at Tiburcio Vasquez Health Center, CEO David Vliet says his clinic has increased the number of patients it can serve due to the Medicaid expansion dollars. In addition to their existing clinics in Hayward, Union City and Fremont, health center administrators have built a $12 million facility with 22 exam rooms.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Regarding the additional Medicaid money, Vliet emphasized that \"those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs.\"\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Vliet said now that changes to the ACA are on hold, he's temporarily relieved. But he will still continue to monitor what's happening in Washington, D.C. If the increased funding continues to flow through Medi-Cal, Vliet says he would like to continue to expand services over the next few years to even more residents in the East Bay. Even after all the growth, TVHC staffers are working at capacity. There are still patients in the community waiting to be seen. \u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Adding to his concern, there is a chance Senate Republicans will revive the stalled health plan and push it through, which is what happened this spring in the House of Representatives.\u003c/span>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">Health care workers at California hospitals and clinics that serve low-income patients are relieved but still wary after the collapse of the Senate Republican health care bill earlier this week.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">The bill proposed deep funding cuts to Medicaid, which is called Medi-Cal in California and covers one out of three state residents. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">A \u003ca href=\"https://www.cbo.gov/publication/52941\" target=\"_blank\" rel=\"noopener noreferrer\">Congressional Budget Office (CBO) analysis\u003c/a> predicted the latest version of the Senate bill\u003c/span>\u003cspan style=\"font-weight: 400\"> would result in 15 million people losing insurance coverage next year and 22 million by 2026. But it would reduce the federal deficit by $420 billion. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">There has also been discussion of reviving a bill to repeal the Affordable Care Act (ACA) outright, without a plan to replace it. But that could be difficult because the \u003ca href=\"https://www.cbo.gov/publication/52939\" target=\"_blank\" rel=\"noopener noreferrer\">CBO estimated\u003c/a> that “repeal only” would lead to a whopping 32 million Americans without insurance by 2026.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Medi-Cal in California\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Since the implementation of the ACA and the subsequent expansion of who qualifies for Medi-Cal, safety-net providers across the state have increased their capacity to treat more patients, and have hired more staff and improved outreach programs and infrastructure. This growth is possible because clinics are getting more reimbursements for their work treating people who were uninsured before the ACA.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When the ACA was implemented, states were given the choice to expand Medicaid eligibility to those making less than 138 percent of the \u003ca href=\"https://aspe.hhs.gov/poverty-guidelines\" target=\"_blank\" rel=\"noopener noreferrer\">federal poverty level\u003c/a>. California, along with 30 other states, adopted this expansion.\u003c/p>\n\u003cp>\u003cb>Here's How it Affects Real Californians:\u003c/b>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\u003cul>\n\u003cli>The number of people on Medi-Cal is \u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">13.5 million as of January 2017\u003c/a>. Of those, 3.8 million got this coverage through the ACA expansion.\u003c/li>\n\u003cli>\u003ca href=\"http://calbudgetcenter.org/resources/republican-plans-end-medicaid-know-threaten-medi-cal-coverage-benefits-millions-californians/\" target=\"_blank\" rel=\"noopener noreferrer\">Half\u003c/a> of \u003ca href=\"http://www.dof.ca.gov/Forecasting/Demographics/Projections/documents/P_PressRelease.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">California's kids\u003c/a> are on Medi-Cal.\u003c/li>\n\u003cli>\u003ca href=\"http://www.dhcs.ca.gov/dataandstats/statistics/Documents/Fast_Facts_January_2017_ADA.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">One out of three California residents\u003c/a> is on Medi-Cal.\u003c/li>\n\u003cli>Medi-Cal covers \u003ca href=\"http://www.kff.org/infographic/medicaids-role-in-nursing-home-care/\" target=\"_blank\" rel=\"noopener noreferrer\">62 percent of seniors in nursing homes\u003c/a>.\u003c/li>\n\u003cli>The uninsured rate has dropped sharply. Before the ACA, \u003ca href=\"http://www.chcf.org/publications/2016/12/californias-uninsured\" target=\"_blank\" rel=\"noopener noreferrer\">16 percent\u003c/a> of Californians had no coverage. As of 2016, that number shrunk to \u003ca href=\"https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201702.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">7.4 percent\u003c/a>.\u003c/li>\n\u003c/ul>\n\u003cp>\u003cstrong>What Was on the Chopping Block\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Both the House of Representatives' American Health Care Act (AHCA) and the Senate Republicans' Better Care Reconciliation Act (BCRA) proposed a hard annual limit on the amount of federal dollars Medi-Cal recipients would get, no matter how much treatment they would need.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Since Medi-Cal is funded by both the state and federal government, less federal money \u003c/span>\u003cspan style=\"font-weight: 400\">would compel states to either make up those dollars or make cuts to current programs. With the collapse of the BCRA, states won't need to think about those difficult decisions for the time being.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cb>'The threat is still there for our patients'\u003c/b>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\u003ca href=\"http://www.tvhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Tiburcio Vasquez Health Center\u003c/a> (TVHC) in Hayward and Union City, and \u003ca href=\"http://zuckerbergsanfranciscogeneral.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Zuckerberg San Francisco General Hospital\u003c/a> have traditionally served low-income patients, regardless of their ability to pay. Before the ACA, the majority of their patients were uninsured, but now that’s reversed, and most patients arrive with Medi-Cal coverage or private insurance purchased with ACA subsidies on \u003ca href=\"http://www.coveredca.com/\" target=\"_blank\" rel=\"noopener noreferrer\">Covered California.\u003c/a>\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Those additional insurance dollars have been the difference between scraping by and being able to make significant improvements.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Safety-net delivery systems are traditionally very poorly resourced,\" said Dr. Alice Chen, chief medical officer for the \u003ca href=\"http://www.sfhealthnetwork.org/\" target=\"_blank\" rel=\"noopener noreferrer\">San Francisco Health Network\u003c/a>, an affiliate of Zuckerberg SF General. \"We've invested the new revenues that have come in for Medicaid patients into improving our systems of care.\" She says her network has brought in $150 million in new revenues from the Medicaid expansion.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">With those dollars, Chen says SF General, where she is based, has been implementing a new electronic health record system, and is working on initiatives to integrate mental and medical health and improve the patient's overall experience. Work like this, she says, wouldn't be possible without the additional resources from Medicaid dollars.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Medical students and residents at the University of California, San Francisco also said they were tentatively happy that it appears the ACA will remain in place. Dr. Emily Thomas is a UCSF resident who has been politically active since the 2016 election. She’s fighting to keep her patients insured through the ACA. She spoke to a crowd of doctors at SF General on Tuesday, explaining why she wanted the advocacy to continue. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">“Even though the BCRA has collapsed at the Senate, the threat is still there for our patients,” Thomas said. “Our patients are still relying on everyone in this room to continue to advocate for their expanded access to care.”\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Across the bay, at Tiburcio Vasquez Health Center, CEO David Vliet says his clinic has increased the number of patients it can serve due to the Medicaid expansion dollars. In addition to their existing clinics in Hayward, Union City and Fremont, health center administrators have built a $12 million facility with 22 exam rooms.\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Regarding the additional Medicaid money, Vliet emphasized that \"those dollars really do have a return on investment, in that when we are able to make sure that Mr. Smith or Mrs. Rodriguez doesn't show up in the ER with tooth pain, everyone in the community enjoys lower costs.\"\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Vliet said now that changes to the ACA are on hold, he's temporarily relieved. But he will still continue to monitor what's happening in Washington, D.C. If the increased funding continues to flow through Medi-Cal, Vliet says he would like to continue to expand services over the next few years to even more residents in the East Bay. Even after all the growth, TVHC staffers are working at capacity. There are still patients in the community waiting to be seen. \u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003cspan style=\"font-weight: 400\">Adding to his concern, there is a chance Senate Republicans will revive the stalled health plan and push it through, which is what happened this spring in the House of Representatives.\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"slug": "trumps-big-repealing-deal-8-takeaways-on-the-senates-health-care-meltdown-moment",
"title": "Why 'Repeal and Replace' Collapsed: 8 Takeaways on the Senate's Health Care Meltdown",
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"content": "\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>President Trump has summoned all Senate Republicans to the White House on Wednesday for a debrief on the state of health care legislation effort in their chamber. Based on the week so far, the meeting may be more like a \u003cem>post\u003c/em> \u003cem>mortem\u003c/em>.\u003c/p>\n\u003cp>The Senate still \u003ca href=\"http://www.cnn.com/2017/07/18/politics/mcconell-repreal-and-replace-obamacare-not-successful/index.html\">reportedly\u003c/a> plans a vote next week on repealing the Affordable Care Act without a replacement plan. But it appears the GOP leadership will not have the votes it needs to bring even that fallback version of their legislation to the floor.\u003c/p>\n\u003cp>So what happened after seven years of prioritizing the promise to repeal Obamacare? And what does it all mean for what’s next?\u003c/p>\n\u003cp>\u003cstrong>1. The president was AWOL\u003c/strong>\u003c/p>\n\u003cp>Few major legislative changes happen without the active support of the White House. We now have another demonstration of why this is true, albeit a demonstration in reverse.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump made the decision to bet the first months of his presidency on a quick “repeal-and-replace” strategy. That decision is now being widely second-guessed. But Trump also failed to put shoulder to the wheel at any stage of the process. Unwilling to engage in the substantive issues, he famously decried the difficulty he had previously denied: \u003ca href=\"http://www.cnn.com/2017/02/27/politics/trump-health-care-complicated/index.html\">“Nobody knew health care could be so complicated.”\u003c/a> He then praised the House bill at a self-congratulatory ceremony \u003ca href=\"http://www.cnn.com/2017/06/13/politics/trump-senators-health-care-white-house-meeting/index.html\">only to trash it later as “mean”\u003c/a> while speaking with GOP senators.\u003c/p>\n\u003cp>When the bill came to the Senate, \u003ca href=\"https://twitter.com/realDonaldTrump/status/884363456849342464\">Trump tweeted his hope that it would be “beautiful,”\u003c/a> (that comment was made \u003ca href=\"http://www.latimes.com/politics/washington/la-na-essential-washington-updates-trump-says-he-hopes-senate-health-care-1498095617-htmlstory.html\">about a week after the president said the Senate bill would have “heart” and that he wanted more money for the GOP health care plan\u003c/a> — presumably to provide more care for everyone at a lower cost). But in the critical days when the bill’s fate hung in the balance, he was more often tweeting about his various media feuds than about the bill. And on the night the final collapse came, he was finally meeting with senators for dinner — but all of them were already “yes” votes.\u003c/p>\n\u003cp>\u003cstrong>2. The president wasn’t the problem\u003c/strong>\u003c/p>\n\u003cp>Trump seems to have wanted to show up for the trophy ceremony, not for the game. But even if he had plunged into the trenches, his presence there might not have made the difference. Because the real challenge here was not the politics or the process but the problem itself.\u003c/p>\n\u003cp>Health care is on its way to being a fifth of the total economy, and the Affordable Care Act, aka “Obamacare,” is now part of its warp and woof. Ripping it out would disrupt the health care system’s delivery of care and payment alike. Replace was always the hard part of repeal-and-replace, and we simply do not have a consensus on how to do it — even among Republicans. After the past few months, one is tempted to say \u003cem>especially\u003c/em> among Republicans.\u003c/p>\n\u003cp>\u003cstrong>3. Health care politics are explosively dangerous\u003c/strong>\u003c/p>\n\u003cp>People are always anxious about their health, their care and its cost, but when they actually get sick, lose their coverage or find their premiums rising, they get scared and angry. Politically, it is often enough just to make them \u003cem>fear\u003c/em> \u003cem>those things might happen\u003c/em>.\u003c/p>\n\u003cp>Democrats found that out eight years ago, before they even got their bill across the finish line. The issue eventually flipped control of Congress. But now the Republicans come with plans to take insurance away from a far \u003cem>larger\u003c/em> number of people and still no guarantee that the insurance will cost less or cover as much. That’s why \u003ca href=\"http://www.npr.org/2017/06/28/534612954/just-17-percent-of-americans-approve-of-republican-senate-health-care-bill\">polls show the country prefers Obamacare to the GOP repeal bills by 2-1.\u003c/a> This was going to give Republicans a case of cold feet no matter how hard Trump worked the bill.\u003c/p>\n\u003cp>\u003cstrong>4. The Senate sorcerer’s hat has been knocked off\u003c/strong>\u003c/p>\n\u003cp>Mitch McConnell is the Senate majority leader and a past master of process and hardball politics. But his mythical status as a magician now looks more like a memory.\u003c/p>\n\u003cp>In fairness, McConnell followed a game plan that has worked in the past and that worked as recently as this spring in the House. He fashioned a bill primarily to please the conservatives who dominate his caucus, then refined it to further accommodate holdouts on the right. His plan for holdouts in the moderate camp called for picking them off one at a time, earmarking billions for specific states or needs such as opioid abuse.\u003c/p>\n\u003cp>At closing, the idea was to cast the last holdouts as preservers of Obamacare, traitors to the party and enemies of the state. (The president’s Twitter finger was a fearsome threat in this regard.) But as it turned out, more than a few conservatives saw too much of Obamacare surviving, while moderates were still worried about Medicaid cuts. McConnell’s magic was not potent enough.\u003c/p>\n\u003cp>\u003cstrong>5. Obamacare in some form is here to stay\u003c/strong>\u003c/p>\n\u003cp>Democrats in 2009 and 2010 did not necessarily want to protect and preserve the private health insurance industry. Many of them would have preferred a “public option” format as a faster track to single-payer “Medicare for all.” But to cobble together the votes to prevail, they went for a hybrid model of public-private insurance, which in the 1990s had been a Republican-proposed compromise alternative.\u003c/p>\n\u003cp>This time around, the mirror image dilemma occurred for the GOP. Their most conservative cadre wanted full repeal of the Obamacare regulations and taxes and a rollback of Medicaid expansion as quickly as possible. Their more pragmatic senators feared the fallout from dumping millions off Medicaid. Even Sen. Shelley Moore Capito, whose West Virginia voters went overwhelmingly for Trump, had to think about having 30 percent of her state’s families now on Medicaid. Other GOP senators were primarily fixated on the plight of those with pre-existing conditions, assured of affordable insurance for the first time under Obamacare.\u003c/p>\n\u003cp>\u003cstrong>6. \u003c/strong>\u003cstrong>Opposition is easy; governing is hard\u003c/strong>\u003c/p>\n\u003cp>The GOP Senate caucus is home to profound ideological diversity. That can be a wonderful thing when all are united in opposition to the governing party. It is a far different creature when it must be united in order to pass things. So the divisions have now been vividly exposed by the coming of a Republican president.\u003c/p>\n\u003cp>Yes, in 2015 it was easy for the Senate GOP to be unified in repealing Obamacare without a replacement. But no one doubted President Barack Obama would veto that. Now, Republican votes alone can make laws happen, and the prospect arises of voters not liking those laws.\u003c/p>\n\u003cp>\u003cstrong>7. The health care issue will not go away\u003c/strong>\u003c/p>\n\u003cp>For more than a decade now, one major party or the other has been agitating for big changes in health care and insurance. The ever-escalating costs of high-tech care and the near-constant debate in the media guarantee the issue’s salience will continue to grow. The average American wants good health care and has been increasingly promised “the best.” But we often do not focus on the cost until necessity arises. Nor do we realize the true cost and reality of insurance coverage. As this changes, health care will demand more political attention, not less.\u003c/p>\n\u003cp>\u003cstrong>8. Surprise: The idea of “single-payer” is gaining ground\u003c/strong>\u003c/p>\n\u003cp>Even without the friendly label of “Medicare for all,” government-guaranteed health care single-payer polls better today than it has for generations. Democrats are increasingly likely to favor it as a logical extension of current programs for children, retirees and lower-income families. Among Republicans, however, it is still “socialized medicine” and it remains anathema — just as when it was first proposed in the late 1940s.\u003c/p>\n\u003cp>But with escalating costs and political wrangling, more people are realizing that the health care system is a series of economic and political choices. The basic choice is between a for-profit health insurance industry that needs to make money (and has the power to raise premiums) and a single-payer system based on taxation and government regulation. This already exists as Medicare and the States Children’s Health Insurance Program (S-CHIP) for the youngest. Those programs are both popular and enjoy bipartisan support in Congress. But extending them to cover the generations from young adulthood to seniority remains the key battleground in health care politics.\u003c/p>\n\u003cp>Seven years ago, an open microphone caught Vice President Joe Biden congratulating President Obama on the passage of the health care bill that would define their legacy. \u003ca href=\"http://www.mediaite.com/tv/joe-biden-drops-f-bomb-during-historic-health-care-signing/\">Biden’s salty choice of words is more politely repeated by the initials “BFD.”\u003c/a> But his assessment of the moment’s importance was far from wrong. Seven years from now will we remember the events of this week as a matching bookend for Biden’s BFD?\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain’s absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama’s health care law.\u003c/p>\n\u003cp>McCain’s office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain’s office says he’ll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a “crusty voice in Washington.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Trump added, “Plus, we need his vote.”\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain’s absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail “is with continued hard work, and that’s just what we intend to do. ”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Foes from left and right are using the delayed vote on the Republican health care bill to make it as politically toxic as possible for wavering GOP senators to support it.\u003c/p>\n\u003cp>Over the weekend Senate Majority Leader Mitch McConnell delayed a vote on the GOP health care bill. Arizona Sen. John McCain’s absence has left Republicans short of the votes necessary to move ahead on the legislation to erase much of Barack Obama’s health care law.\u003c/p>\n\u003cp>McCain’s office says the 80-year-old Arizona senator underwent surgery Friday to remove a blood clot. McCain is at home and recuperating.\u003c/p>\n\u003cp>McConnell said he had spoken to McCain and that he hoped the ailing senator will be back in the Senate soon. McCain’s office says he’ll remain in Arizona this week.\u003c/p>\n\u003cp>President Trump says he hopes McCain gets better soon and calls him a “crusty voice in Washington.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Trump added, “Plus, we need his vote.”\u003c/p>\n\u003cp>Trump brought up McCain while calling for the repeal of the national health care law during a trade event at the White House.\u003c/p>\n\u003cp>McCain’s absence has led Senate leaders to postpone action on the health care measure. It needs almost every Republican vote to pass.\u003c/p>\n\u003cp>But the postponement also gives McConnell and the White House more time to cut the deals they need to rescue the imperiled measure.\u003c/p>\n\u003cp>McConnell signaled Monday that days of bargaining and persuasion with reluctant colleagues lie ahead. He says the only way to prevail “is with continued hard work, and that’s just what we intend to do. ”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The AARP is aiming TV and radio ads at undecided, moderate Republican senators in five states. From the right, Americans for Prosperity is rallying its members to urge senators to make the bill even more conservative.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"nprByline": "\u003ca href=\"http://khn.org/news/author/julie-rovner/\">\u003cstrong>Julie Rovner\u003c/strong>\u003c/a>\u003c/span>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Senate Republican leaders Thursday released their revised bill to “repeal and replace” the Affordable Care Act, but they acknowledged that furious days of negotiation have not yet secured the 50 votes necessary to pass the measure over unanimous Democratic objections.\u003c/p>\n\u003cp>Sen. John Cornyn (R-Texas) the No. 2 GOP leader, told reporters that while backers of \u003ca href=\"https://www.budget.senate.gov/bettercare\">the measure\u003c/a> did not yet have the GOP votes needed, “we will by the time we vote.”\u003c/p>\n\u003cp>The revised draft was presented to Republican senators at a closed meeting Thursday morning. Among its many provisions, it would cap federal funding for the Medicaid program, covers more than 70 million low-income Americans, and give states authority to waive insurance regulations in the ACA.\u003c/p>\n\u003cp>Senate Majority Leader Mitch McConnell (R-Ky.) has been struggling for more than two weeks to satisfy holdouts from both wings of the party. Conservatives complain that the \u003ca href=\"http://khn.org/news/senate-health-bill-would-revamp-medicaid-alter-aca-guarantees-cut-premium-support/\">draft bill unveiled last month\u003c/a> did not go far enough to repeal many of the ACA’s regulations, while moderates argue that structural changes and cuts to the Medicaid program for the poor are too deep.\u003c/p>\n\u003cp>So far, two of the 52 Republican senators have declared they will not even vote for the preliminary motion that would begin formal debate: conservative Rand Paul of Kentucky and moderate Susan Collins of Maine. “Still deep cuts to Medicaid,” Collins tweeted. “Will vote no on” motion to proceed to the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Collins told reporters separately that she cannot support the bill, and criticized Senate leaders for the way they produced it. Such a fundamental change to Medicaid should have a full set of legislative hearings, she explained. Even fully repealing the ACA would not cap spending for Medicaid in the way the Senate bill is proposing. “Repealing Obamcare would not change the underlying Medicaid program,” she said.\u003c/p>\n\u003cp>The ACA expanded Medicaid, but the Senate changes would cut it back well beyond that expansion.\u003c/p>\n\u003cp>One more “no” vote would stop the bill in its tracks, even with a potential tie-breaking vote from Vice President Mike Pence. Several moderate senators emerged from the closed meeting saying they were still undecided, including Shelley Moore Capito (R-W.Va.) and Lisa Murkowski (R-Alaska).\u003c/p>\n\u003cp>Leaders did, however, apparently satisfy some of their more conservative members by making some changes proposed by Ted Cruz (R-Texas). Cruz touted after the meeting that the legislation includes provisions to allow people to use tax-preferred health savings accounts to pay insurance premiums (which are currently banned). It would also allow anyone to purchase a plan that covers only catastrophic health expenses (which the ACA limits to those under age 30) and permit insurers to offer plans that do not conform to many of the regulations in current law. Those rules include the ACA’s requirements for coverage of specific health benefits as well as bans on insurers charging sick people more and limiting out-of-pocket costs.\u003c/p>\n\u003cp>Senate leaders offered to spend more money on people who could be adversely affected by the insurance changes, including an additional $45 billion to combat opioid abuse, but moderates said it does not solve the problem.\u003c/p>\n\u003cp>“There’s money,” Collins told reporters, “but too many uses for that money.”\u003c/p>\n\u003cp>Democrats remained steadfastly opposed to the measure. “The meat of this bill is exactly the same as it was before, and in some ways, they’ve somehow managed to make it even worse,” said Minority Leader Chuck Schumer (D-N.Y.).\u003c/p>\n\u003cp>Even if leaders round up the needed votes, there are still a number of obstacles between this draft bill and President Donald Trump’s signature. They include:\u003c/p>\n\u003cp>\u003cstrong>Procedural Restrictions\u003c/strong>\u003c/p>\n\u003cp>Republicans are trying to pass their health bill using a \u003ca href=\"http://khn.org/news/a-guide-to-budget-reconciliation-the-byzantine-rules-for-disassembling-the-health-law/\">special budget process\u003c/a> that lets them avoid a filibuster and the usual requirement to get 60 votes for passage. But strict rules govern what can and cannot be included in such a “budget reconciliation” bill. Democrats this week are arguing to the \u003ca href=\"https://www.theatlantic.com/politics/archive/2017/06/this-one-senate-staffer-could-sink-the-gops-health-care-plan/532296/\">Senate parliamentarian\u003c/a> that many sections of the bill should not be allowed, including those that would impose abortion restrictions and modify the private insurance regulations included in the ACA.\u003c/p>\n\u003cp>\u003cstrong>Cost Estimates\u003c/strong>\u003c/p>\n\u003cp>The Congressional Budget Office is the official scorekeeper for Congress. It said the \u003ca href=\"https://www.cbo.gov/publication/52849\">first version of the Senate bill\u003c/a> would result in 22 million more uninsured people by 2026.\u003c/p>\n\u003cp>CBO is expected to offer its score of the bill next week, but some \u003ca href=\"http://thehill.com/policy/healthcare/341904-senate-gop-may-not-use-cbo-to-score-cruz-amendment\">Senate Republicans\u003c/a> on Thursday said that rather than wait for that, they might ask the Department of Health and Human Services to do it instead. That would be likely to produce a number more favorable to Republicans.\u003c/p>\n\u003cp>Democrats saw that option as a partisan play by Republicans. “It’s gaming the score,” said Sen. Sherrod Brown (D-Ohio). “Why don’t they just have the score written in McConnell’s office by his staff?”\u003c/p>\n\u003cp>\u003cstrong>House Passage\u003c/strong>\u003c/p>\n\u003cp>Whatever the Senate produces must be acceptable to a majority of the House, or else the two chambers could get bogged down in weeks or months of negotiations. But changes that would make the Senate bill more acceptable to moderates there would likely not be able to get through the more conservative House. Leaders are walking a thin tightrope.\u003c/p>\n\u003cp>On the other hand, Republicans continue to be driven by the imperative of keeping their seven-year promise to overturn the health law.\u003c/p>\n\u003cp>“Virtually every Republican in this body has supported the effort to repeal and replace Obamacare more or less since the day it was signed into law,” Senate Finance Committee Chairman Orrin Hatch (R-Utah) said on the floor. “This legislation, while far from perfect, would fulfill the vast majority of those promises.”\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\u003cp>\u003c/p>\n",
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"excerpt": "Will it change my job-based coverage? What about my pre-existing condition? Will it cover mental illness? Does it cover abortion? This searchable FAQ has answers.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>When covering the GOP efforts to repeal and replace the Affordable Care Act, we tend to focus on the big picture: billions of cuts in Medicaid spending, say, or millions fewer people with health coverage.\u003c/p>\n\u003cp>But the real impacts would be felt in states, cities and towns, and they would vary a lot depending on where you live, how old you are and your particular health concerns. Reporters for NPR and NPR member stations across the country have delved into those geographic and demographic impacts; their reporting fuels this Q&A, which you can search by topic and locale.\u003c/p>\n\u003cp>[healthbilleffects]\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/\u003c/div>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Rural Californians Want Price Relief From GOP Health Bill – But Most Won’t Get It",
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"content": "\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.\u003c/p>\n\u003cp>Democrats have also said if the Republican bill fails, they’d be willing to \u003ca href=\"https://www.statnews.com/2017/07/05/health-care-compromise/\">work together on solutions\u003c/a>, but it’s not clear the parties could agree on one that would help people like Anklin.\u003c/p>\n\u003cp>If they can’t, she says she has no choice but to continue to go without coverage. Financially it makes sense in the short term, but it still worries her.\u003c/p>\n\u003cp>“If I ever have a problem,” she says, “I know I will be paying for the rest of my life.”\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/07/2017-07-11b-tcr.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Aaron-car-768x576.jpg\" Title=\"Rural Californians Want Price Relief From GOP Health Bill – But Most Won’t Get It\" program=\"The California Report\"]\u003c/p>\n\u003cp>\u003cem>*Premiums in this region of the state went up an average of 10.6 percent in 2016, according to Covered California’s \u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\" rel=\"noopener noreferrer\">rate booklet\u003c/a>, and most premium increases are matched with an increase in subsidy, so the most likely explanation for why Anklin’s premium jumped this much is that she lost her subsidy. This can happen if customers, intentionally or unintentionally, do not check a box on their application form that allows the federal government to verify their income, or, if customers do not file tax returns.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n",
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"excerpt": "In far northern Lassen and Modoc counties, residents say Obamacare premiums are unaffordable. But under the proposed Senate bill, insurance premiums would increase even more. ",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Aaron Albaugh peers out from under the brim of his cowboy hat, surveying the acres of hay fields in front of him. The fourth-generation \u003ca href=\"http://www.frostyacres.net/index.html\">rancher\u003c/a> is raising about 450 cattle this year, in this remote corner of Lassen County.\u003c/p>\n\u003cp>His closest neighbor lives a half mile away. “And that’s my brother,” Albaugh says.\u003c/p>\n\u003cp>“If I want to go see a movie, it’s 70 miles round trip,” he adds. “If I want to go bowling, that’s 100 miles round trip.”\u003c/p>\n\u003cp>Living a half day’s drive from civilization, you learn to do without, he explains. If your refrigerator breaks, you put your food on ice until the weekend when you can go buy a new one. With health care, it’s the same thing.\u003c/p>\n\u003cp>“Put a Band Aid on it,” Albaugh says. “I was raised: ‘You don’t need to cry’ and ‘Suck it up, buttercup.’ That’s the way I still live, and I try to treat my kids the same way.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So, when people are already used to doing without health coverage, it’s particularly annoying to have the government say you have to buy it, according to Albaugh and many of his neighbors in Lassen, Modoc and Shasta Counties.\u003c/p>\n\u003cp>While Obamacare is largely viewed as a success in California – the state marketplace, \u003ca href=\"http://www.coveredca.com/\">Covered California\u003c/a>, is one of the most financially stable in the country – it hasn’t worked as well for folks in this rural northeast corner of the state.\u003c/p>\n\u003cp>There are two insurers selling plans in each county here, but residents say that hasn’t created enough competition to bring down prices. Plus, a lot of the doctors they’re used to seeing don’t take the marketplace plans.\u003c/p>\n\u003cp>“Being told you have to have insurance you can’t afford, and then that doesn’t cover what you need? You are stuck,” says Modoc County resident Althia Cline, who decided to forego coverage – and a surgery she needed for her asthma.\u003c/p>\n\u003cp>Just like the movie theater and bowling alley, most medical specialists are miles away. In Modoc County, there’s nowhere to have a baby. Tessa Anklin, who lives in Canby, Calif., gave birth to her son and daughter over the border in Oregon, an hour and a half away from home.\u003c/p>\n\u003cp>Anklin makes about $33,000 a year as a dental receptionist. Her husband does seasonal work baling hay and herding cattle at local ranches. While their kids are covered by Medi-Cal, neither parent gets health insurance through work, and before the Affordable Care Act passed, Anklin and her husband did without coverage for a while.\u003c/p>\n\u003cfigure id=\"attachment_353608\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-353608 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/07/Tessa-front-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Tessa Anklin says Covered California health plans are too expensive for her family. \u003ccite>(April Dembosky/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Two years ago, they bought a plan through Covered California. With a subsidy, they paid just $2 a month for their premium, but their deductible was $10,000.\u003c/p>\n\u003cp>“We paid for all of our medical services and our prescriptions,” she says. “We had no help until we reached the $10,000 deductible. So really, we had nothing.”\u003c/p>\n\u003cp>Then, last year, their monthly premium jumped to $600. The plan was the same, Anklin says, and their household income was the same. But they still faced the same hour and a half drive to see doctors they almost never needed.*\u003c/p>\n\u003cp>Anklin thought of all the other ways she could spend that money.\u003c/p>\n\u003cp>“It makes the car payment. Almost your mortgage payment. Groceries for at least four months,” she says. “That’s a big difference, when you think about how little you actually use the health coverage.”\u003c/p>\n\u003cp>That’s the reason she decided to cancel her health plan this year and go without. But she’ll still have to pay a penalty when the next tax season comes around.\u003c/p>\n\u003cp>“It basically penalizes us one way or the other because we can’t afford the coverage,” she says. “So that’s kind of difficult, to be that middle-class person.”\u003c/p>\n\u003cp>Anklin says she’d be happy to see Republicans get rid of Obamacare.\u003c/p>\n\u003cp>“To me, it’s no good, if you have to force people to pay yet another something out of their paycheck when they’re already trying to survive with what they have,” she says. “It should be an option.”\u003c/p>\n\u003cp>But the Republican repeal and replace plan wouldn’t make things much better for Anklin and her neighbors. Average premiums in California would double under the GOP plan, according to a recent \u003ca href=\"http://www.kff.org/health-reform/issue-brief/premiums-under-the-senate-better-care-reconciliation-act/\">analysis\u003c/a> from the Kaiser Family Foundation. Anklin could end up paying more than $2,000 a month for coverage, according to Kaiser’s \u003ca href=\"http://www.kff.org/interactive/premiums-and-tax-credits-under-the-affordable-care-act-vs-the-senate-better-care-reconciliation-act-interactive-maps/\">county-by-county projections\u003c/a>.\u003c/p>\n\u003cp>That’s not what she had in mind for a fix.\u003c/p>\n\u003cp>“I’d love that insurance could be more affordable for families that need it, for families that work hard for it,” Anklin says.\u003c/p>\n\u003cp>With the Republican bill now in flux, Democrats have been more willing to admit to Obamacare’s flaws. The Dems agree that the rising costs of marketplace plans are the chief complaint they hear about, too.\u003c/p>\n\u003cp>Democrats have also said if the Republican bill fails, they’d be willing to \u003ca href=\"https://www.statnews.com/2017/07/05/health-care-compromise/\">work together on solutions\u003c/a>, but it’s not clear the parties could agree on one that would help people like Anklin.\u003c/p>\n\u003cp>If they can’t, she says she has no choice but to continue to go without coverage. Financially it makes sense in the short term, but it still worries her.\u003c/p>\n\u003cp>“If I ever have a problem,” she says, “I know I will be paying for the rest of my life.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>*Premiums in this region of the state went up an average of 10.6 percent in 2016, according to Covered California’s \u003ca href=\"http://www.coveredca.com/news/\" target=\"_blank\" rel=\"noopener noreferrer\">rate booklet\u003c/a>, and most premium increases are matched with an increase in subsidy, so the most likely explanation for why Anklin’s premium jumped this much is that she lost her subsidy. This can happen if customers, intentionally or unintentionally, do not check a box on their application form that allows the federal government to verify their income, or, if customers do not file tax returns.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"disqusTitle": "Patients With Pre-Existing Conditions Fear Bias Under GOP Health Proposals",
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"content": "\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ca href=\"http://www.kaiserhealthnews.org/\">Kaiser Health News\u003c/a> (KHN) is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Cheasanee Huette, a 20-year-old college student in Northern California, is worried. Two years ago, knowing she was protected by the Affordable Care Act’s guarantees of coverage for preexisting conditions, she decided to find out if she carried the same genetic mutation that eventually killed her mother.\u003c/p>\n\u003cp>She tested positive for one of the cancer-related mutations referred to as \u003ca href=\"https://ghr.nlm.nih.gov/condition/lynch-syndrome\">Lynch syndrome\u003c/a>.\u003c/p>\n\u003cp>Now, as congressional Republicans advance proposals to overhaul the health law’s consumer protections, she frets that her future health insurance and employment options will be defined by that test — and that the mutation documented in her medical records and related screenings could rule out individual insurance coverage.\u003c/p>\n\u003cp>“Once I move to my own health care plan, I’m concerned about who is going to be willing to cover me and how much will that cost,” said Huette, who now has coverage under her father’s policy.\u003c/p>\n\u003cp>With the protections of Obamacare in place, physicians in recent years have urged patients to be screened for a variety of diseases and predisposition to illness, feeling confident it would not affect their future insurability. Being predisposed to an illness — such as carrying BRCA gene mutations associated with breast and ovarian cancer — does not mean a patient will come down with the illness. And it may allow them to take steps to prevent its development.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the results recorded on patients’ charts could haunt them, experts say.\u003c/p>\n\u003cp>Dr. Kenneth Lin, associate professor of family medicine at Georgetown University School of Medicine in Washington, D.C., said that doctors might become reluctant to screen for widespread conditions such as prediabetes. The Centers for Disease Control and Prevention and the American Medical Association have \u003ca href=\"https://assets.ama-assn.org/sub/prevent-diabetes-stat/downloads/you-can-prevent-type2-diabetes.pdf\">urged primary care doctors to screen patients\u003c/a> at risk for the condition with a blood test. It is one of the screening tests covered under the ACA at no-cost to those patients.\u003c/p>\n\u003cp>\u003c/p>If the changes being proposed by the GOP become law, Lin wrote in an email, “you can bet that I’ll be even more reluctant to test patients or record the diagnosis of prediabetes in their charts.” Such a notation might mean hundreds of dollars a month more in premiums for individuals in some states under the new bill, according to Lin.\n\u003cp>It is a concern expressed by many patient-advocacy groups, who say members could be penalized or face the possible loss of the guarantee of coverage.\u003c/p>\n\u003cp>Huette is sharing her story publicly, since — come what may — her genetic mutation is already on the record — her medical record.\u003c/p>\n\u003cp>But genetics experts and patient advocates worry that people are already shying away from testing as the health law’s future becomes more uncertain. Their underlying concern: What if a positive result is added to their medical record, along with related screening and other preventive procedures that might further flag them to future insurers?\u003c/p>\n\u003cp>There have been “panicked expressions of concern,” said Lisa Schlager, vice president of community affairs and public policy at the nonprofit group Facing Our Risk of Cancer Empowered (FORCE). “Somebody who had cancer even saying, ‘I don’t want my daughter to test now.’ Or ‘I’m going to be dropped from my insurance because I have the BRCA mutation.’ There’s a lot of fear.”\u003c/p>\n\u003cp>These fears, which come in an era of accelerating genetics-driven medicine, rest upon whether a gap that was closed by the ACA will be reopened.\u003c/p>\n\u003cp>A law passed in 2008, the \u003ca href=\"https://www.eeoc.gov/laws/types/genetic.cfm\">Genetic Information Nondiscrimination Act\u003c/a> (GINA), bans health insurance discrimination if someone tests positive for a mutation. But that protection stops once the mutation causes “manifest disease,” jargon for a diagnosable health condition.\u003c/p>\n\u003cp>That means “when you become symptomatic,” although it’s not clear how severe the symptoms must be to constitute having the disease, said Mark Rothstein, an attorney and bioethicist at the University of Louisville School of Medicine in Kentucky, who has written extensively about GINA.\u003c/p>\n\u003cp>The ACA, passed two years later, closed that gap by barring health insurance discrimination based on preexisting conditions, Rothstein said.\u003c/p>\n\u003cp>On paper, the legislation unveiled by Senate Majority Leader Mitch McConnell (R-Ky.) last week wouldn’t permit higher rates to be charged to people with preexisting conditions, but health policy analysts said \u003ca href=\"http://khn.org/news/promises-made-to-protect-preexisting-conditions-prove-hollow/\">it could effectively exclude such patients\u003c/a> from coverage because it allows states to offer insurance that carved out coverage for certain maladies. The bill that passed the House last month has a provision that allows states to waive preexisting protections for people buying their own insurance if they have a gap in coverage of 63 days or longer during the prior year.\u003c/p>\n\u003cp>A genetic predilection for a certain disease is “not black-and-white,” said Dr. Robert Green, a medical geneticist who directs the Genomes2People (G2P) Research Program at Brigham and Women’s Hospital and Harvard Medical School in Boston. Once someone tests positive for a mutation, the recommended screening to catch disease at an earlier point could over time identify clinical or laboratory data “that are suggestive, but not definitive,” he said.\u003c/p>\n\u003cp>Green was involved with a study published this week in the Annals of Internal Medicine, which found that even seemingly healthy individuals can carry — unbeknownst to them — mutations for rare diseases. Of the 50 healthy patients who agreed to undergo whole-genome sequencing, 11 tested positive. Subsequently, two of the 11 were found to have related symptoms; the rest showed no signs of disease.\u003c/p>\n\u003cp>Lisa Salberg, chief executive officer of the Hypertrophic Cardiomyopathy Association, has cardiomyopathy, \u003ca href=\"https://www.nhlbi.nih.gov/health/health-topics/topics/cm\">a condition\u003c/a> that can make the walls of the heart thick and rigid. She was recovering from a heart transplant earlier this year when her phone and social media accounts blew up over the preexisting waivers in the House bill. “We finally got to a place where people understood the value [of genetic testing],” she said. “Now, because we’re turning health care on its head, people are becoming more paranoid again.”\u003c/p>\n\u003cp>When members of a Lynch syndrome-related social media group were asked about their views on testing, with assurance of no direct attribution without prior consent, slightly more than two dozen men and women responded.\u003c/p>\n\u003cp>Nearly all of those who posted said they were delaying action for themselves or suggesting that family members, and particularly children, should hold off. (Lynch syndrome refers to a cluster of mutations that can boost the risk of a wide range of cancers, particularly colon and rectal.)\u003c/p>\n\u003cp>Huette was the only one who agreed to speak for attribution.\u003c/p>\n\u003cp>She had witnessed the impact that worries about insurance coverage before the ACA had on patients. Her mother, a veterinarian, had wanted to run her own practice but instead took a federal government job for the guarantee of health insurance. She died at age 57 in 2011 of pancreatic cancer, one of six malignancies she had been diagnosed with over the years.\u003c/p>\n\u003cp>Huette said she doesn’t regret getting tested. Without that result, Huette pointed out, how was she going to persuade a doctor to give her a colonoscopy in her 20s? She added: “Ultimately, my health is more important than my bank account.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>[contextly_sidebar id=\"mrVakER0R6f0AToNbkAK83dprja2VTaO\"]\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The Senate vote on the health care bill has been pushed back, but it still has a lot of people in the nursing home industry worried. About two-thirds of nursing home residents are paid for by Medicaid. And the Congressional Budget Office \u003ca href=\"https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/52849-hr1628senate.pdf\">found\u003c/a> that the Senate health care bill would cut Medicaid by more than $770 billion over the next decade.\u003c/p>\n\u003cp>That could mean trouble for people like 88-year-old Betty Redlin. She's lived at the \u003ca href=\"http://victoriacarecenter.com/\">Victoria Care Center\u003c/a> in Ventura, Calif. for about 2 1/2 years.\u003c/p>\n\u003cp>She explains that she fell and broke her hip and never regained her ability to walk. \"I was living with my granddaughter,\" she says, \"and my doctor won't [allow] going back to her place.\"\u003c/p>\n\u003cp>Betty had a career as a bookkeeper. She also raised three children. Now she's spent everything she had. There's no way she could afford the roughly $80,000 a year this nursing home costs. (That fee is pretty standard for nursing homes.) So it's Medicaid that enables her to stay here.\u003c/p>\n\u003cp>\"There's nothing I can do about it,\" she says. \"It's gotta be [Medicaid] or [I'm] out on the street. One or the other.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe src=\"https://www.npr.org/player/embed/534764940/534764941\" width=\"100%\" height=\"290\" frameborder=\"0\" scrolling=\"no\" title=\"NPR embedded audio player\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>John Gardner, executive director of the Victoria Care Center, says that most of the long-term care residents like Redlin are on Medicaid or, as it's called in California, Medi-Cal.\u003c/p>\n\u003cp>\"If you look at what it costs to provide that service and what we get from Medi-Cal, we're actually losing a little bit of money every day on that.\" He says they make up the difference with short-term residents who have Medicare, which pays more than Medicaid does. Private pay patients also pay more than Medicaid.\u003c/p>\n\u003cp>Gardner says he's an optimist. Whatever Congress does, he doesn't think that Victoria Care Center would close down, though there might have to be cuts in staff and in the costs of food and supplies. Also, Gardner says that Victoria Care Center is part of a chain of 200 facilities, which could cushion the blow.\u003c/p>\n\u003cp>But not everyone is as optimistic as he is. According to the \u003ca href=\"https://www.ahcancal.org/Pages/Default.aspx\">American Health Care Association\u003c/a> (AHCA), a national trade group for nursing homes, the current Senate bill's cuts to Medicaid could mean that a typical nursing home would eventually run deficits of hundreds of thousands of dollars a year. James Gomez is the CEO of The \u003ca href=\"http://www.cahf.org/\">California Association of Health Facilities\u003c/a>, the AHCA's California chapter.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"If you can't break even or make a few dollars, you're not going to keep running your business,\" says Gomez. And that could lead to closures. \"So access [to nursing home beds] will become a huge issue.\"\u003c/p>\n\u003cp>The repercussions of cuts and closures would be felt across the nation's health care system, says Katie Smith Sloan, the president of \u003ca href=\"http://www.leadingage.org/\">Leading Age\u003c/a>, which represents non-profit nursing homes and other services for older adults.\u003c/p>\n\u003cp>\"People who are in nursing homes are there because they need the kind of services that a nursing home provides\" says Sloan. \"Without those services, they'll be forced to get that kind of care in a hospital, which will simply increase costs to Medicare.\"\u003c/p>\n\u003cp>Reining in Medicaid has been on conservatives' to-do list for a long time. House Speaker Paul Ryan has said he's \u003ca href=\"http://www.cnbc.com/2017/03/20/paul-ryan-has-wanted-to-reform-medicaid-since-his-frat-days.html\">dreamed of it\u003c/a> since his college days. Robert Moffit, a senior fellow in health policy studies at the conservative \u003ca href=\"http://www.heritage.org/\">Heritage Foundation\u003c/a>, argues that the program isn't being used as intended.\u003c/p>\n\u003cp>\"Do we want Medicaid, which was a program designed for the poor and the indigent, to become a kind of backdoor mechanism to establish a middle class entitlement for long-term care? Medicaid was never really intended to do that,\" says Moffit.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The Senate bill is likely to change. But leader Mitch McConnell has indicated that Medicaid cuts will still be part of it.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Nursing+Homes+Worry+Proposed+Medicaid+Cuts+Will+Force+Cuts%2C+Closures&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"disqusTitle": "Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal",
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"content": "\u003cp>Three years ago, Carol Morris was put in charge of a massive remodel of the new Mountain Valleys health clinic in Burney, a small town in mountains in eastern Shasta County.\u003c/p>\n\u003cp>She painted the new exam rooms in muted greens and browns, to reflect the pine forest and cattle ranches outside, and she made a series of equipment upgrades: new sonogram and retina scanning machines, a designer vaccine refrigerator, and a fleet of cushy new exam tables.\u003c/p>\n\u003cp>“Some of the staff will come in and nap on one at lunchtime,” Morris says, stroking the leather table.\u003c/p>\n\u003cp>The new Burney clinic is three times as big as the old one, Morris says. They’ve doubled the number of patients they see, and they’ve doubled their staff.\u003c/p>\n\u003cp>All thanks to money from the Affordable Care Act.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I guess it's true, build it and they will come,” Morris says.\u003c/p>\n\u003cp>[audio src=\"http://www.kqed.org/.stream/anon/radio/tcr/2017/06/2017-06-29a-tcr.mp3\" Image=\"https://u.s.kqed.net/2017/06/29/Stethoscope.jpg\" Title=\"Small Town Clinics – and Businesses – Fear Economics of Obamacare Repeal\" program=\"The California Report\"]\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>[contextly_sidebar id=\"uO0r77wi0xkfHFV79VI4jRtVOZYGMW8u\"]\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>President Obama’s signature health law provided grants for capital construction at rural clinics, and increased payments for treating patients on Medi-Cal, the state’s health program for low-income people. The law also expanded who qualified for Medi-Cal, adding close to 4 million Californians to the rolls, many of them from \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">rural, Republican counties\u003c/a> in the state, like Shasta, Lassen, and Siskiyou, where Mountain Valleys clinics operate.\u003c/p>\n\u003cp>With many of their previously uninsured patients now covered by Medi-Cal, the clinic is making money instead of losing it.\u003c/p>\n\u003cp>“That was a real boon to us,” says Dave Jones, CEO of \u003ca href=\"http://mtnvalleyhc.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Mountain Valleys clinics\u003c/a>. “We went from struggling payday to payday, to actually having a reserve at this point.”\u003c/p>\n\u003cp>In addition to moving into the new medical clinic in Burney, Jones was able to buy a dental building next door, expand mental health and drug counseling services, and hire a range of new administrative staff.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Across Shasta County, the Obamacare Medi-Cal expansion helped create more than 900 jobs in the health care sector and beyond, according to an economic impact report commissioned by \u003ca href=\"http://www.partnershiphp.org/Pages/PHC.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Partnership Health Plan\u003c/a>, the insurer that manages Medi-Cal in far northern California.\u003c/p>\n\u003cp>One of the Burney clinic’s newest hires is Laura Hodge. The clinic had noticed a lot of patients who got health coverage for the first time were going to the Emergency Room more -- for simple things, like a headache or Band-Aid.\u003c/p>\n\u003cp>They brought Hodge on to start a program aimed at reducing overuse of the ER. She sat in her office on a recent afternoon calling patients, asking them if they wanted to participate in the new program.\u003c/p>\n\u003cp>“I would be your liaison with the doctors,” she explains over the phone. “If you feel like you're not being listened to, or if you have any questions and you don't feel like you're being answered, you could come to me.”\u003c/p>\n\u003cp>The new job is a huge economic help for Hodge. Her husband is a trucker and they have three kids. Hodge’s salary is critical to keeping the household going.\u003c/p>\n\u003cp>And that’s critical to Burney. After the logging company, the clinic is one of the largest employers in town. A lot of the money Hodge and her coworkers make goes straight back into the community.\u003c/p>\n\u003cp>“The grocery store, the tire shop, the gas station,” Hodge lists the places she spends her paycheck. “Our little theater, the bowling alley, Kristi’s Unique Boutique.”\u003c/p>\n\u003cfigure id=\"attachment_348515\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-348515\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/06/Laura-Hodge-sips-red-bull-800x600.jpg\" alt=\"\" width=\"800\" height=\"600\">\u003cfigcaption class=\"wp-caption-text\">Laura Hodge sips a blended Red Bull at her favorite coffee shop in Burney. \u003ccite>(April Dembosky)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hodge takes me to one of her favorite haunts, the drive-thru window of the Mt. Burney Coffee Co.\u003c/p>\n\u003cp>“I will take a blended Red Bull,” she says, mulling over the list of flavors, deciding on the Fruit Loop – club soda with passion fruit, peach, and red raspberry syrup mixed in the blender with ice and a can of Red Bull.\u003c/p>\n\u003cp>“The first time I drank one, oh my gosh,” Hodge laughs, “I went home and I cleaned everything in my house.”\u003c/p>\n\u003cp>Staff from the health clinic are regulars at the coffee shop, says barista Abby Fristine.\u003c/p>\n\u003cp>“Most of them come through everyday, before or after work,” she says.\u003c/p>\n\u003cp>The money earned and spent by the health clinic staff ripples through the local economy. And all the people they’ve hired in recent years makes a difference in a small town like this, says Jones, the clinic CEO.\u003c/p>\n\u003cp>“I'm sure over the last two or three years it's been worth a couple million dollars to the community,” he says.\u003c/p>\n\u003cp>That’s why Jones is sounding the alarm on attempts to repeal the Affordable Care Act.\u003c/p>\n\u003cp>He and other clinic directors have managed to convince conservative officials, like the Shasta County Board of Supervisors, to \u003ca href=\"https://ww2.kqed.org/stateofhealth/2017/06/28/obamacare-inspires-unlikely-political-action-in-californias-rural-republican-territory/\" target=\"_blank\" rel=\"noopener noreferrer\">formally oppose the Republican health bill\u003c/a>, in part because of the potential economic impacts. The Siskiyou board is considering a similar move.\u003c/p>\n\u003cp>Together, both counties stand to lose close to $200 million in business revenue from a rollback to Medicaid funding, hitting not just clinics, but local shops and restaurants, too.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“If we have to revert back to where we were,” Jones says, “it could be disastrous.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?",
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"info": "Political Breakdown is a new series that explores the political intersection of California and the nation. Each week hosts Scott Shafer and Marisa Lagos are joined with a new special guest to unpack politics -- with personality — and offer an insider’s glimpse at how politics happens.",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"radiolab": {
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},
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"info": "The Snap Judgment radio show and podcast mixes real stories with killer beats to produce cinematic, dramatic radio. Snap's musical brand of storytelling dares listeners to see the world through the eyes of another. This is storytelling... with a BEAT!! Snap first aired on public radio stations nationwide in July 2010. Today, Snap Judgment airs on over 450 public radio stations and is brought to the airwaves by KQED & PRX.",
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"soldout": {
"id": "soldout",
"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
"info": "Sold Out: Rethinking Housing in America",
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