8 years of “suffering” under Barack Obama

Take a moment and think. What have/did we “suffer ” under 8 years of President Obama? An improving economy. Kindness and outreach to all. No scandals in the White House…. 

I say, “Let’s have more of this. Not more of 45’s junk, scandal, and fear mongering.”

Teri Carter's Library

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3C54DC7D00000578-4140672-Barack_Obama_waves_as_he_boards_Marine_One_and_departs_the_Capit-a-77_1484945371469 Photo credit: The Associated Press

The sentence I hear most from well-meaning, conservative friends since President Trump’s election is this: “We suffered 8 years under Barack Obama.”

Fair enough. Let’s take a look.

The day Obama took office, the Dow closed at 7,949 points. Eight years later, the Dow had almost tripled.

General Motors and Chrysler were on the brink of bankruptcy, with Ford not far behind, and their failure, along with their supply chains, would have meant the loss of millions of jobs. Obama pushed through a controversial, $8o billion bailout to save the car industry. The U.S. car industry survived, started making money again, and the entire $80 billion was paid back, with interest.

While we remain vulnerable to lone-wolf attacks, no foreign terrorist organization has successfully executed a mass attack here since 9/11.

Obama ordered the raid that killed Osama Bin Laden.

He drew down the number…

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The Federal State-Based Universal Health Care Waiver Act of 2015

banner picture of Universal Healthcare from http://www.healthcareforallcolorado.org/

One Agenda: Universal Health Care.
Picture courtesy of Healthcare for All Colorado

As part of the Affordable Care Act (ACA), states have been given the ability to innovate or create their own form of health care insurance or coverage starting on January 1, 2017 AS LONG AS “benefits are at least as comprehensive and affordable as those offered by Qualified Health Plans available on the Exchanges,” according to Representative Jim McDermott (D-WA-7).

As a result, at least 14 states—California, Colorado, Hawaii, Illinois, Maine, Maryland, Minnesota, Missouri, , New York, Ohio, Oregon, Pennsylvania, Vermont, and Washington—have community advocates and state legislators working towards implementing a state-level form of universal health care. They have been working for affordable healthcare access for all residents of their states before and since the Affordable Care Act – aka Obamacare – was passed in 2010.

Now that the US Supreme Court has basically settled the fact that the ACA is constitutional both on June 28, 2012 (Florida v. Department of Health and Human Services) and again on June 25, 2015 (King v. Burwell), we can consider ways to improve our healthcare system at both the state and federal level. As a medical doctor and a member of Congress, McDermott voted for the ACA. He also recognizes that “still more needs  to be done to control costs, improve care, and cover everyone.”

One way to further control these costs and improve health care while covering everyone is to create a universal health care system which I’ve previously blogged about (see here, here, here, here, and here). That means we either have the federal government create a federal single payer plan OR we use the waiver clause in the ACA to help states create their own universal single-payer health care program.

Yet even with the waiver currently allowed within the ACA for innovative state-based health care plans, creating a state-based universal care plan that saves funds for states and individuals while providing health care access to all has a big hurdle to overcome. Rep. McDermott explained this issue in a speech on the floor of the House of Representatives on July 28:

One of the many achievements of the Affordable Care Act is its provisions that grant states the authority to innovate in their health care systems. Under Section 1332 of the law, a state may apply for a State Innovation Waiver that will provide it with control of federal dollars that otherwise would have been spent on premium tax credits and cost-sharing reductions for its residents. Through this waiver, a state may design a system to cover its residents, so long as benefits are at least as comprehensive and affordable as those offered by Qualified Health Plans available on the Exchanges.

However, even with this flexibility, numerous barriers limit states’ ability to design true single-payer systems. Existing waivers are narrow in scope, requiring states to seek out imperfect and convoluted solutions to circumvent federal limitations. A sweeping preemption provision in the Employee Retirement Income Security Act (ERISA) denies states authority to regulate employer-sponsored health plans. And, due to the complexities of our existing federal health programs, it is essentially impossible for a state to design a single benefit package that can be administered simply and efficiently on behalf of all of its residents.

This speech was McDermott’s announcement that he was introducing HR 3241, aka the “State-Based Universal Health Care Act of 2015:” If passed, this bill would allow states to apply for a universal health care waiver that would allow them to have access to and authority over federal health care dollars that would otherwise be spent on the residents of that state. More specifically, this additional waiver act goes beyond the ACA to deal with the hurdles mentioned above. The new provisions of this law, according to McDermott, would waive all of the following:

  • The rules governing premium tax credits and cost-sharing reductions, as provided for in existing waiver authority under Section 1332 of the ACA.

  • Provisions necessary for states to pool funds that otherwise would be spent on behalf of residents enrolled in Medicare, Medicaid, CHIP, TRICARE, and the Federal Employee Health Benefits Program.

  • ERISA’s preemption clause, which cur-rently forbids states from enacting legislation relating to employee health benefit program

After the introduction of HR 3241, the House referred this bill to five committees — the Committee on Energy and Commerce, the Committee on Ways and Means, the Committee on Oversight and Government Reform, the Committee on Armed Services, and the Committee on Education and the Workforce. I believe that the large number of committee referrals was done because of the need to review all of the different laws that this waiver would impact.

You can read the bill in its entirety here.

I am pleased that this bill has been introduced. It however needs many co-sponsors and advocates to pressure Congress to actually hear, review, and pass this legislation. Please contact your US Representative and ask her/him to co-sponsor Representative Jim McDermott, MD’s bill HR 3241. Here’s the lookup page to find your US. Representative by zip code.

As this is the summer, your Representative should be in the home district. Call, write, set up a meeting and tell her/him why you want to see a universal health care program in your state and why this bill is so necessary. If your Representative agrees to sign on, have him/her contact Mr. McDermott’s aides that are focusing on this issue. They are Jayme Shoun, located in Seattle at (206) 553-7170 and Daniel Foster, Health Counsel in the DC Office at (202) 225-3106.

Thanks.

The French Way or the Broken US Way of Healthcare?

Advocates for Single Payer Healthcare Rallying in 2009 in Harrisburg, PA

Advocates for Single Payer Healthcare Rallying in 2009 in Harrisburg, PA

Anya Schriffrin has just written a wonderful piece on universal health care from the French perspective called “The French Way of Cancer Treatment.”  She discusses the differences in the treatment her father received at Sloan Kettering Memorial Hospital v. his treatment at Cochin Hospital, a public hospital in Paris.

The differences she saw in her father’s cancer treatment in both countries included:

Issue

At Sloan Kettering (United States)

At Cochin (France)

 

Average length of treatment day

7.5 hours

90 minutes

How specialists see patients

Patient traveled to each specialist’s office

All specialists came to see patient either in home or in the hospital room.

Treatment received

Chemo selected based on insurance company’s formulary

Chemo selected based on doctor’s determination of best treatment

Who paid for meals while in hospital

Patient

Hospital: Included in treatment

Who paid for transportation to and from hospital

Patient and/or Insurance Company

Hospital: Included in treatment

Type of medical care

Insurance based, for-profit

Universal Health Care

Average cost/person for medical care in each country (2011)

$8,608

$4,086

% of Country’s Gross Domestic Product for Health Care

17.9%

11.6%

 

The one statement that stood out for me on the French system was this:

“There were other nice surprises. When my dad needed to see specialists, for example, instead of trekking around the city for appointments, he would stay in one room at Cochin Hospital, a public hospital in the 14th arrondissement where he received his weekly chemo. The specialists would all come to him. The team approach meant the nutritionist, oncologist, general practitioner and pharmacist spoke to each other and coordinated his care. As my dad said, ‘It turns out there are solutions for the all the things we put up with in New York and accept as normal [emphasis added].’

As a cancer survivor, I can attest to similar experiences in the United States just about a quarter century ago.  Nothing has changed.  Like Ms. Schriffrin’s father, my visits to the hospital often took 7-8 hours after getting up way before the break of dawn to travel 3 hours to the hospital to be one of the first people to wait in line to see the doctors and other specialists.  I too had one doctor who wandered in to the clinic for my chemo 7-8 hours AFTER he was scheduled for treating patients. In that particular case, he kept patients and nursing staff waiting until about an hour after the clinic should have closed for the day.  And I had to fight for my life with two insurance companies in order to get the bone-marrow transplant I needed.

My story is similar to many others here in the states.  That’s why I support national universal, single-payer healthcare via Congressman John Conyers’ (D-MI) HR 676 in the United States.  It’s why I support federal legislation to expand the Affordable Healthcare Act to all states to create a state-level single-payer plan like what Vermont has already passed and signed into law. It’s why I support the plan that Senator Bernie Sanders (I-VT) has crafted; it’s called the American Health Security Act of 2013 bill and it creates state-level single-payer healthcare programs with Federal support.   It’s why I am a board member of Health Care for All PA Education Fund.  And it’s why I support the Pennsylvania Health Care Plan proposed by Pennsylvania State Senator Jim Ferlo.

We can do better here in the US.  Better than what Ms. Schriffrin’s father and I have both experienced.

Let’s fix this broken US healthcare system.  Let’s create access to quality healthcare for all via a universal, single-payer healthcare program in the United States.  Check it out.  Let’s do healthcare the French Way in the American style as suggested by Congressman John Conyers Jr. (D-MI), Senator Bernie Sanders (I-VT),  PA Senator Jim Ferlo, the state of Vermont, and Health Care for All PA.

Pennsylvania General Assembly Again Attacking Women’s Reproductive Health

Keep Abortion Legal NOW Round

Keep Abortion Legal Safe, Legal and Accessible (http://www.now.org/issues/abortion/)

It’s 2013 and the Pennsylvania General Assembly continues to attack women’s access to reproductive health. According to WeveHadEnoughPA.org, the Pennsylvania legislature has launched and maintained a 2+ year attack on women’s health. There have been numerous bills introduced and in some cases passed that restrict women’s vital access to reproductive health.  Since January 2011, there have been at least 55 votes in the Pennsylvania General Assembly to restrict access from birth control to safe, legal abortions.

The most recent attack is happening this month.  On April 10, the Pennsylvania Senate Insurance and Banking Committee heard and passed out SB 3 by an 8-5 vote; a floor vote could occur any time this month.  This coming Monday, April 15th, the Pennsylvania House Health Committee will be hearing and voting on HB 818, the companion bill to SB 3.

The Additional Burdens on Women Seeking Abortion Care in These Bills

Both of these bills would prohibit insurance companies who provide health care coverage from including abortion coverage within the new healthcare Exchange crafted by the Affordable Care Act (aka Obamacare). The only exceptions to this proposed ban are for women who become pregnant because of rape or incest if they personally report the sexual assault to law enforcement officials and for women who will die without immediate access to abortion services. If a woman doesn’t meet one of these two exceptions, she must completely pay for the abortion totally out of her own pocket, unlike any other medical care she would receive under her health insurance plan.

Currently, about 80% of private insurance companies provide coverage for abortion services. This is important because these very same plans will be offered to people purchasing insurance through the Exchange. As part of the federal law, however, all plans that offer abortion coverage in the Exchange must have a separate payment for that portion of the coverage. This bill would deny women the right to make this separate payment and deny them what is currently available to most people covered by the current private health insurance system. While women would still be able to have abortions in this circumstance, they would be forced to fully pay out-of-pocket all cost for these procedures; their insurance company would be prohibited from paying any portion of this treatment.

This proposed ban places an undue burden on victims of rape and incest and on those women whose lives are in danger health-wise by adding unnecessary barriers to receiving the critical medical attention they need. The two exceptions allowed are extremely limited. These bills require woman who are victims of rape or incest to notify the police and identify the perpetrator prior to seeking abortion treatment.  It also limits women with health issues that complicate their medical treatment to those that are in immediate danger of dying and requires additional medical certification by second, non-attending physician.

This bill places these restrictions on access to health insurance not by mentioning rape or incest or the death aversion clause, but by referring to and expanding Pennsylvania’s version of the Hyde Amendment.  This language is embedded in 18 Pa.C.S. § 3215(c) and would expand restrictions on public funds to all privately paid insurance plans purchased within the Exchange. The law (18 Pa.C.S. § 3215(c))as currently written is a prohibition of the state spending of public funds but not personal funds provided by the person herself for her own health insurance coverage.

The Rape and Incest Exception

Women and minors who are raped would be denied access to abortion services unless they formally report and identify their rapist to the police or child protective services.  Most sexual assaults are not reported to the police. This is even truer when the perpetrator is a family member or acquaintance. According to the Pennsylvania Coalition Against Rape, sexual assault occurs at a much higher rate than is actually reported.

Reasons for not reporting include an initial denial that they have been raped; fear that you won’t be believed or are ashamed for having been raped; or having an ongoing relationship (such as a spouse or parent) with the perpetrator. In order to be safe from further violence by the perpetrator, women and girls may decide not to report the attack to the authorities.  And if you are in denial you are also unlikely to report your rape or the incest of your child to authorities as required in this proposed legislation.

So that means if this bill becomes law and you become pregnant from rape or incest, you are further burdened with the additional costs of fully paying for the abortion. If this bill were not to go into effect, then following the restrictions placed on abortion care under federal law, you would have the abortion services covered based on the insurance rider you purchased in the exchange and you wouldn’t be forced to file a complaint with the police.  This is just one reason why this bill should be voted down.

The “Avert” Death Exception and Need for Expanded Health Exception

In addition, under this proposed law, women who are near death could receive an abortion.  However, say a woman develops cancer or an infection during her pregnancy that will not immediately kill her but would complicate her medical treatment should she continue with the pregnancy.

This health threat/complication is not included in the current bill’s health exception as that exception allows abortions only to “avert” the woman’s death. Any woman with a medical condition that is complicated by the pregnancy but doesn’t immediately place her in danger of death would be forced to bear the additional burden of the full cost of an abortion in addition to the increased threats to her health as well as the additional medical bills for the remaining part of her care.  The medical community, advocates and some legislators are very concerned about this limited exception and have proposed an amendment to both the House and Senate bill to expand this exception from “averting” her death to coverage of the abortion for any pregnancy that poses a substantial risk to the woman’s physical health.

But even if the health exception is expanded to include threats to women’s physical health and care, this bill continues to attack women’s health and lives and should be voted down.

Why this Bill Should be Voted Down

The question of whether abortion will be covered in federally subsidized insurance exchanges has already been settled.  In response to concerns raised by US Senator Ben Nelson, a staunch opponent of abortion, women who want to use their own money to purchase a health insurance plan that covers abortion services must send a separate payment so the funding for abortion coverage is completely separate and paid entirely by the individual. This bill denies women their right to make this separate payment.  And with an estimated 80% of private insurance plans currently covering abortion care, banning abortion coverage in the state exchange would leave women worse off than they were before health care reform began.

Abortion care is a legally authorized and fundamental component of women’s basic health care.  Women should not be denied access to safe, legal, and critical care as part of health care reform implementation.

If abortion coverage is available to some, it should be available to all.  Politicians should not discriminate against women participating in the health insurance exchange.  All women deserve the same peace of mind that they can obtain the health care they need, regardless of where their insurance comes from.

The decision to have an abortion is a private decision between a patient and her physician. It should not be denied by politicians interfering with an insurance company and the policies they offer to the consumer for this procedure.

Banning abortion coverage in transactions between a private company and an individual is governmental activism of the worst kind.  With all of the heated rhetoric over healthcare reform, one would assume that lawmakers would be sensitive about taking any action that suggests government intervention in private healthcare decisions.

Finally, instead of denying Pennsylvania women access to fundamental reproductive health care services, politicians should be working to protect and advance women’s health.

Action Needed

Contact your Pennsylvania Senator and Representative today (find their contact information here).  Tell her/him to support the expanded health exception amendment to both SB 3 and HB 818 and to oppose the entire bill regardless of the inclusion of the amendment.