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Veto the Cold-Hearted Health Bill

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Donald Trump is right. The House health insurance bill is “mean, mean, mean,” as he put it last week. He correctly called the measure that would strip health insurance from 23 million Americans “a son of a bitch.”

The proposal is not at all what Donald Trump promised Americans. He said that under his administration, no one would lose coverage. He said everybody would be insured. And the insurance he provided would be a “lot less expensive.”

Senate Democrats spent every day this week pointing this out and demanding that Senate Republicans end their furtive, star-chamber scheming and expose their health insurance proposal to public scrutiny. That unveiling is supposed to happen today.

Republicans have kept their plan under wraps because, like the House measure, it is a son of a bitch. Among other serious problems, it would restore caps on coverage so that if a young couple’s baby is born with serious heart problems, as comedian Jimmy Kimmel’s was, they’d be bankrupted and future treatment for the infant jeopardized.

Donald Trump has warned Senate Republicans, though. Even if the GOP thinks it was fun to rebuff Democrats’ pleas for a public process, they really should pay attention to the President. He’s got veto power.

Republicans have spent the past six years condemning the Affordable Care Act (ACA), which passed in 2010 after Senate Democrats accepted 160 Republican amendments, held 110 bipartisan public hearings and conducted 25 consecutive days of public floor debate. Despite all of that, Republicans contend the ACA is the worst thing since Hitler.

That is what they assert about a law that increased the number of insured Americans by 20 million, prohibited discrimination against people with pre-existing conditions and eliminated the annual and lifetime caps that insurers used to cut off coverage for sick infants and people with cancer.

The entire cavalry of Republican candidates for the GOP nomination for President promised to repeal the ACA, but Donald Trump went further. He pledged to replace it with a big league better bill.

In May 2015, he announced on Twitter: “I’m not going to cut Social Security like every other Republican and I’m not going to cut Medicare or Medicaid.”

In September 2015, he said of his health insurance plans on CBS News’ 60 Minutes, “I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody’s going to be taken care of much better than they’re taken care of now.”

In another 60 Minutes interview, this one with Lesley Stahl last November, he said, “And it’ll be great health care for much less money. So it’ll be better health care, much better, for less money. Not a bad combination.”

In January, he told the Washington Post, “We’re going to have insurance for everybody.” He explained, “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

But then, the House Republicans betrayed him. The nonpartisan Congressional Budget Office said the measure they passed, called the American Health Care Act (AHCA), would cut more than $800 billion from Medicaid. It said people with pre-existing conditions and some older Americans would face “extremely high premiums.”

Extremely high is an understatement. Here is an example from the CBO report: A 64-year-old with a $26,500 income pays $1,700 for coverage under the Affordable Care Act (ACA), but would be forced to cough up more than half of his or her income – $16,000 – for insurance under the House Republican plan. Overall, premiums would increase 20 percent in the first year. And insurers could charge older people five times the rate they bill younger Americans.

House Republicans said states could permit insurers to squirm out of federal minimum coverage requirements, and in states where that occurred, the CBO said some consumers would be hit with thousands of dollars in increased costs for maternity care, mental health treatment and substance abuse services.

In the first year, the House GOP plan would rob insurance from 14 million Americans.

So much for covering everyone with “great health care at much less money.”

It’s true that President Trump held a party for House Republicans in the Rose Garden after they narrowly passed their bill. But it seems like he did not become aware until later just how horrific the measure is, how signing it into law would make him look like a rank politician, a swamp dweller who spouts promises he has no intention of keeping.

By last week when President Trump met with 15 Senate Republicans about their efforts to pass a health insurance bill, he no longer was reveling in the House measure. He called it “cold-hearted.” He asked the senators to be more “generous,” to put “additional money” into their version.

Senators told reporters that President Trump wanted them to pass a bill that is not viewed as an attack on low-income Americans and provides larger tax credits to enable people to buy insurance.

Now that sounds a little more like the Donald Trump who repeatedly promised his health insurance replacement bill would cover everyone at a lower cost. Still, those goals remain amorphous.

The House bill is stunningly unpopular, almost as detested as Congress itself. President Trump seems to grasp the enormity of that problem. But even his calling it a “son of a bitch” doesn’t seem to have been enough to persuade senators that he’s serious about getting legislation that achieves his promises to leave Medicaid intact, cover everyone and lower costs.

Republican senators deciding the fate of millions of Americans must hear from Donald Trump that passing a health insurance bill that doesn’t fulfill his campaign promises is, shall we say, a cancer on the Presidency.

A veto threat would get their attention.

This blog originally appeared at OurFuture.org on June 21, 2017. Reprinted with permission. 

About the Author: Leo Gerard is president of the United Steelworkers.


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The House GOP health care bill is a job killer, says a new report

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 In addition to potentially increasing the number of uninsured by 23 million and being unequivocally unpopular, House Republicans’ Obamacare replacement plan could leave nearly a million people unemployed.

That’s according to a new study published Wednesday by the Milken Institute School of Public Health at George Washington University and The Commonwealth Fund projects, which finds that the U.S. economy could see a loss of 924,000 jobs by 2026 if the American Health Care Act (AHCA) becomes law.

The study concentrated on coverage-related and tax repeal policies included in the AHCA. Some of the key provisions it said could add to job losses would:

  1. Phase out enhanced funding for Medicaid expansion by restricting eligibility in 2020, and imposing either a block grant or per capita caps.
  2. Replace premium tax credits with age-based tax credits. The premiums can be five times higher for older individuals, compared to the current threefold maximum.
  3. Allow states to waive key insurance rules, like community rating and essential health benefits. (The study does account for the Patient and State Stability Fund, a $8 billion grant meant to relieve states of high-cost patients.)
  4. Eliminate the individual mandate tax penalty and premiums hikes for people who do not maintain continuous coverage.
  5. Repeal numerous taxes and tax increases, like a tax on high-cost insurance (i.e. the “Cadillac tax”).

Short-term gain, long-term pain

Federal health funding stimulates the economy and job creation. Health funds pay hospitals, doctor’s offices, and other providers, and these facilities pay for their own respective employees and other goods and services, like rent and equipment. Health care employees and private businesses then use their earnings to purchase consumer goods like housing and transportation, circulating this money through the larger economy.

The GWU study found government spending or subsidies stimulate the economy more than tax cuts. Tax cuts do help, but only in the short term. The way AHCA is set up is that the tax cuts take effect sooner than federal funding cuts, which is why some states see net job growth by 2018. Then, when federal dollars are eventually pulled, states begin to see job losses by 2026.

Who’s most affected:

The employment rate among states that expanded Medicaid eligibility could disproportionately be affected, because those states received more federal dollars. New York, a state that expanded Medicaid, could be among the hardest hit with 86,000 job losses by 2026.

Between April 2016 and April 2017, New York added 76,800 jobs and the educational & health services sector saw the largest job gains, at 46,600 jobs. “The Affordable Care Act [ACA] contributed to that [growth],” Ronnie Kauder, senior research director at the New York City Labor Market Information Service, told ThinkProgress.

Kauder emphasized that the ACA wasn’t solely responsible for New York’s job growth, even in the health care sector. Uncontrollable factors like the state’s growing aging population and increasing life expectancy contribute to job growth as well.

New York has reaped the employment benefits of comprehensive health care, said Kauder. That’s in part because ACA encouraged states to test new models of health care delivery and shifted from a reimbursement system based on volume of services to value of services.

For example, New York received ACA grant funding to test effective ways to incentivize Medicaid beneficiaries, who struggle with chronic diseases, to participate in prevention programs and change their health risks. With that grant, New York created new programs at existing managed care organizations, which required new hires. The grant created positions like care coordinators, who connect and follow-up up with patients and providers in the program, said Kauder. “They are heavy on the training, but not licensed professionals,” she said.

But while she attributed some of New York’s job gains to the ACA, Kauder was skeptical that the GOP replacement plan would kill as many of them as the GWU study projects. “We don’t know what the state response will be,” he said. “It could be worse in Kentucky.”

The largest health care provider in New York, Northwell Health, hires on average 150 people a week. Northwell chief public relations officer Terry Lynam told ThinkProgress he doesn’t think the ACA directly contributed to a spike in job growth; however, it did help expedite the provider’s move from hospitals to outpatient care centers, also called ambulatory care, in an effort to slow rising health costs.

“What [ACA] has done was contribute to the ambulatory net growth [by cutting costs],” said Lynam. Northwell Health has 550 outpatient locations.

Northwell Health has qualms with the House GOP bill; specifically its cuts to Medicaid and change in coverage rules. “We are in a stronger financial position to survive that kind of reduction in revenue,” said Lynam. “But what about small providers serving low income areas, who need those Medicaid [dollars]?”

This blog was originally published at ThinkProgress on June 15, 2017. Reprinted with permission. 

About the Author: Amanda Michelle Gomez is a health care reporter at ThinkProgress.


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Tax Credits for New Jobs, but Really for Union Busting?

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mike elkA California-based company called VWR is busting its union, moving work to a non-union workforce a few hours away and receiving both federal and state tax incentives to do it. The scandal is yet another example of how companies can game the tax systems while hurting workers, and the government does little to stop them.

In Brisbane, Calif., 183 workers, members of Teamsters Local 853 that work at VWR, will lose their jobs at the end of the year when their scientific chemical warehouse closes. VWR, which is owned by Chicago-based private equity firm Madison Dearborn Partners, is moving the warehouse 230 miles away to Visalia, Calif. At the warehouse in Visalia, workers will be non-union and are expected to make half of what the current workers in Brisbane earn, according to the Teamsters.

The job losses will devastate local workers, many of whom are close to retirement age and will have difficulty finding jobs elsewhere. It will also devastate the city of Brisbane. A study conducted by the Federal-State Inquiry into Job Losses and Misdirected Tax Policy, chaired by Rep. Jackie Speier (D-Calif.) and California State Treasurer Bill Lockyer, found that the warehouse closure will result in the loss of 183 direct jobs and 83 indirect jobs among the suppliers and surrounding community in the Brisbane area. The loss of jobs will also reduce the City of Brisbane’s tax revenue by 18.5 percent.

The company, though, will benefit financially not only from halving workers’ salaries, but from a large amount of federal and state incentives to move. The City of Visalia, where the warehouse is being moved to, has received $2 million in federal Department of Commerce grants to do infrastructure improvements to the industrial park where the new warehouse will be located. VWR will also receive a total amount of $30,000 over a five-year period in tax credits from the state of California for every new worker hired.

“They aren’t creating new jobs, all they are doing is union busting,” says VWR worker John Thomas. “It’s a shame they are getting our tax dollars to destroy good middle-class jobs.”

This isn’t the first time VWR has used the new hire tax credits intended for job creation to simply move jobs from one place to another. Recently, the company received tax credits from Monroe County, N.Y., to move jobs from one warehouse in Towanda, N.Y., to another warehouse in Henrietta, N.Y. The move resulted in the layoffs of 41 warehouse workers in Towanda.

“I think this is a formula that union and non-union companies are using to abuse federal funds. You are not creating new jobs. You are really just transferring jobs and getting paid to screw these people out of their employment,” says Teamsters International Vice President Rome Aloise. “There should be some restrictions on how federal funding is provided to not allow this kind of transfer to occur.”

There are supposed to be “non-relocation” laws in place at the federal level to prevent corporations from receiving federal tax dollars for moving jobs from one area of the country to another area of the country. Teamsters are upset that the Department of Commerce is still providing a $2 million dollar infrastructure improvement grant for a project that will facilitate union warehouse jobs being moved from Brisbane to Visalia. The Department of Commerce counters that it has not violated “non-relocation” laws since the grant was intended to facilitate the creation of other jobs besides VWR ones in Visalia’s industrial park. Furthermore, the Department of Commerce claims it didn’t know about the VWR facility when issuing the $2 million grant.

“The site of the VWR facility was not contemplated as part of the project, nor was it included in any job creation estimates. Moreover, the City advises us that it had no knowledge of VWR’s interest when it applied for EDA funds and that it did not solicit or court the company to relocate,” wrote Assistant Secretary of Commerce for Economic Development John Fernandez in a letter to Teamsters President Jimmy Hoffa, Jr.  “As the decision should be clear from the above, the decision to the Plaza Driver project was entirely independent of the VWR matter.”

However, in a written response to the Commerce Department, Hoffa Jr. argued:

Just as VWR is dealing in bad faith with employees and the City of Brisbane by refusing to explore viable alternatives, VWR and the City of Visalia are dealing in bad faith with the U.S. Department of Commerce, Economic Development Administration and U.S. taxpayer about how will benefit from this public financing. The $2 million grant awarded to the City of Visalia in April 2011 to make infrastructure improvements to Plaza Driver will benefit VWR in its relocation efforts according to city documents and news reporters. However VWR was omitted from the list of companies, Visalia identifies as beneficiaries in its EDA grant application.

As evidence of Visalia’s bad fatih, the Teamsters point to an August 2010 newspaper account that quotes the Visalia City community development director saying that “the planned widening of Plaza… and improvements to Riggin Avenue… (and) the Betty Drive interchange… were big selling points to (VWR).“ But it appears that regardless of whether Visalia told the truth in its application for the $2 million grant, the city will receive the money and Brisbane’s workers will lose their jobs.

Economist Dean Baker, co-director of the Center for Economic Policy and Research, says such schemes are intrinsic to programs that give tax credits to companies hiring new workers.

You inevitably run a risk with new hire credits that most of the hires would have occurred even without the credit,” says Baker. “In those cases, you’re giving money for nothing. Obviously the story is worse when what you’re giving money for is a union-busting scheme. As a practical matter, this can be hard to prevent since there will always be some way to game the system.

This blog originally appeared in Working in These Times on June 7, 2012. Reprinted with Permission.

About the Author: Mike Elk is an In These Times Staff Writer and a regular contributor to the labor blog Working In These Times. He can be reached at mike@inthesetimes.com.


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