Health Insurance Expansion Linked to Fewer Sudden Cardiac Arrests

July 6, 2017 by · Leave a Comment 

The incidence of sudden cardiac arrest, a sudden and usually deadly loss of heart function, declined significantly among previously uninsured adults who acquired health insurance through the Affordable Care Act, also known as “Obamacare,” according to a study published June 28 in the Journal of the American Heart Association.

The findings, based on an analysis of emergency medical services in an urban Oregon county before and after the insurance expansion mandated by the ACA, underscore how health insurance can affect outcomes. Most adults in the study gained insurance through Medicaid expansion, a jointly funded federal-state health insurance program for low-income people that was expanded under the federal law.

Among previously uninsured adults ages 45 to 64, the incidence of cardac arrest  decreased by 17 percent. The incidence remained the same among adults age 65 and older, a group that had consistently high rates of health insurance coverage before and after the ACA, primarily through Medicare.

“Cardiac arrest is a devastating and under-recognized cause of premature death for both men and women age 45 and older,” said Eric Stecker, MD, MPH, associate professor of Cardiology at Oregon Health & Science University’s Knight Cardiovascular Institute in Portland, Oregon, and the study’s lead author. “Health insurance allows people to engage in regular medical care, which is crucial for the prevention of cardiovascular disease and the diagnosis and treatment of conditions that can cause cardiac arrest.”

More than 350,000 out-of-hospital cardiac arrests happen yearly in the United States. Although the terms “sudden cardiac arrest” and “heart attack” often are used interchangeably, the conditions are vastly different. A heart attack is caused when one of the major arteries leading to the heart becomes clogged, usually with plaque, disrupting the flow of blood to the heart muscle. A sudden cardiac arrest is an electrical disturbance in the heart rhythm that causes the heart to stop beating. Patients may have little or no warning, and the disorder usually causes instantaneous death. Sudden cardiac arrest has been blamed for the deaths of journalist Tim Russert and filmmaker John Hughes.

“Because so few survive a sudden cardiac arrest, it is imperative that we be able to predict which patients are the most vulnerable,” said the study’s senior author, Sumeet Chugh, MD,  director of the Heart Rhythm Center at the Cedars-Sinai Heart Institute in Los Angeles. “Effective primary prevention is the only way to make a significant impact on this problem. Fewer than 10 percent of these patients are going to make it out of the hospital alive. By the time we dial 911, it’s much too late for most of them.”

The findings published today came out of a larger research enterprise called the Oregon Sudden Unexpected Death Study, a comprehensive, 16-hospital, multiyear assessment of cardiac deaths in the Portland metropolitan area, home to 2.4 million people. The study, led by Chugh, has been underway for more than a decade. Data collected from it provides Chugh and his team with unique, community-based information to mine for answers to what causes sudden cardiac arrest.

Researchers examined records for emergency medical services in Multnomah County, Oregon, to identify patients with out-of-hospital cardiac arrest. They compared this information to U.S. Census Bureau data for the county’s adult population in the years before ACA implementation (2011-2012) and after the law took effect (2014-2015).

The investigators caution that although the study shows a strong association between health insurance and lower rates of cardiac arrest, it does not prove cause and effect. If larger studies among more diverse groups of patients confirm these findings, that would potentially have major public health implications, the study’s authors said.

“It is crucial to more comprehensively identify the health benefits of insurance and to carefully consider public policies that affect the number of uninsured Americans,” Stecker said.

Community Clinic Re-opening Is Reminder of Importance of Health Care ‘Safety Net’

June 29, 2017 by · Leave a Comment 

Andres and Rosa Garcia sat patiently waiting for the grand re-opening program to begin, quietly recalling that it had been over 15 years since they turned to the Arroyo Vista Family Medical Center in Highland Park for their health care.

The temperature was rising and just a couple of hours earlier news broke that the U.S. Senate had released it’s version of a bill to “repeal and replace” the Affordable Care Act. If passed, the change could cut off health care insurance to tens of millions of low-income and middle class Americans, and potentially raise the cost of health insurance to the elderly five-fold.

Councilman Gil Cedillo greets Arroyo Vista Family Health Center patient while touring newly re-opened clinic with CEO Lorraine Estradas. (Office of Councilman Gil Cedillo)

Quality health care that is accessible and affordable is not something to be taken for granted, something the Garcias know firsthand.

“The people who work here [at Arroyo Vista] have always taken good care of us,” said Andres, appearing much younger than his 86 years.

“Everyone here is helpful and friendly, “ adds 81-year-old Rosa, explaining in Spanish that the couple uses the clinic’s dental and vision services as well as its primary health and medical services, a convenience they appreciate having close to their Highland Park home.

“Whenever we need to see a specialist they refer us right away, to White Memorial, and get us to the right doctor” to treat my ulcer and arthritis, Andres told EGP. Rosa says she appreciates that the staff “all speak Spanish.”

The couple was among several dozen people from the Arroyo Vista staff, board of directors, patients, professional and community partners and a local councilman gathered to mark the latest milestone in the community clinic network’s mission to provide quality, affordable and non-discriminating health care services.

Passage of the Affordable Care Act, also known as Obamacare, increased the number of people in California and across the country with health insurance, swelling the demand for providers.

One of five community-based clinics and a mobile clinic operated by Arroyo Vista, the facility on North Figueroa Street was closed to patients for several months as it underwent a $1Million remodel, adding new state-of-the-art upgrades to better serve and accommodate its predominately low-income clients who range in age from newborns to the elderly. An on-site pharmacy allows patients to fill prescriptions with ease.

Arroyo Vista is a very important “safety net for this community,” said Steven Kasten, a Lincoln Heights businessman who served as MC for the grand re-opening ceremony and ribbon cutting. He recalled meeting Arroyo Vista CEO Lorraine Estradas 35 years earlier, marveling at her years of dedication and leadership in growing the clinic network.

Los Angeles Councilman Gil Cedillo (CD-1) represents three of the neighborhoods where Arroyo Vista clinics are located. He said the importance of clinics like Arroyo Vista that treat patients with “dignity and respect” can’t be understated, especially as the country faces forces intent on “cutting Medicaid and health insurance for the poor” and “give tax breaks to the rich,” a reference to Republican House and Senate plans to unravel Obamacare.

“I know firsthand how important these clinics are,” Cedillo said. Years ago, “I was unemployed, without health insurance and then my wife was diagnosed with cancer,” he told the audience. He said he had to call on friends and acquaintances — build his own health care network — to get his wife the medical help she needed.

“My wife got help at clinics like Arroyo Vista,” which take care of people with few resources, no matter their income level or legal status, Cedillo said.

“We have a crisis in leadership,” Cedillo said. “We have to bring business and labor together” to champion the working poor as the country “suffers the policies of Trump.”

Arroyo Vista is doing a great job of providing quality care, and the community has to support its effort, the councilman said.

Tours of the newly renovated facility were offered following the formal program and ceremonial ribbon cutting. Traveling through the facility with Estradas and other guests, Cedillo stopped to shake hands with staff and patients, and ask what each thought of the changes at the clinic.

The responses were overwhelming positive, with doctors and patients alike remarking on the aesthetic improvements, but calling particular attention to changes that made the delivery of care more efficient and responsive to clients’ needs.

“My whole family comes here and we love it, they treat my kids really good,” said one mother, who told EGP she appreciates that the doctors listen to her.

There’s no doubt that challenges to the healthcare system are on the horizon. For Estradas that means staying true to Arroyo Vista’s mission of using all its resources to give their clients the best health outcomes possible.

“We are watching what’s going on very closely,” she told EGP. “We are constantly planning for whatever is to come down the road.”


Calif. Officials Sound Alarm, Envisioning $114B Hit To Medi-Cal Under U.S. Senate Bill

June 29, 2017 by · Leave a Comment 

California risks losing $114.6 billion in federal funds within a decade for its Medicaid program under the Senate health care bill, a decline that would require the state to completely dismantle and rebuild the public insurance program that now serves one-third of the state, health leaders said Wednesday.

The reductions in the nation’s largest Medicaid program would start at $3 billion in 2020 and would escalate to $30.3 billion annually by 2027, according to an analysis released by the state departments of finance and health care services.

“It is not Medicaid reform,” Jennifer Kent, director of the state Department of Health Care Services, said in an interview. “It is not entitlement reform. It is simply a huge funding reduction in the Medicaid program. We are deeply concerned what that means for the long-term viability of the program as it stands today.”

Los Angeles County Supervisor Hilda Solis and other county leaders pledged to fight Republican efforts to overturn Obamacare. “The bill ends Medi-Cal as we know it,” Solis said during a press conference Tuesday in downtown Los Angeles. “We are not going to give up.” (Anna Gorman/California Healthline)

Los Angeles County Supervisor Hilda Solis and other county leaders pledged to fight Republican efforts to overturn Obamacare. “The bill ends Medi-Cal as we know it,” Solis said during a press conference Tuesday in downtown Los Angeles. “We are not going to give up.” (Anna Gorman/California Healthline)

Medicaid covers a staggering 13.5 million low-income Californians — children, people with disabilities, nursing home residents and others. About 3.8 million of them, many of whom are chronically ill, became eligible for coverage under the Affordable Care Act, informally known as Obamacare.

California would face the biggest losses of any state, according to a report issued Wednesday by the consulting firm Avalere Health. Federal funding would drop by 26 percent over 10 years, the report said. Many states, including Alabama, Georgia, Texas and Florida, would face a drop of less than 10 percent.

The Senate bill to repeal and replace the ACA would be a “massive and significant fiscal shift” of responsibility from the federal government to states, according to the analysis. It would force difficult decisions about who and what to cover and how much to pay doctors, hospitals and clinics, the report said.

In addition to expanding its Medicaid population early and vigorously under Obamacare, the state began covering undocumented immigrant children last year. California’s program, known as Medi-Cal, also provides dental care and other services that are optional under federal Medicaid rules.

The state’s Medicaid director, Mari Cantwell, said Republican proposals present a fundamental problem that can’t be solved by making cuts around the edges.

“Nothing is safe — no population, no services,” Cantwell said. “It is really disheartening and honestly horrifying to think about the world under this Senate bill and what it would mean.”

The losses are more than what was predicted under the House bill. The analysis said that’s because the cost shift increases over time under the Senate proposal.

Ken Bascom, 62, was diagnosed with kidney cancer after becoming eligible for Medi-Cal in 2014. Bascom is now cancer-free but said that without insurance, “more likely than not, I would’ve been dead.” (Anna Gorman/California Healthline)

GOP leaders in Congress have been trying to repeal the ACA for seven years, deeming it disastrous public policy that costs too much and leaves consumers with rising premiums and too few choices for care.

The Senate bill would overhaul Obamacare in several ways. Besides revamping the Medicaid program, it would dramatically change the system of tax credits used to help low-income Americans get health coverage. The Congressional Budget Office concluded that the bill would cut the federal deficit by $321 billion over the next decade while leaving 22 million more Americans without health insurance.

Unable to lock down the support he needs in the Senate, Majority Leader Mitch McConnell on Tuesday postponed a vote on the bill until after the July Fourth holiday. Its fate remains uncertain as senators head back to their districts for a weeklong recess.

Under the legislation, the federal government would pay a fixed amount to states for Medicaid expenditures, a per capita rate, instead of paying for a share of all expenses incurred.

State health leaders predict that the state’s costs would outpace the federal government’s allocation, meaning California would have to come up with an additional $37.3 billion between 2020 and 2027.

“Whether it’s drugs or cost of living going up or new technologies in health care, there are costs we can’t control,” Cantwell said. “And if you have a trend factor that doesn’t really reflect the reality of what health care looks like, the state is always going to be in a place of not being able to bring the costs within that target.”

The proposed financial caps would have a “devastating and chilling effect” on spending in the Medicaid program and would pinch providers further, the analysis said. California already ranks near the bottom for how much it pays Medicaid providers.

The Senate’s overhaul of Obamacare would also force hospitals and clinics serving the poor and uninsured to live within the new financial limits, leading to “uncompensated care in the hundreds of millions, if not billions annually,” according to the analysis.

In addition, the Senate bill would phase out funding for the expansion of Medicaid, which enabled 3.8 million single, childless adults and others in the state to qualify. Under the Affordable Care Act, the federal government pledged to pay for 90 percent of their costs. But the Senate bill would reduce that to 50 percent beginning in 2024.

Without the promised federal funds, California would have to spend five times more than previously estimated to continue covering those newly eligible. By 2027, the cumulative cost to California would be $74.1 billion, according to the analysis.

California leaders vowed Tuesday to fight the bill, known as the Better Care Reconciliation Act. “Simply stated, this is a terrible bill and we must defeat it,” said Democratic Sen. Dianne Feinstein in a call with reporters.

Sen. Kamala Harris, also a Democrat, added that the most vulnerable populations are the ones who have most to lose: children, people with disabilities, seniors. “This bill is nothing short of a disaster, and it’s no wonder they did it in secret because they have nothing to be proud of,” said Harris, who aims to kill the bill before it hits the Senate floor.

The fallout would be particularly bad in Los Angeles County, home to 1 of every 20 Medicaid recipients in the nation, county officials said Tuesday.

“L.A. County will be ground zero for the plan’s deadly consequences,” said county Supervisor Sheila Kuehl during a press conference. “This is not just about money. … This is about the people who count on us for health care.”

During the conference, several Los Angeles County residents and union members held up signs that read “Healthcare is a Human Right” and, in Spanish, “SALUD para todos,” or “Health for everyone.”

Ken Bascom, 62, who lives in Venice, Calif., and attended the gathering, said he lost his job and his employer-based insurance during the recession. Soon after Bascom became eligible for Medi-Cal in 2014, he was diagnosed with kidney cancer. Now cancer-free, Bascom said he often thinks about what would have happened if he hadn’t been able to get health care.

“More likely than not, I would’ve been dead,” said Bascom, who gets care at Venice Family Clinic. “It’s very scary.”

Also in attendance was Steven Martin, 27, who said he depends on insurance he got through Obamacare to pay for his leukemia treatment. Martin, who has private insurance through Covered California, the state’s exchange, said his medication costs tens of thousands of dollars each year.

“Without insurance, I’m not going to have access to my medication,” he said.

Los Angeles County Health Agency Director Mitch Katz said the ACA made a “huge difference” in the county — dramatically cutting the uninsured rate, reducing wait times at emergency rooms and helping connect patients to primary care doctors.

“The emergency rooms themselves often had two- and three-day waits,” he said. “Because of the ACA, that is no longer the case. … The emergency room now is back to what is should be — for emergencies.”

Katz said he feared all of that would change if the Republicans succeed in overhauling the health law.

Ana Ibarra contributed to this report.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Aprobación de Ley de Salud, Primer Paso en Larga Batalla de Trump

May 11, 2017 by · Leave a Comment 

El presidente Donald Trump se anotó una victoria legislativa al lograr la aprobación de su ley de salud en la Cámara de Representantes, sin embargo, la batalla para derogar y sustituir el actual sistema, impulsado por Barack Obama, será larga y compleja en los pasillos del Senado.

Tras el sonado fracaso de hace unas semanas, cuando los propios republicanos de la Cámara baja tuvieron que suspender hasta en dos ocasiones el voto a falta de consenso en su bancada, Trump necesitaba reivindicar su poder en el Congreso, y logró por fin un acuerdo, aunque por un margen estrechísimo.

Al multimillonario no le importó que se votara el texto sin que la Oficina no partidista de Presupuesto del Capitolio emitiera su informe final de impacto sobre la legislación, algo que nunca ocurre, ni tampoco ceder en las demandas de los ultraconservadores, quienes lograron retirar las disposiciones sobre las enfermedades preexistentes, un asunto vital para los estadounidenses.

Con evidentes aires de celebración, y rodeado de congresistas, Trump auspició la rueda de prensa posterior al voto en los jardines de la Casa Blanca, como si el proyecto de ley ya estuviera firmado y él pudiera dar por cumplida su gran promesa de campaña: acabar con Obamacare, como se conoce al actual sistema de salud.

Sin embargo, el texto legislativo ahora pasa a manos del Senado, donde los republicanos tienen una mayoría mucho más estrecha que en la Cámara baja, los procesos de análisis son mucho más lentos y varios senadores conservadores ya han mostrado su rechazo al proyecto.

Los más moderados, y en que cuyos estados la ley de salud de Obama ha supuesto un impacto considerable mejorando el acceso sanitario de sus ciudadanos, saben del peligro que corren sus escaños si permiten que la propuesta de la Cámara baja prospere, por lo que es previsible que el texto actual sufra cambios drásticos.

Por otra parte, los republicanos más radicales, como Rand Paul o Ted Cruz, no aceptarán tampoco una versión edulcorada de la legislación porque quieren acabar con el actual sistema completamente, por lo que está claro que Trump necesitará de mucha paciencia y mano izquierda si quiere llegar a estampar su firma en una nueva sanitaria.

La primera versión de la ley, antes de las enmiendas requeridas por los ultraconservadores, supondría perder el seguro médico a más de 24 millones de estadounidenses en una década, a lo que se suma el hecho de que la disposición sobre enfermedades preexistentes hará que millones de personas no puedan costear sus seguros.

Las asociaciones nacionales de médicos han mostrado su rechazo a la propuesta y han advertido de su “devastador impacto”: la ley de Obama había reducido a la mitad en siete años los casos de bancarrota familiar por enfermedad de alguno de sus miembros.

Los demócratas, que reconocen que el sistema sanitario puede ser mejorable, no están sin embargo dispuestos a ponerle las cosas fáciles a los republicanos para acabar con el actual sistema, y utilizarán todas las herramientas legislativas posibles para que eso no ocurra.

“Este proyecto de ley no va a llegar a ningún lado en el Senado de Estados Unidos”, aseveró el líder de la minoría demócrata en la Cámara alta, Chuck Schumer.

“En lugar de tratar de aprobar una versión diferente del mismo Trumpcare, que significaría costos más altos por menos cuidado, los republicanos en el Senado deberían negarse a seguir a sus colegas de la Cámara hacia el precipicio, rechazar la legislación, y trabajar con los demócratas para mejorar nuestro sistema de cuidado de salud de una manera bipartidista”, agregó.

De hecho, como se ha demostrado esta semana con las negociaciones del presupuesto, los demócratas tienen la capacidad para presionar lo suficiente a la mayoría republicana con las maniobras de bloqueo.

Los fondos federales para lo que resta de año fiscal, que se acordaron finalmente en los últimos días, no contaron con la mayoría de las demandas del multimillonario, como la financiación para la construcción de un muro en México, dinero para una fuerza de deportación masiva, o el retiro de fondos para Obamacare o las clínicas abortivas.

Así, pese a la victoria simbólica y el paso adelante que ha dado Trump para acabar con uno de los grandes legados de su predecesor, está todavía lejos de poder colgarse verdaderamente esa medalla.

Republicanos Siguen Sin Votos Suficientes para Reemplazar ‘Obamacare’

May 4, 2017 by · Leave a Comment 

El liderazgo republicano de la Cámara de Representantes reconoció el 2 de mayo que aún no tiene los 216 votos necesarios para aprobar su propuesta de derogación y sustitución de la ley sanitaria del expresidente Barack Obama, una de las mayores promesas del actual mandatario, Donald Trump.

Los legisladores republicanos que asistieron a una reunión de su bancada a puerta cerrada confirmaron que no hay votos suficientes para impulsar la legislación, pese a la presión de la Casa Blanca para que esto ocurra a lo largo de la semana.

El mes pasado, los republicanos tuvieron que suspender hasta en dos ocasiones el voto sobre la propuesta liderada por el presidente de la Cámara Baja, Paul Ryan, y respaldada por el multimillonario, al no contar con el respaldo suficiente en su propia bancada.

Uno de los principales escollos entonces era la negativa del ultraconservador Caucus de la Libertad, que se negaba a aceptar los preceptos de la propuesta presupuestaria al considerar que mantenía demasiadas disposiciones en pie del “Obamacare”, como se conoce popularmente a la reforma sanitaria que Obama promulgó en 2010.

Entre sus demandas, los ultraconservadores querían acabar con la obligatoriedad para las aseguradoras de ofrecer beneficios básicos (como los de maternidad o urgencias), así como eliminar el hecho de que las aseguradoras no pudieran subir los precios o negar seguros a personas con enfermedades preexistentes.

Precisamente esas dos cuestiones fueron abordadas la semana pasada al incluir en el texto la conocida como “enmienda McArthur”, que permite a los estados pedir exenciones sobre los beneficios mínimos, y retiraría las obligaciones sobre las personas que han sufrido enfermedades con anterioridad.

Este hecho llevó a los ultraconservadores a aceptar la nueva propuesta de ley, sin embargo, los republicanos más moderados ya han mostrado sus reticencias, y cada vez son más los que no están dispuestos a respaldar la propuesta.

Ryan argumentó hoy en una rueda de prensa que la propuesta tiene “capas” de protección que permiten que las personas que hayan sufrido enfermedades no queden desamparadas.

Sin embargo, consciente de la polémica por este asunto, el propio Trump insistió esta semana en que se encargará de que la ley de salud que reemplace a “Obamacare” cubra a aquellos que han sufrido enfermedades con anterioridad.

Por otra parte, la líder de la minoría demócrata en la Cámara de Representantes, Nancy Pelosi, exigió que no se proceda a ningún voto hasta que no se actualicen los contenidos de la ley y el estudio de impacto realizado por la Oficina de Presupuesto no partidista del Congreso (CBO, en inglés).

Sin contar con los cambios de la nueva enmienda, la CBO estimó el mes pasado que la ley republicana le quitaría la cobertura médica a 14 millones de estadounidenses en tan solo un año, y a hasta 24 millones en una década.

House Leaders Came Up Short In Effort To Kill Obamacare

March 30, 2017 by · Leave a Comment 

Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders last Friday failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act.

House Speaker Paul Ryan pulled the bill from consideration after he rushed to the White House to tell President Donald Trump that there weren’t the 216 votes necessary for passage.

“We came really close today, but we came up short,” he told reporters at a hastily called news conference.

When pressed about what happens to the federal health law, he added, “Obamacare is the law of the land. … We’re going to be living with Obamacare for the foreseeable future.”

Trump laid the blame at the feet of Democrats, complaining that not one was willing to help Republicans on the measure and he warned again that the Obamacare insurance markets are in serious danger. “Bad things are going to happen to Obamacare,” he told reporters at the White House. “There’s not much you can do to help it. I’ve been saying that for a year and a half. I said, look, eventually it’s not sustainable. The insurance companies are leaving.”

But he said the collapse of the bill might allow Republicans and Democrats to work on a replacement. “I honestly believe the Democrats will come to us and say, look, let’s get together and get a great health care bill or plan that’s really great for the people of our country,” he said.

Ryan originally had hoped to hold a floor vote on the measure Thursday — timed to coincide with the seventh anniversary of the ACA — but decided to delay that effort because GOP leaders didn’t have enough “yes” votes. The House was in session Friday before his announcement while members debated the bill.

House Democratic leader Nancy Pelosi (Calif.) said the speaker’s decision to pull the bill “is pretty exciting for us … a victory for the Affordable Care Act, more importantly for the American people.”

The legislation was damaged by a variety of issues raised by competing factions of the party. Many members were nervous about the Congressional Budget Officeshowing that the bill would lead eventually to 24 million people losing insurance, while some moderate Republicans worried that ending the ACA’s Medicaid expansion would hurt low-income Americans.

At the same time, conservatives, especially the hard-right House Freedom Caucus that often has needled party leaders, complained that the bill kept too much of the ACA structure in place. They wanted a straight repeal of Obamacare, but party leaders said that couldn’t pass the Senate, where Republicans don’t have enough votes to stop a filibuster. They were hoping to use a complicated legislative strategy called budget reconciliation that would allow them to repeal only parts of the ACA that affect federal spending.

The decision came after a chaotic week of negotiations, as party leaders sought to woo more conservatives. Trump personally lobbied 120 members through personal meetings or phone calls, according to a count provided Friday by his spokesman, Sean Spicer. “The president and the team here have left everything on the field,” Spicer said.

On Thursday evening, Trump dispatched Office of Management and Development Budget Mick Mulvaney to tell his former House GOP colleagues that the president wanted a vote on Friday. It was time to move on to other priorities, including tax reform, he told House Republicans.

“He said the president needs this, the president has said he wants a vote tomorrow, up or down. If for any reason it goes down, we’re just going to move forward with additional parts of his agenda. This is our moment in time,” Rep. Chris Collins (R-N.Y.), a loyal Trump ally, told reporters late Thursday. “If it doesn’t pass, we’re moving beyond health care. … We are done negotiating.”

Trump’s edict clearly irked some lawmakers, including the Freedom Caucus chairman, Rep. Mark Meadows (R-N.C), whose group of more than two dozen members represented the strongest bloc against the measure.

“Anytime you don’t have 216 votes, negotiations are not totally over,” he told reporters who had surrounded him in a Capitol basement hallway as he headed in to the party’s caucus meeting.

Trump, Ryan and other GOP lawmakers tweaked their initial package in a variety of ways to win over both conservatives and moderates. But every time one change was made to win votes in one camp, it repelled support in another.

The White House on Thursday accepted conservatives’ demands that the legislation strip federal guarantees of essential health benefits in insurance policies. But that was another problem for moderates, and Democrats suggested the provision would not survive in the Senate.

Republican moderates in the House — as well as the Senate — objected to the bill’s provisions that would shift Medicaid from an open-ended entitlement to a set amount of funding for states that would also give governors and state lawmakers more flexibility over the program. Moderates also were concerned that the package’s tax credits would not be generous enough to help older Americans — who could be charged five times more for coverage than their younger counterparts — afford coverage.

The House package also lost the support of key GOP allies, including the Club for Growth and Heritage Action. Physician, patient and hospital groups also opposed it.

But Ryan’s comments made clear how difficult this decision was. “This is a disappointing day for us,” he said. “Doing big things is hard. All of us. All of us — myself included — we will need time to reflect on how we got to this moment, what we could have done to do it better.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

[Update]: Apr. 4, 2017 to correct spelling of author Mary Agnes Carey’s name.


Californianos Luchan Por Mantener Obamacare

March 30, 2017 by · Leave a Comment 

La Coalición Lucha por Nuestra Salud de California, apoyada por el poderoso Sindicato Internacional de Trabajadores de Servicios (SEIU), realizó manifestaciones por todo el Estado Dorado, el 23 de marzo, para pedir que se mantenga la ley actual de Cuidado de Salud Accesible (ACA).

Las protestas fueron convocadas al cumplirse siete años del llamado Obamacare y mientras la Cámara de Representantes se disponía a votar la nueva propuesta republicana para derogar y reemplazar la ley sanitaria, un plan que cuenta con una fuerte oposición dentro de los propios conservadores.

Una marcha que terminó con una manifestación frente al edificio Federal Edward Roybal en el centro de Los Ángeles contó con el apoyo de la supervisora del condado Hilda Solís y de cerca de 70 secciones sindicales y organizaciones comunitarias y de salud.

En Modesto otra protesta se realizó en la sede del representante republicano Jeff Denham en la que los participantes “murieron” frente a las instalaciones para dramatizar el impacto que, según sus denuncias, tendría la nueva ley especialmente entre la niñez y los ancianos.

“Sin ACA habrá un efecto dominó en nuestras comunidades. Más gente dejará de recibir cuidado preventivo y tendrá que ser tratada cuando se enferme y sea más costoso”, aseguró Rogenia Cox, miembro de SEIU y empleada del Departamento de Salud Pública del Condado de Fresno.

Los manifestantes insistieron en la cifra presentada por un informe de la Oficina de Presupuesto del Congreso de “24 millones de estadounidenses que quedarán sin seguro de salud” en la próxima década si se aprueba el nuevo proyecto.

Algunos legisladores estatales también denunciaron durante una conferencia de prensa frente al Capitolio en Sacramento las “pérdidas potenciales” que puede significar para California el nuevo proyecto.

La administración estatal calcula que California tendría que asumir 6.000 millones de dólares en nuevos costos anuales para 2020 si se aprueba la nueva ley de salud y 24.000 millones por año para 2027.

Plan de Salud Republicano Podría Afectar a Millones de Latinos

March 16, 2017 by · Leave a Comment 

Millones de latinos, en especial los ancianos y aquellos de bajos recursos, se verían afectados si se aprueba el nuevo plan sanitario republicano que reemplazaría al Obamacare, alertaron activistas.

“No se equivoquen: este plan dañará a los latinos, los estadounidenses que trabajan e, irónicamente, a los partidarios de Trump que estaban pidiendo su derogación”, dijo a EFE el presidente del movimiento de líderes hispanos Latino Victory Fund, Cristóbal J. Alex.

Las advertencias y las criticas aumentaron tras el reporte publicado este lunes por la Oficina de Presupuesto del Congreso (CBO) que asegura que la aprobación del nuevo proyecto republicano de seguro de salud que reemplazaría la Ley de Cuidado de Salud Asequible (ACA), conocida como “Obamacare”, dejaría sin un seguro de salud a 14 millones de personas ya en 2018.

Las proyecciones para los próximos años tampoco son alentadoras. El número de personas sin cobertura médica aumentaría a 24 millones en 2026.

Aunque el reporte no habla de la comunidad hispana, antes de la implementación de Obamacare, al menos 4.2 millones de hispanos lograron obtener un plan de salud bajo el programa de ACA, y esta cobertura representa la diferencia entre la vida y la muerte para muchos hispanos como Guadalupe Guerrero.

Hace un año y medio la joven fue sometida a un transplante de corazón. Su plan de salud de Obamacare le ha permitido obtener las medicinas y controles que necesita.

“Por muchos años no tuve seguro médico y por eso no pudieron detectar mi condición a tiempo, yo soy el ejemplo de lo que pasa cuando no tienes medicina preventiva”, aseguró a EFE Guerrero, de 28 años.

Entre 2013 y 2016, la población latina logró reducir en 11 puntos porcentuales el número de personas que carecían de cobertura médica, al pasar del 26.2% al 15.1%, lo que la convierte en la segunda comunidad más favorecida después de la afroamericana.

La salud de las latinas también estaría en riesgo con la nueva propuesta republicana, que elimina fondos a Planned Parenthood, la mayor organización de planificación familiar de Estados Unidos. Con Obamacare 17 millones de hispanas lograron tener acceso a controles de cáncer cervical, mamogramas y a pastillas anticonceptivas.

“Desde que tengo consciencia he sabido que las hispanas confían en Planned Parenthood para que les brinde servicios a bajo costo, esto sería devastador para nuestra salud y para prevenir enfermedades graves”, apuntó a EFE Hortencia Armendariz, vocera del sindicato SEIU-United Healthcare Workers West.

Alex, al igual que congresistas demócratas, sostiene que los republicanos criticaron ACA durante siete años y ahora, en lugar de mejorar el proyecto para ayudar a los que aún no han obtenido un plan de salud, optaron por eliminar la cobertura de los miembros más vulnerables de la sociedad.

En California, el golpe a la salud de latinos sería “devastador”, pues un tercio de los 1.4 millones de asegurados bajo el programa Covered California es hispano.

“Hemos visto que hay mucho miedo entre los hispanos a perder la cobertura”, advirtió Yurina Melara, vocera de Covered California.

La zozobra ante la posibilidad de perder el seguro de salud también afecta a residentes de estados como Florida, donde Donald Trump ganó en las elecciones pasadas y donde al menos 1.6 millones de residentes del estado están en riesgo.

Para Martha Baker, enfermera y directora del sindicato SEIU local, la revocación de ACA mandaría a miles de hispanos a las salas de emergencia, lo que llevará a se llegue a pagar por la amputación de una pierna en vez de pagar por la insulina de un diabético.

Pero la preocupación no es sólo para los que pagan un seguro por medio de Obamacare, el Comisionado de Seguros de California Dave Jones advirtió que al menos cinco millones de personas amparadas con Medicaid, se verán afectados por los recortes, y 150,000 niños hispanos del estado dorado fueron incluidos el año pasado en este servicio.

“Nuestros abuelitos tendrán que pagar más y recibir menos beneficios de atención médica, mientras que los individuos y corporaciones más ricos de este país recibirán un recorte de impuestos de $900,000 millones”, lamentó Alex.

Las organizaciones que representan Armendaríz, Baker y Axel, junto a otras decenas, trabajando ya para detener la derogación de Obamacare y la implementación del plan republicano. El 23 de marzo el Congreso votará la medida, en abril será el turno del Senado.

“La única solución a futuro es que sostengan Obamacare y que ayuden con más recursos para poder extender la cobertura, no hay otro camino”, aseguró Armendariz.

Impulsores de Nueva Ley de Salud Defienden Plan Para Eliminar Obamacare

March 9, 2017 by · Leave a Comment 

Los congresistas republicanos Greg Walden y Kevin Brady, impulsores del nuevo plan para cambiar el sistema de salud, aseguraron hoy que ataja dos asuntos fundamentales que preocupaban a los estadounidenses, devolver el control a los estados y la libertad de elección a los consumidores.

En una rueda de prensa conjunta, Walden y Brady defendieron los principios de sus dos proyectos de ley, que desvelaron este lunes y que tienen como objetivo desmantelar la reforma sanitaria promulgada por el expresidente Barack Obama.

Brady insistió en que la ley actual, conocida como Obamacare, “es una ley fallida” que no le permite a los estadounidenses pagar los costes sanitarios ni los copagos, por lo que la ciudadanía necesita “un alivio inmediato” como el que ellos plantean.

“Esta propuesta le devuelve el poder a la gente para tomar sus propias decisiones sobre su cobertura de salud”, insistió el congresista, presidente del Comité de Medios y Arbitrios de la Cámara de Representantes, que este miércoles comenzará a debatir las nuevas piezas legislativas.

Por su parte, Walden insistió en que la propuesta que han diseñado, y que hoy obtuvo el respaldo de la Casa Blanca, es fundamental para “avanzar en crear más opciones de mercado”, de manera que cada ciudadano pueda escoger su plan sanitario.

La propuesta, largamente esperada después de las promesas reiteradas de derogación y reemplazo de la reforma sanitaria, desmantela las disposiciones básicas de Obamacare, incluyendo sus subsidios para ayudar a la gente a adquirir sus seguros y la expansión del Medicaid, programa para el acceso sanitario a la gente con bajos recursos.

Asimismo, termina con los mandatos de adquisición de coberturas, que obligaban a los individuos que no contaban con ningún tipo de seguro a adquirir uno si no querían ser multados, además de retirar los fondos para Planned Parenthood, la mayor organización de clínicas que ofrecen el derecho al aborto en el país.

No obstante, la propuesta ya ha encontrado detractores en las propias filas republicanas: por un lado, de aquellos conservadores más moderados cuyos estados se vieron beneficiados por el Obamacare; y por otro, los más conservadores, como Rand Paul, que lo han calificado como una versión “Light” del sistema actual.

“Hemos escuchado muy cuidadosamente a los republicanos de la Cámara de Representantes sobre cómo hacer lo mejor para devolver el control a los estados, regresar a un mercado libre y hacer eso equilibrando el presupuesto”, defendió Brady, quien dijo convencido que este nuevo plan ampliaría aun más las coberturas.

Con una mayoría republicana muy ajustada en el Senado, los conservadores podrían ver bloqueada esta nueva propuesta en la Cámara Alta, lo que prevé un largo y agrio debate en el Legislativo, al que se sumará la oposición demócrata.

Además, la oficina presupuestaria no partidista del Congreso (CBO, en inglés) aún no ha analizado el contenido e impacto de los proyectos legislativos, por lo que no existe una previsión clara de su efectividad.

En ese sentido, la líder de la minoría demócrata de la Cámara Baja, Nancy Pelosi, requirió a los republicanos que no comiencen el debate este miércoles, como tienen previsto, hasta que no se emita dicho informe.

If Obamacare Is Being Repealed, Do The Uninsured Still Face Penalties?

February 9, 2017 by · Leave a Comment 

California Healthline – In some recent emails, readers asked about what to expect as Republicans move to overhaul the health law. Should people bother paying the penalty for not having health insurance when they file their taxes this year? Will they be able to sign up on the exchange for 2018 after their COBRA benefits end? Here are some answers.

  1. I didn’t have health insurance for part of last year and thought I’d get stuck paying a penalty. Now the new administration is talking about not enforcing the insurance requirement. Could I really be off the hook at tax time?

As long as the “individual mandate” — which requires most people to have health coverage or face a tax penalty — is the law of the land, you should pay the fine for not having coverage in 2016 unless you qualify for an exemption, said Tara Straw, a senior policy analyst at the Center on Budget and Policy Priorities. Straw also manages a Volunteer Income Tax Assistance site, part of an Internal Revenue Service program that provides free tax filing services for low and middle income taxpayers.

Straw said she has heard that some tax preparers are advising taxpayers either not to pay the penalty or to delay filing because they anticipate changes in the law.

Bad idea. “It’s not a thing a reputable tax preparer would do,” Straw said. “The requirement that people have health insurance or an exemption [from the mandate] is still in effect.”

The confusion stems from uncertainty over Republican officials’ comments that they may do away with the individual mandate when they overhaul the health law. In addition, President Donald Trump signed an executive order in January that required federal agencies to waive or exempt health law-related provisions that would impose costs or penalties on individuals, to the extent permitted by law.

One strategy that has been discussed has been to broaden the hardship exemption so more people would qualify for it, which the secretary of Health and Human Services has the authority to do.

However, Straw says that approach might run into trouble. “A hardship has to mean something, you can’t say that everyone has a hardship,” she said. “Complying with the law is not considered a hardship.”

Some experts say changing the rules now could create even more confusion, since some people have already filed their returns. Those taxpayers might have to file amended returns, an extra expense if they use a tax preparer.

“Since the 2016 tax season is already underway, I would think it unlikely that the Treasury Department would say, ‘Don’t bother paying the penalty,’” said Mark Luscombe, a principal federal tax analyst at Wolters Kluwer Tax & Accounting, an information services company.

KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs.

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