Ending DACA Could Have Dire Public Health Consequences

September 21, 2017 by · Leave a Comment 

President Obama signed an executive order in 2012 protecting undocumented immigrants who were brought to the United States as children, and studies suggest that this order, known as Deferred Action for Childhood Arrivals (DACA), markedly improved measures of mental health among its beneficiaries and their families. The pending termination of DACA may reverse these mental health benefits for the 800,000 DACA beneficiaries, and trigger a public health crisis, according to an essay in the New England Journal of Medicine, co-authored by Atheendar. S. Venkataramani, MD, PhD, an assistant professor of medical ethics and health policy at Perelman School of Medicine at the University of Pennsylvania.

“DACA was not a public health program by design,” Venkataramani said, “but numerous studies have shown that implementing it had positive effects on mental health that truly rival those from large-scale health policies.”

DACA is meant to cover undocumented immigrants who were born after June 15, 1981, were brought to the U.S. before turning 16, and have lived in the U.S. continuously since 2007. It provides legal access to work permits, which can be renewed every two years, and confers freedom from deportation. Eligible applicants must provide evidence of current school attendance, completion of high school or GED certification, or U.S. military service, and must not have serious criminal records.

Several recent studies, including one by Venkataramani and essay co-author Alexander Tsai, MD, PhD, an assistant professor of Psychiatry at Massachusetts General Hospital, have indicated that measures of psychological stress and mental illness among DACA-eligible immigrants fell dramatically after the policy began. Another study, which used data from the Emergency Medicaid program in Oregon, suggested that DACA’s mental health benefits may have extended even to the children of DACA-eligible mothers—among whom rates of adjustment and anxiety disorders fell by more than half after DACA started.

Given that DACA improved mental health for beneficiaries and their families, its termination is expected to have the opposite effect. That termination will occur in March 2018 if no DACA-preserving legislation is passed by Congress and signed into law by the President.

“Health care and public health professionals now have a limited window of opportunity to engage policymakers about protecting Dreamers through legislative action, with an emphasis on the potentially dire mental health consequences of failing to enact a definitive legal remedy,” Venkataramani said.

If such efforts fail and DACA does expire next year, the health care profession will face a serious challenge, he added. Many former DACA beneficiaries, in the absence of the law’s protections, will not only experience adverse effects on mental health and psychological well being, but will also be less likely—because of their status as deportable illegals—to seek help from health care professionals.

Venkataramani and Tsai argue that if DACA expires, health care and public health organizations will need to proactively reach out to undocumented immigrants, to reassure them of continued access to quality health care and to provide them with information about public mental health care resources.

“On a broader systems level, tracking health care utilization and health outcomes will help organizations monitor health at the population level and provide hard data to policymakers seeking to implement other supportive remedies,” they note.

Republicanos Reabren Debate Sanitario en el Congreso

September 21, 2017 by · Leave a Comment 

WASHINGTON – Los senadores republicanos Lindsay Graham y Bill Cassidy han reabierto el debate sobre el sistema sanitario en el Congreso del país, al volver a poner sobre la mesa su propuesta legislativa mediante la que los estados podría elegir acogerse o no a ciertas directrices de Obamacare.

Obamacare, como se conoce a la actual ley sanitaria porque fue impulsada por el expresidente Barack Obama, ha sido objetivo de los conservadores y del presidente Donald Trump, quienes han pretendido derogarla en diversas ocasiones, aunque sin éxito, ya que no han podido ponerse de acuerdo sobre cómo sustituir sus mandatos.

Sen. Lyndsay Graham

Sen. Lyndsay Graham

Tras un estrepitoso fracaso este verano en el Capitolio, cuando el magnate insistió a sus colegas para aprobar cualquier tipo de derogación y así poder cumplir su promesa electoral, la opción de Graham y Cassidy ha reabierto el debate sobre el asunto.

La propuesta de ambos senadores plantea la posibilidad de dejar el destino de los seguros médicos y sus subsidios en manos de los estados, algo que apela a la libertad de gobierno defendida por el conservadurismo estadounidense.

El proyecto derogaría partes clave de Obamacare, incluyendo el mandato individual por el que los ciudadanos son multados si no obtienen seguro; los subsidios a las aseguradoras y los fondos para la expansión de Medicaid – acceso sanitario para las personas con bajos recursos –, con subvenciones en bloque que serían entregadas a los estados.

Sin embargo, los demócratas, encabezados por los líderes de las minorías en el Senado y la Cámara de Representantes, Chuck Schumer y Nancy Pelosi respectivamente, han advertido de las consecuencias del texto legislativo y han llamado a la Oficina no partidista del Congreso (CBO, en inglés) a que evalúe su posible impacto.

“Un análisis integral de la CBO es esencial antes de que los republicanos impongan una votación precipitada y peligrosa sobre una ley de abrogación extrema y destructiva”, escribieron los líderes demócratas en una carta enviada a la Oficina y divulgada el lunes.

Las propuestas anteriores que plantearon los conservadores hubieran supuesto entre 22 y 32 millones de personas sin seguro médico en los próximos diez años.

Los republicanos están tratando de averiguar si tienen suficiente apoyo para aprobar la ley antes del 30 de septiembre, el plazo para usar un proceso vinculado a los presupuestos y conocido como reconciliación, que impediría que los demócratas bloqueen el proyecto legislativo.

Condados Contra la Revocación de Obamacare

July 27, 2017 by · Leave a Comment 

Mientras el Senado se preparaba para abrir un debate sobre la derogación de la Ley del Cuidado de Salud a Bajo Precio, mejor conocido como Obamacare, miembros de la Junta de Supervisores del Condado de Los Ángeles acusaron el martes a los legisladores de jugar con la vida de las personas y no solicitar aportaciones de los proveedores de la atención sanitaria.

El supervisor Mark Ridley-Thomas dijo que el cuidado de la salud fue un punto crítico de una reunión el pasado fin de semana de la Asociación Nacional de Condados (NACO).

“El debate sobre la salud debe ser sobre la mejoría de los resultados y no solo un ejercicio presupuestario”, dijo Ridley-Thomas, citando un amplio consenso entre los funcionarios del condado en todo el país, sin tener en cuenta la política partidista.

Si se anula a Obamacare, el Congreso creará “un cambio masivo de costos…para que los condados puedan soportar” y dado su tamaño, “el condado de Los Ángeles sería el condado más afectado,” dijo Ridley-Thomas, agregando que el condado podría perder tanto como $1 millón en financiamiento.

La supervisora Kathryn Barger, quien también asistió a la reunión de NACO y es la única republicana en la junta no partidista del condado, estuvo de acuerdo.

“Se está haciendo en Washington sin solicitar aportaciones de los proveedores,” dijo Barger. “Es la vida de la gente que está siendo jugada como un peón político”.

La votación del Senado para abrir el debate sobre la revocación fue de 51-50, con el vicepresidente Mike Pence como el desempate. El senador John McCain votó “si” a su regreso a Washington, D.C., menos de dos semanas después de someterse a una cirugía para extirpar un tumor cerebral.

Los republicanos han buscado durante mucho tiempo la derogación de la ley de salud, diciendo que ha impulsado el costo de las primas de salud y los deducibles hasta un nivel que muchos estadounidenses no pueden pagar y creó desequilibrios del mercado de seguros que no pueden sostenerse.

El presidente Donald Trump presionó al Congreso para que cumpliera su promesa de revocar la ACA en un discurso el lunes, calificando a Obamacare como “desastroso” y una “pesadilla”.

Los funcionarios del condado están particularmente preocupados por los recortes a Medicaid como resultado de una derogación, diciendo que los recortes afectarían de manera desproporcionada a las personas mayores y discapacitadas y quitarían una herramienta critica en la lucha contra la epidemia de opioides en todo el país.

Casi dos tercios de los gastos de Medicaid en 2011 beneficiaron a los discapacitados y los estadounidenses de edad avanzada, a pesar de que constituyeron menos de una cuarta parte de los inscritos del programa, de acuerdo con NACO. Estos datos son anteriores a la puesta en ACA, que amplio el acceso a Medicad.

La supervisora Hilda Solís emitió una declaración tras la votación instando a los republicanos y demócratas a trabajar juntos para encontrar una solución.

“Hay un enorme costo humano para revocar o sabotear y el Primer Distrito será particularmente golpeado si este esfuerzo que niega la salud sea exitoso”, dijo Solís. “Un estimado encontró que aproximadamente 300,000 residentes del Primer Distrito perderán su cobertura de salud, incluyendo alrededor de 50,000 niños y 16,000 ancianos. Otros 60,000 perderán su seguro patrocinado por el empleador, mientras casi 20,000 perderán su seguro a través de Covered California”.

Aunque el voto del Senado despejó el camino para el debate, sigue siendo incierto que proyecto de ley puede finalmente ser aprobado para derogar o reemplazar a Obamacare, dados los objetivos de las facciones dentro la legislatura dirigida por los republicanos.

Trump fracasa de nuevo en su intento por acabar con Obamacare

July 20, 2017 by · Leave a Comment 

WASHINGTON – Los republicanos del Senado no han logrado ponerse de acuerdo para encontrar un reemplazo a la ley sanitaria que impulsó el expresidente Barack Obama, pero tampoco son mayoría aquellos que quieren optar por derogarla sin alternativa, como pretende el presidente, Donald Trump.

La incapacidad de los senadores republicanos para encontrar un consenso alrededor de esta cuestión supone el mayor fracaso legislativo del presidente en los casi seis meses que lleva al frente de la Casa Blanca, ya que tumbar el sistema sanitario de Obama fue una de sus grandes promesas de campaña.

En la noche del lunes, otros dos senadores republicanos sumaron su negativa al proyecto de ley presentado la semana pasada para revocar y reemplazar la conocida como “Obamacare”, por lo que los votos no daban para su aprobación en el pleno y el líder de la mayoría conservadora, Mitch McConnell, anunció que abandonaba esos esfuerzos.

Sin embargo, McConnell indicó que sometería a voto un proyecto que sí logró el consentimiento de la Cámara Alta en 2015, y que fue vetado entonces por Obama, con el objetivo de derogar la ley sanitaria y darse un plazo de dos años para lograr un nuevo proyecto alternativo.

Esa propuesta, cuyos efectos, según la oficina de presupuesto no partidista del Congreso (CBO, en inglés), tendría aun efectos más devastadores sobre el acceso a la salud que los proyectos de ley debatidos hasta la fecha, al dejar sin seguro médico a 18 millones de estadounidenses en apenas un año.

La derogación total y limpia de la ley sanitaria de Obama era el objetivo de los ultraconservadores, sin embargo, los más moderados, en cuyos estados Obamacare ha ampliado el acceso a la salud de forma exponencial, no pueden permitirse el desmantelamiento del sistema, por lo que ya hoy han tumbado cualquier alternativa al respecto.

Es el caso de las senadoras Lisa Murkowski (Alaska), Susan Collins (Maine) y Shelley Moore Capito (Virginia Occidental), con cuyas negativas la derogación pretendida por Trump no tiene futuro alguno.

Aunque el multimillonario instó la pasada noche a la derogación sin alternativa, la imposibilidad de esa postura le ha llevado hoy a asumir que su propio partido no encuentra el camino para ello.

“Creo que probablemente estamos en la posición en la que dejaremos que Obamacare fracase, no nos vamos a responsabilizar, no me voy a responsabilizar”, dijo el mandatario al ser preguntado por los periodistas en un encuentro en la Casa Blanca.

“Dejaremos que Obamacare fracase y luego los demócratas vendrán a nosotros”, agregó.

La ley sanitaria de Obama ha tenido problemas en su implementación, falta de alternativas de seguros en algunos estados, y el incremento de los precios de los mismos por la falta de más oferta en otros casos, sin embargo, ha proporcionado acceso a la salud a más de 20 millones de personas desde su entrada en vigor en 2010.

Conscientes de sus falencias, los demócratas han tendido la mano a los republicanos para trabajar en políticas de mejora, siempre y cuando se mantenga la estructura y los principios de la ley, por la que por ejemplo las aseguradoras se ven obligadas a ofrecer servicios básicos, así como a no elevar los costes de las pólizas por enfermedades previas, algo que antes llevaba a muchas familias a la bancarrota.

“Es hora de seguir adelante, es hora de empezar de nuevo”, dijo hoy el líder de la minoría demócrata en el Senado, Chuck Schumer.

“Los republicanos deben trabajar con los demócratas en un proyecto de ley que reduzca las primas, proporcione estabilidad a largo plazo a los mercados y mejore nuestro sistema de salud”, reiteró.

Schumer, veterano senador por Nueva York, también rechazó la afirmación del Partido Republicano de que los demócratas no han estado dispuestos a trabajar con ellos sobre la ley sanitaria, argumentando que Trump, junto con los líderes republicanos en la Cámara y el Senado, comenzaron el debate político rechazando la entrada de los demócratas.

Lo cierto es que los republicanos no celebraron audiencias sobre su propuesta sanitaria como suele ser el procedimiento, de manera que los demócratas no tuvieron opción de discutir los contenidos de los textos legislativos.

Acabar con Obamacare y los fondos que esta ley contempla para ayudar a las rentas más bajas y a los jubilados en sufragar sus seguros médicos era parte fundamental para ejecutar el siguiente objetivo del multimillonario: una reforma fiscal con grandes recortes impositivos para los más ricos.

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.

 

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