Newspaper column: Nevada politicians balk at Trump’s budget

The Obama administration managed to increase the national debt from $10.6 trillion in 2009 to nearly $20 trillion in 2016, meaning the cost of serving that debt has doubled and will rise as interest rates rise.

But when President Trump proposes a budget that would cut spending by $4.23 trillion over the next decade there is wailing and gnashing of teeth — including from the majority of Nevada politicians.

Much of the lamenting is over the budget’s proposal to carry out the House-passed modest rollback of Obamacare, specifically rolling back Medicaid eligibility. Previously, Medicaid covered low-income children, pregnant women and disabled, but largely excluded other low-income adults. Obamacare allowed just about anyone earning below 138 percent of the poverty level to become eligible.

Nevada was one of the 31 states to expand Medicaid eligibility since the federal government promised to initially pick up 100 percent of the increased cost and 90 percent in later years.

Gov. Brian Sandoval has said he intends to protect Medicaid funding “at all cost” — meaning your cost. The expansion has added 220,000 Nevadans to Medicaid.

U.S. Sen. Dean Heller also said he is concerned about the budget’s cuts to Medicaid and its affect on Nevadans now covered by it.

Freshman Nevada U.S. Sen. Catherine Cortez Masto joined other senators in signing a letter to Trump bemoaning the proposed Medicaid cuts. She noted that more than 18,000 veterans in Nevada are covered by Medicaid. How many were previously covered or still would be after a rollback was not stated.

“Your proposed cuts to Medicaid and your efforts to take away people’s health coverage are inconsistent with the promises you made to America’s veterans. They deserve better,” the letter states.

Spending as well as cuts are drawing fire.

There is that $120 million in Trump’s budget to restart the licensing process for Yucca Mountain to become a nuclear waste storage site, a measure apparently opposed by a majority of state politicians.

This prompted Heller to say, “From slashing funding for important public lands programs to its renewed effort to revive the Yucca Mountain nuclear waste repository, the President’s budget request contains several anti-Nevada provisions. While Congress ultimately has the power of the purse, I will continue to stand up for Nevada’s priorities by defending our important public lands programs and fighting any effort to turn Nevada into the nation’s nuclear waste dump. Yucca Mountain is dead …”

Rep. Dina Titus of Clark County fired off this missive: “President Trump wants to fund a revival of the failed Yucca Mountain boondoggle that will ultimately cost taxpayers tens of billions of dollars. Just as his budget overlooks the needs of the America people, Trump’s Yucca Mountain line item ignores the majority of Nevadans who don’t want this dangerous project rammed down their throats.”

On the other hand, Nye County Commission Chairman Dan Schinhofen sent out a statement saying, “I am pleased that the just published fiscal 2018 budget submitted by President Donald Trump includes funding that will continue the licensing process for the Yucca Mountain Waste Repository in Nye County. The promise of a safe and secure site for nuclear waste has been promised to the nation for more than three decades.”

Time to negotiate for benefits?

Then there is the plan in the budget to save $10 million a year by finally following the provisions of the original 1970s act to protect wild horses by allowing excess animals to be sold for slaughter instead of being warehoused at taxpayer expense.

The wild horse management budget has doubled under Obama to more than $80 million a year. The usual suspects decry this trim.

Few seem willing to throttle back on the government largesse, even though the economy has picked up a bit since the depths of the recession and unemployment has fallen from October 2009’s 10 percent peak to 4.7 percent.

Trump’s budget proposes to cut more than $800 billion from Medicaid over the next decade, and trim $192 billion from nutritional assistance and $272 billion over all from welfare programs — all of which have increased in recent years.

Medicaid enrollment has grown by 47 percent since 2006 and spending by 75 percent — to $554 billion in 2015. Food stamp recipients have increased by 11 million.

Trump’s budget is 55 percent larger than 2007’s, though inflation has been 20 percent.

As Ronald Reagan once remarked, “No government ever voluntarily reduces itself in size. Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this earth!”

A version of this column appeared this week in many of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel and the Lincoln County Record — and the Elko Daily Free Press.

Yucca Mountain (CBS pix)

 

No expansion of the role of government can ever be reversed

No government ever voluntarily reduces itself in size. Government programs, once launched, never disappear. Actually, a government bureau is the nearest thing to eternal life we’ll ever see on this earth! — Ronald Reagan

Nevada Sen. Dean Heller is pushing to keep spending federal tax dollars to keep the Medicaid expansion under Obamacare. Sen. Catherine Cortez Masto, of course, is on board, along with all of the rest of the state’s delegation except Rep. Mark Amodei. Nevada lawmakers want to expand Medicaid. The governor is for keeping the Medicaid expansion.

Dean Heller

Thus far, according to the morning newspaper, the expansion has added 221,000 to Nevada’s Medicaid roles, although previous stories in the same paper put the number at 400,000. Most of those are able-bodied, childless adults earning above the poverty level.

Few seem willing to throttle back on the government largesse, even though the economy has picked up a bit since the depths of the recession and unemployment has fallen from October 2009’s 10 percent peak to 4.7 percent.

Meanwhile, Medicaid enrollment has grown by 47 percent since 2006 and spending by 75 percent — to $554 billion in 2015.

Trump’s budget proposes to cut more than $800 billion from Medicaid over the next decade, and trim $192 billion from nutritional assistance and $272 billion over all from welfare programs — all of which have increased in recent years.

What goes up must never go down.

 

Editorial: Rural residents being harmed by health care changes

From the beginning under ObamaCare rural residents throughout the nation have had fewer choices for health care coverage and have been charged considerably higher premiums than those in urban areas.

As insurers flee the ObamaCare market there is even less competition and still higher rates.

It has reached the point that in 2017 a majority of Nevada counties — Esmeralda, Mineral, Humboldt, Pershing, Churchill, Lincoln, White Pine, Eureka, Lander, and Elko — will have only one firm offering coverage under the ObamaCare program.

To ameliorate the blow to residents of single-provider counties nationwide, Nevada Republican Reps. Joe Heck, Mark Amodei and Cresent Hardy a couple of weeks ago introduced a bill that amends the Internal Revenue Code to exempt those residents from the requirement to pay a tax penalty if they fail to maintain minimum health coverage under ObamaCare, or as it is laughably titled, the Affordable Care Act.

Heck is running for the Senate seat being vacated by the retirement of Harry Reid, who rammed through ObamaCare — using deals such as the Cornhusker Kickback and the Louisiana Purchase — without obtaining the vote of a single Republican.

The bill is called Protection from Insurance Exchange Monopolies Act, H.R. 6049. It has been referred to the House Ways and Means Committee.

In the coming year there will be only three companies offering ObamaCare coverage in Nevada — Anthem, Health Plan of Nevada, and Prominence Health Plan (formerly St. Mary’s). In the 10 counties listed above the only carrier option is Anthem.

All three congressmen commented on the necessity of their bill in a press release.

“The better way to solve rural Nevada’s access to health care is to replace Obamacare with a fairer and more patient-centered approach,” Hardy said. “But as long as ObamaCare is the law, Nevadans shouldn’t be forced to pay a tax on a monopoly caused by a government mandate that forced out other competition. All Nevadans, and particularly those in our rural communities, deserve access to more health care choices and lower health care costs.”

“The Affordable Care Act promised Nevadans more healthcare choices and lower costs but, as expected, we now know those promises were empty” Heck said. “Nevadans in 10 counties will be living under an ObamaCare insurance monopoly in 2017 and it is unfair to inflict a penalty tax on residents in counties with only one carrier option. This is yet another example of the failures of the ACA and highlights the urgent need to replace the broken parts of the law with healthcare reforms that actually expand access to quality, affordable care.”

“President Obama promised his healthcare law would bring Americans ‘more choice’, ‘more competition’, and ‘real health care security,’” Amodei said.  “Despite the president’s assurances, ObamaCare has delivered nothing more than higher premiums and less choices – with millions of Americans having even fewer choices in 2017. In Nevada, ObamaCare will soon be leaving residents in 10 counties with only one choice – choose what Washington says is right for them – or pay the penalty. By allowing people who reside in areas with less than two provider options to be exempt from the individual mandate, our bill provides much needed relief to those who have been left with no alternative.”

Repealing ObamaCare is the preferred solution, but this is a worthy patch in the meantime.

Adding further problems for rural communities, in January the Centers for Medicare and Medicaid Services changed the reimbursement process for medical suppliers. CMS is now using bids from metro areas to start cutting reimbursement rates in rural areas.

But providing care in rural areas can be more expensive due to distances between patients and providers and the time and expense it takes to cover those distances. The Medicare reimbursement rate has been cut by more than 50 percent for many items.

Health care providers are hoping Congress remedies the devastating cuts to Medicare reimbursement rates that are impacting medical suppliers throughout the country. Many providers are cutting services or refusing to take new patients. Some are even closing their doors.

Congress needs to act on both of these problems for rural America.

A version of this editorial appeared this week in some of the Battle Born Media newspapers — The Ely Times, the Mesquite Local News, the Mineral County Independent-News, the Eureka Sentinel,  Sparks Tribune and the Lincoln County Record.

Where is the nearest doctor?

Where is the nearest doctor?

Unintended consequences: Watching the ObamaCare death spiral

Today is supposedly the last day to sign up for ObamaCare and have your health insurance effective Jan. 1, but with the ever shifting sands that are the ObamaCare foundation, one never knows for sure. (That didn’t take long.)

Over the weekend, an AP medical writer had a story about how many gullible insurance purchasers may get hit with sticker shock in 2014 because they are signing up for the cheaper plans without reading the fine print.

While the so-called bronze plans may be cheaper than the silver and gold and platinum plans, it requires one pay more expenses out of pocket. With the bronze plan premiums are cheaper, but if you get ill you have to pay 40 percent of the cost. With silver it is 30 percent, 20 percent with gold and 10 percent with platinum.

Lisa Benson cartoon

But wait, there’s more. The deductibles one must pay before the coverage even kicks in vary from plan to plan and add up to several thousand dollars — as much as $4,300 for the average cheaper bronze plan. Then there are co-pays for doctor or emergency room visits.

“Increasingly, experts in health insurance are becoming concerned that many of these first-time buyers will be in for a shock when they get medical care next year and discover they’re on the hook for most of the initial cost,” the AP said.

But, that AP story assures, “Out-of-pocket costs are now capped at $6,350 for individuals and $12,700 for a family.”

Not so fast, sports fans. You can’t tell the players without a program … or reading thousands of pages of filings with the Federal Register for the assorted waivers, delays, retrenchments and dodges — the latest being a hardship waiver of the penalty/tax for not buying insurance if your individual plan was canceled, even though Obama said you could keep it.

It turns out that back in February the Department of Health and Human Services delayed the out-of-pocket caps until 2015 for many insurers. So there may not be a limit to what one might have to pay out of pocket in 2014.

No one discovered this little tweak until August.

The New York Times reported that ObamaCare, passed more than three years ago, clearly established an overall limit on out-of-pocket costs for each individual or family.

The Times quoted an administration official anonymously, “We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person’s out-of-pocket costs. They asked for more time to comply.”

And never mind the cost to insurers.

Now, for those 72,000 Nevadans expected to qualify for Medicaid since the governor expanded eligibility to those making 138 percent of the poverty level, comes this little caveat from a Seattle newspaper: Those who incur health care expenses under Medicaid can have their estates — home equity, vehicles, bank and savings accounts — billed for those expenses, leaving nothing for heirs.

The AP story warned that as people come to realize how much they will have to pay out-of-pocket, even though they have insurance, hospitals administrators worry those who run up uncovered medical bills next year will not be able to pay, thus obviating one of the primary objectives of ObamaCare in the first place.

And if insurance companies fail to sign up enough young, healthy customers to cover the cost of care for older, sicker customers, 2014 will be the beginning of a death spiral resulting in an already broke federal government having to bailout hospitals and insurers.

Just wait and see. Affordable Care Act? What an oxymoron.

(p.s.: I had no idea when putting this piece together Sunday afternoon that the Las Vegas newspaper would make that AP tale of sticker shock, posted before noon Sunday, its front page banner, nor that the editorial today would reach similar conclusions. As my ol’ pappy used to say: Great minds travel in the same plane, but fools just think alike.)

Newspaper column: ObamaCare is path to single payer

Nate Beeler, The Washington Examiner

In the first month of ObamaCare, only 513 Nevadans purchased insurance through the Silver State Health Insurance Exchange, while 25,000 had their individual health policies canceled, as reported in this week’s newspaper column, available online at The Ely Times and the Elko Daily Free Press.

The Healthcare.gov website is a dud. People are losing their health insurance plans that they liked. Period. The prices of new individual policies are 41 percent higher on average nationally and 179 percent higher in Nevada, the highest increase in the nation.

So how do you think Barack Obama, Harry Reid and Nancy Pelosi will try to fix the problems? They’ve all said they favor a single payer plan — which eliminates insurance companies and their overhead and profit margins entirely and has the government make direct payments.

Take a hint from an Obama speech in August at a Syracuse, N.Y., high school: “So over the past four years, what we’ve done is to try to take some steps to make college more affordable. First thing we did — we enacted historic reforms to the student loan system.

What was happening was student loans were going through banks; banks were making billions of dollars. We said why don’t we just give the loans directly to the students, cut out the banks, then we can help more students.”

This is how they think: To save billions of dollars give the money directly to doctors, cut out the insurance companies, so you can help more patients. Profit is so vulgar.

And how much will doctors be paid? Medicare pays 80 percent of what private insurance pays and Medicaid pays doctors only about 58 percent.

Some doctors are refusing to take on new Medicaid patients. In Nevada that’s 25 percent of doctors. Some Democrats are already contemplating a law that would mandate doctors treat Medicare and Medicaid patients.

Do you have any doubts that politicians are capable of forcing doctors to take patients at reimbursement rates below what it costs for treatment?

A recent Investor’s Business Daily editorial put it thusly:

“If doctors can be forced to participate in a government payment system they don’t want to be in, then doctors are owned by government. Their education, labor and intellects will have been seized by the state. They are no longer free agents — they are serfs, the bondsmen of legislators who will sweat them like galley slaves.”

A commenter on the Elko website stated: “Clearly all we need do is take from each according to their abilities and give to each according to their needs. Any other alternative is just so hateful. You can just ask the 100 million that system murdered in the 20th century. They’d tell you if … well that is a problem isn’t it?”

Read the entire column at the Ely or Elko site.

Obama touts ObamaCare success story … prematurely

Obama went on television in October and read a letter from a woman in Washington state expressing thanks for ObamaCare, because her state exchange had informed her she could get health insurance for herself and her son for only $169 a month after subsidies.

Jessica Sanford

That was one of those infamous computer glitches. Jessica Sanford was informed recently that she doesn’t qualify for any subsidies. She said she hasn’t had health insurance in 15 years and that will continue to be the case, according to Washington State Wire. The story she will have to pay a “tax” of $95, but the first year “tax” is 1 percent of income or $500. It goes up each year.

The error was caught four days after Obama read her letter. The state exchange was submitting monthly income to the federal hub, which was reading it as annual income. The mistake was made on 4,600 policies.

In another computer foul-up, Sanford was informed by the computer that her income was low enough to qualify her son for a child’s Medicaid program, for which she would have to pay $30 a month. She enrolled him, but that made her ineligible for a tax credit. The website made it seem like the opposite was true.

Then she got a letter from the state saying that her income — a little less than $50,000 a year — was too high for subsidies anyway. The cutoff was $44,680.

Despite the runaround, Sanford doesn’t blame Obama or ObamaCare. She told the wire service:

“I don’t want this to be a political thing. I don’t want to be bashing the president. I don’t want to be bashing the ACA. I don’t want to come across as saying that. I am a big Obama fan.

“But to me there is a big problem with the way the state is handling it. It is like a big machine – you put your stuff in there and once you do it, it is impossible to do anything. You can’t get through to them [on the phone], the website is really limited. So you are stuck on this big treadmill of bureaucracy, and you know, it feels very out of control.”

Now, what is it we keep saying about central planners?

Now this is only apropos

Just as Gov. Brian Sandoval is making noise about the unworkable ObamaCare and its abominable website, the state’s website is down. The first page of the exchange site is up, but I can’t attest beyond that.

But before the crash the governor stated:

Gov. Brian Sandoval (R-J file photo)

“I opposed Obamacare from its inception.  However, when the U.S. Supreme Court upheld it, every state and every American was forced to abide by it. As a state, Nevada’s only choice was whether to let the federal government control the process or manage the process ourselves.  We rightly opted for the latter.  Now, despite our best efforts to comply with this ill-conceived law, the failure at the federal level has made this effort in Nevada significantly more difficult or even impossible.
 
“Without a doubt, the President’s actions this week are a direct acknowledgement that the law is unworkable. What’s more, the announcement yesterday does not fix any problems and only adds more confusion. I strongly urge the President and Congress to reconsider this law.”

Before that he was saying the state was right to set up its own exchange and avoid the 36-state debacle known as the ObamaCare exchange.

He also expanded Medicaid under ObamaCare, which expected to add 72,000 Nevadans. Though the federal government picks up the tab for three years — I believe most Nevadans pay federal taxes, too, governor — I wonder if Sandoval is now concerned about three years hence?

With only 513 signed up in the Nevada exchange and 6,000 found eligible for Medicaid, that is far short of the 25,000 who’ve had there policies canceled. Come Jan. 1, Nevada just might have more uninsured as a result of ObamaCare, not fewer.

Obama: We can’t go back to the bad old days

In his briefing today, in which he waved his magic wand and declared imperially that everyone could keep their old individual health insurance policy, if your company still offers it — fat chance — Obama declared that the country can’t go back to the bad old days before ObamaCare.

The president stammered:

I’m just going to work as hard as I can to make things better for folks.

And what that means specifically in this health care arena is we can’t go back to the status quo. I mean, right now everybody is properly focused on us not doing a good job on the rollout. And that’s legitimate and I get it.

There have been times where I thought we were — got, you know, slapped around a little bit unjustly. This one’s deserved, all right? It’s on us.

But we can’t lose sight of the fact that the status quo before the Affordable Care Act was not working at all. If — if the health care system had been working fine and everybody had high-quality health insurance at affordable prices, I wouldn’t have made it a priority. We wouldn’t have been fighting this hard to get it done, which is why when I see sometimes folks up on Capitol Hill, and Republicans in particular, who have been suggesting, you know, repeal, repeal, let’s get rid of this thing, I keep on asking, well, what is it that you want to do? Are you suggesting that the status quo was working? Because it wasn’t, and everybody knows it. It wasn’t working in the individual market, and it certainly wasn’t working for the 41 million people who didn’t have health insurance.

Everybody knows it, except perhaps the American people.

A Fox News article published in 2009 prior to the passage of ObamaCare in 2010 looked at a number of surveys of Americans, asking about their satisfaction with their health care.

One survey found that 93 percent of insured Americans who had recently suffered a serious illness were satisfied with their health care, as were 95 percent of those who suffered from chronic illness.

Even the uninsured weren’t all that disappointed with their health care. Some 70 percent said they were “satisfied” or “very satisfied” with their health care.

About 14 million of those 41 million uninsured were eligible for Medicaid but did not bother to sign up until they became ill. There are no pre-existing condition limits under Medicaid.

Obama also claimed, “This is something that’s really important to me, and it’s really important to millions of Americans who have been waiting for a really long time to try go get health care because they don’t have it.”

No, many don’t have health insurance, but health care is available in one way or another and many were quite satisfied with the way things were.

That is not to say there is no need to make changes. The old system was saddled with government mandates, too. There needs to be some free market fixes.

Take the Heritage Foundation plan. Yes, I know they once backed mandatory health insurance for all.

The Heritage plan is to allow tax breaks for individuals who buy health insurance and not just employers. The insurance would be portable from job to job, across state lines and even into retirement.

Heritage points out that ObamaCare cuts in Medicare payments will make 15 percent of all hospitals unprofitable within a decade and 40 percent unprofitable by 2050. You can keep your hospital, if it is still open.

ObamaCare is working just the way they planned

Obama talks about cutting banks out of the student loan business in Syracuse, N.Y. (White House photo)

It’s not a bug. It’s a feature.

Yes, the Healthcare.gov website is a dud. Yes, people are losing their health insurance plans that they liked. Period. Yes, the prices of new individual policies are 41 percent higher on average nationally and 179 percent higher in Nevada, the highest in the nation.

So how do you think Harry, Barry and Nancy will try fix the problems? They’ve all said they favor a single payer plan — which eliminates insurance companies and their overhead and profit margins entirely.

Let’s take a hint from an Obama speech in August at a Syracuse, N.Y., high school:

“So over the past four years, what we’ve done is to try to take some steps to make college more affordable. First thing we did — we enacted historic reforms to the student loan system.  What was happening was student loans were going through banks; banks were making billions of dollars.  We said why don’t we just give the loans directly to the students, cut out the banks, then we can help more students.”

To save billions of dollars give the money directly to doctors, cut out the insurers, so you can help more patients.

According to the Office of the Actuary for the Centers for Medicare and Medicaid Services, as reported in an Investor’s Business Daily editorial, doctors are reimbursed by Medicare at a rate of about 80 percent of what private insurance pays, while Medicaid pays them only about 58 percent of what private coverage does. In many cases that reimbursement doesn’t cover the cost of providing care.

Some doctors are refusing to take on new Medicaid patients. Do you think Harry and Barry and Nancy will stand for that?

That Medicare reimbursement is that high only because Congress for every year since 2002 has voted for the “doc fix” to stop scheduled decreases in reimbursement. This next year a cut of 27 percent is currently on the books.

Also, ObamaCare cuts $716 billion from Medicare.

When doctors become basically federal government serfs who must live off whatever Congress and the president decides they are worth, how good will care be? How many doctors will retire early?

You might have government “insurance” but where will you find a doctor?

That IBD editorial put it thusly:

“This isn’t a political molehill. If doctors can be forced to participate in a government payment system they don’t want to be in, then doctors are owned by government. Their education, labor and intellects will have been seized by the state. They are no longer free agents — they are serfs, the bondsmen of legislators who will sweat them like galley slaves.”

Be sure and thank Sandoval for expanding Medicaid under ObamaCare

Expanded Medicaid will cost Nevadans in the long run, though the governor gets to bank a bit of savings in the short run.

I told you Gov. Brian Sandoval was taking a myopic view when he opted to expand Medicaid under ObamaCare and create a state health insurance exchange.

The Heritage Foundation has put a sharp pencil to the Medicaid expansion and found 40

  •  states are projected to see increases in costs due to this. Most of these states will see costs surpass savings as soon as the

federal match rate is lowered after the first three years. From there, costs skyrocket.

Sandoval has noted  the federal government will pay 100 percent to the additional cost for the first three years of expanded Medicaid and Nevada can pull out later if it chooses. Right, end an entitlement.

Instead of having Medicaid cover people up to 87 percent of the poverty level, ObamaCare gives Medicaid to those making 138 percent of the poverty level. Currently a family of three with income of $16,000 qualifies for Medicaid, but expanding the coverage qualifies such a family if it earns about $32,000 a year. It also subsidizes health insurance for a family of four making up to $91,000 now and $100,000 in a couple of years.