Tag Archives: ACA

Straight, No Chaser in the News: Evaluating the Next Version of Trumpcare – The Graham-Cassidy Bill (Includes Numbers for Your Senator)

 

The newest effort to repeal and replace the Affordable Care Act (aka Obamacare, ACA) is called the Graham-Cassidy Bill. Although the actual legislation has been clouded in secrecy, there are a few fundamentals that can be shared, and we’ll present them in Q&A format. Be reminded that this reform is meant to impact approximately 1/6th of the United States economy. We’ve done our best to prevent facts Straight, No Chaser style, so consider points that seem slanted self-evident truths and evaluate your reaction to them.

I. What’s a block grant? Let’s address both the facts and the spin. Block grants are a means for the federal government to cap expenses by taking a fixed amount of funds (typically what’s currently or historically being spent) and offering those same funds to individual states for their management. This isn’t a new idea. Republicans have been pushing block grants for Medicaid since the Reagan administration (1981). Block grants were notably used in converting welfare (Aid to Families with Dependent Children) away from an entitlement program in 1996. The spin (and the danger) is states would be allowed to manage those funds as they saw fit, which allows for either greater or lesser health protections, as well as innovation and restrictions. Simply put, states would be empowered to decide what services are offered and who would qualify for those services.

2. What would happen to Medicaid? In the block grant scenario, the amount would be capped with annual adjustments to account for inflation, but those amounts would not keep pace with the rate of medical inflation. In other words, states would eventually have less money with which to work. Furthermore, the proposal explicitly ends coverage for childless adults and ends the Medicaid expansion that occurred under Obamacare and currently covers 15 million adults. As such, there will be a massive redistribution away from states who opted into the ACA Medicaid expansion toward those that did not. Although the Congressional Budget Office hasn’t yet had time to score the Graham-Cassidy bill, in the past, it has opined that block grant proposals could cut Medicaid spending by as much as a third over the next decade. That’s not all. Most notoriously, the block grant would end after 2026. That’s right, in ten years the federal government would have to renew the grant, or states would need to replace every last federal dollar or roll back coverage even more. In other words, all funds currently assigned to Medicaid and the ACA would no longer be spent by the federal government in ten years under the currently proposed bill. Whether or not you believe in reducing costs, you should be quite concerned about the lack of market stability that represents, much less what’s going to happen to health care in 10 years. A conservative estimate is tens of millions of Americans will lose healthcare under any scenario of Graham-Cassidy.

3. How are preexisting conditions affected? Here’s the facts and the spin. Based on the best information available, states would be required to “offer” services to those with preexisting conditions. However, remember that services are actually provided by insurance companies. This bill neither addresses pricing nor mandates affordability to those covered. Thus, a health service could be offered, but it is probable that the price of coverage will become so high for the high-risk patient and those with preexisting conditions that they’ll either elect to or not be able to pay the cost. The nuances here allow competing interests to claim both that pre-existing conditions are or are not going to be covered.

4. Is this supported by the medical and public health communities? How about the public? Every conceivable apolitical sector, from hospitals, insurance companies, health organizations and the public are speaking out against this proposal. On Saturday, a joint press release was signed by multiple prominent medical organizations and insurance companies, united in opposition to the bill. Signing healthcare entities included the following: American Medical Association, American Academy of Family Physicians, Federation of American Hospitals, American Hospital Association, American Health Insurance Plans and the Blue Cross Blue Shield Association. Here is a quote from the press release: “While we sometimes disagree on important issues in health care, we are in total agreement that Americans deserve a stable healthcare market that provides access to high-quality care and affordable coverage for all… The Graham-Cassidy-Heller-Johnson bill does not move us closer to that goal. The Senate should reject it.” Only 24 percent of Americans support Graham-Cassidy, according to a new poll released Thursday by Public Policy Polling. Meanwhile, the public supports retaining the Affordable Care Act over replacing it with the proposed Graham-Cassidy bill by 56-33 percent in a new ABC News/Washington Post poll.

5. What’s going on with Obamacare (Affordable Care Act/ACA) these days? It actually is very much intact, although multiple executive orders have been enacted to weaken it (that will further the appearance and reality that it is flawed). The Trump administration has reduced advertising funds by 90% to announce enrollment, but you should know enrollment for 2018 starts November 1 and ends December 15.

6. Are there any women’s health concerns? It is implicit in the effort to rollback delivery of healthcare to the states that politics will play a role in multiple issues, including those of women’s health. It is explicitly of note that the Graham-Cassidy proposal eliminates federal funding to Planned Parenthood for one year.

7. How can I express my concern? What follows is an exhaustive list of contact numbers for your Senators. Media reporting suggests the number of calls hasn’t been close to that of previous efforts to repeal the ACA, so if you have a voice to share, you have until week’s end (Friday) to be heard.

StateSenatorOffice LocationPhone Number
AlabamaStrange, LutherBirmingham(205) 731-1500
AlabamaStrange, LutherHuntsville(256) 533-0979
AlabamaStrange, LutherMobile(251) 414-3083
AlabamaStrange, LutherMontgomery(334) 230-0698
AlabamaStrange, LutherWashington, D.C.(202) 224-4124
AlabamaStrange, LutherWiregrass(334) 792-4924
AlabamaShelby, RichardBirmingham(205) 731-1384
AlabamaShelby, RichardHuntsville(256) 772-0460
AlabamaShelby, RichardMobile(251) 694-4164
AlabamaShelby, RichardMontgomery(334) 223-7303
AlabamaShelby, RichardTuscaloosa(205) 759-5047
AlabamaShelby, RichardWashington, D.C.(202) 224-5744
AlaskaMurkowski, LisaAnchorage(907) 271-3735
AlaskaMurkowski, LisaFairbanks(907) 456-0233
AlaskaMurkowski, LisaJuneau(907) 586-7277
AlaskaMurkowski, LisaKenai(907) 283-5808
AlaskaMurkowski, LisaKetchikan(907) 225-6880
AlaskaMurkowski, LisaMat-Su Valley(907) 376-7665
AlaskaMurkowski, LisaWashington, D.C.(202) 224-6665
AlaskaSullivan, DanAnchorage(907) 271-5915
AlaskaSullivan, DanFairbanks(907) 456-0261
AlaskaSullivan, DanJuneau(907) 586-7277
AlaskaSullivan, DanKenai(907) 283-4000
AlaskaSullivan, DanKetchikan(907) 225-6880
AlaskaSullivan, DanMat-Su Valley(907) 357-9956
AlaskaSullivan, DanWashington, D.C.(202) 224-3004
ArizonaFlake, JeffPhoenix(602) 840-1891
ArizonaFlake, JeffTucson(520) 575-8633
ArizonaFlake, JeffWashington, D.C.(202) 224-4521
ArizonaMcCain, JohnPhoenix(602) 952-2410
ArizonaMcCain, JohnPrescott(928) 445-0833
ArizonaMcCain, JohnTucson(520) 670-6334
ArizonaMcCain, JohnWashington, D.C.(202) 224-2235
ArkansasBoozman, JohnEl Dorado(870) 863-4641
ArkansasBoozman, JohnFort Smith(479) 573-0189
ArkansasBoozman, JohnJonesboro(870) 268-6925
ArkansasBoozman, JohnLittle Rock(501) 372-7153
ArkansasBoozman, JohnLowell(479) 725-0400
ArkansasBoozman, JohnMountain Home(870) 424-0129
ArkansasBoozman, JohnStuttgart(870) 672-6941
ArkansasBoozman, JohnWashington, D.C.(202) 224-4843
ArkansasCotton, TomEl Dorado(870) 864-8582
ArkansasCotton, TomJonesboro(870) 933-6223
ArkansasCotton, TomLittle Rock(501) 223-9081
ArkansasCotton, TomSpringdale(479) 751-0879
ArkansasCotton, TomWashington, D.C.(202) 224-2353
CaliforniaFeinstein, DianneFresno(559) 485-7430
CaliforniaFeinstein, DianneLos Angeles(310) 914-7300
CaliforniaFeinstein, DianneSan Diego(619) 231-9712
CaliforniaFeinstein, DianneSan Francisco(415) 393-0707
CaliforniaFeinstein, DianneWashington, D.C.(202) 224-3841
CaliforniaHarris, KamalaFresno(916) 448-2787
CaliforniaHarris, KamalaLos Angeles(213) 894-5000
CaliforniaHarris, KamalaSacramento(916) 448-2787
CaliforniaHarris, KamalaSan Diego(619) 239-3884
CaliforniaHarris, KamalaSan Francisco(213) 894-5000
CaliforniaHarris, KamalaWashington, D.C.(202) 224-3553
ColoradoBennet, MichaelArkansas Valley(719) 542-7550
ColoradoBennet, MichaelDenver Metro(303) 455-7600
ColoradoBennet, MichaelFour Corners(970) 259-1710
ColoradoBennet, MichaelNorthern Colorado(970) 224-2200
ColoradoBennet, MichaelNorthwest/I-70W(970) 241-6631
ColoradoBennet, MichaelPikes Peak(719) 328-1100
ColoradoBennet, MichaelSan Luis Valley(719) 587-0096
ColoradoBennet, MichaelWashington, D.C.(202) 224-5852
ColoradoGardner, CoryColorado Springs(719) 632-6706
ColoradoGardner, CoryDenver(303) 391-5777
ColoradoGardner, CoryFort Collins(970) 484-3502
ColoradoGardner, CoryGrand Junction(970) 245-9553
ColoradoGardner, CoryGreeley(970) 352-5546
ColoradoGardner, CoryPueblo(719) 543-1324
ColoradoGardner, CoryWashington, D.C.(202) 224-5941
ColoradoGardner, CoryYuma(970) 848-3095
ConnecticutBlumenthal, RichardBridgeport(203) 330-0598
ConnecticutBlumenthal, RichardHartford(860) 258-6940
ConnecticutBlumenthal, RichardWashington, D.C.(202) 224-2823
ConnecticutMurphy, ChrisHartford(860) 549-8463
ConnecticutMurphy, ChrisWashington, D.C.(202) 224-4041
DelawareCarper, TomDover(302) 674-3308
DelawareCarper, TomGeorgetown(302) 856-7690
DelawareCarper, TomWashington, D.C.(202) 224-2441
DelawareCarper, TomWilmington(302) 573-6291
DelawareCoons, ChrisDover(302) 736-5601
DelawareCoons, ChrisWashington, D.C.(202) 224-5042
DelawareCoons, ChrisWilmington(302) 573-6345
FloridaNelson, BillBroward(954) 693-4851
FloridaNelson, BillFort Myers(239) 334-7760
FloridaNelson, BillJacksonville(904) 346-4500
FloridaNelson, BillMiami-Dade(305) 536-5999
FloridaNelson, BillOrlando(407) 872-7161
FloridaNelson, BillTallahassee(850) 942-8415
FloridaNelson, BillTampa(813) 225-7040
FloridaNelson, BillWashington, D.C.(202) 224-5274
FloridaNelson, BillWest Palm Beach(561) 514-0189
FloridaRubio, MarcoJacksonville(904) 398-8586
FloridaRubio, MarcoMiami(305) 418-8553
FloridaRubio, MarcoNaples(239) 213-1521
FloridaRubio, MarcoOrlando(407) 254-2573
FloridaRubio, MarcoPalm Beach(561) 775-3360
FloridaRubio, MarcoPensacola(850) 433-2603
FloridaRubio, MarcoTallahassee(850) 599-9100
FloridaRubio, MarcoTampa(813) 287-5035
FloridaRubio, MarcoWashington, D.C.(202) 224-3041
GeorgiaIsakson, JohnnyAtlanta(770) 661-0999
GeorgiaIsakson, JohnnyWashington, D.C.(202) 224-3643
GeorgiaPerdue, DavidAtlanta(404) 865-0087
GeorgiaPerdue, DavidWashington, D.C.(202) 224-3521
HawaiiHirono, MazieHawaii(808) 522-8970
HawaiiHirono, MazieWashington, D.C.(202) 224-6361
HawaiiSchatz, BrianHonolulu(808) 523-2061
HawaiiSchatz, BrianWashington, D.C.(202) 224-3934
IdahoCrapo, MikeEastern Idaho, North(208) 522-9779
IdahoCrapo, MikeEastern Idaho, South(208) 236-6775
IdahoCrapo, MikeIdaho State(208) 334-1776
IdahoCrapo, MikeNorth Idaho(208) 664-5490
IdahoCrapo, MikeNorth-Central Idaho(208) 743-1492
IdahoCrapo, MikeSouth-Central Idaho(208) 734-2515
IdahoCrapo, MikeWashington, D.C.(202) 224-6142
IdahoRisch, JimBoise(208) 342-7985
IdahoRisch, JimCoeur D’Alene(208) 667-6130
IdahoRisch, JimIdaho Falls(208) 523-5541
IdahoRisch, JimLewiston(208) 743-0792
IdahoRisch, JimPocatello(208) 236-6817
IdahoRisch, JimTwin Falls(208) 734-6780
IdahoRisch, JimWashington, D.C.(202) 224-2752
IllinoisDuckworth, TammyChicago(312) 886-3506
IllinoisDuckworth, TammyWashington, D.C.(202) 224-2854
IllinoisDurbin, RichardCarbondale(618) 351-1122
IllinoisDurbin, RichardChicago(312) 353-4952
IllinoisDurbin, RichardRock Island(309) 786-5173
IllinoisDurbin, RichardSpringfield(217) 492-4062
IllinoisDurbin, RichardWashington, D.C.(202) 224-2152
IndianaDonnelly, JoeEvansville(812) 425-5813
IndianaDonnelly, JoeFort Wayne(260) 420-4955
IndianaDonnelly, JoeHammond(219) 852-0089
IndianaDonnelly, JoeIndianapolis(317) 226-5555
IndianaDonnelly, JoeJeffersonville(812) 284-2027
IndianaDonnelly, JoeSouth Bend(574) 288-2780
IndianaDonnelly, JoeWashington, D.C.(202) 224-4814
IndianaYoung, ToddEvansville
IndianaYoung, ToddFort Wayne
IndianaYoung, ToddIndianapolis(317) 226-6700
IndianaYoung, ToddNew Albany(812) 542-4820
IndianaYoung, ToddWashington, D.C.(202) 224-5623
IowaErnst, JoniCedar Rapids(319) 365-4504
IowaErnst, JoniCouncil Bluffs(712) 352-1167
IowaErnst, JoniDavenport(563) 322-0677
IowaErnst, JoniDes Moines(515) 284-4574
IowaErnst, JoniSioux City(712) 252-1550
IowaErnst, JoniWashington, D.C.(202) 224-3254
IowaGrassley, ChuckCedar Rapids(319) 363-6832
IowaGrassley, ChuckCouncil Bluffs(712) 322-7103
IowaGrassley, ChuckDavenport(563) 322-4331
IowaGrassley, ChuckDes Moines(515) 288-1145
IowaGrassley, ChuckSioux City(712) 233-1860
IowaGrassley, ChuckWashington, D.C.(202) 224-3744
IowaGrassley, ChuckWaterloo(319) 232-6657
KansasMoran, JerryHays(785) 628-6401
KansasMoran, JerryManhattan(785) 539-8973
KansasMoran, JerryOlathe(913) 393-0711
KansasMoran, JerryPittsburg(620) 232-2286
KansasMoran, JerryWashington, D.C.(202) 224-6521
KansasMoran, JerryWichita(316) 631-1410
KansasRoberts, PatDodge City(620) 227-2244
KansasRoberts, PatOverland Park(913) 451-9343
KansasRoberts, PatTopeka(785) 295-2745
KansasRoberts, PatWashington, D.C.(202) 224-4774
KansasRoberts, PatWichita(316) 263-0416
KentuckyMcConnell, MitchBowling Green(270) 781-1673
KentuckyMcConnell, MitchFt. Wright(859) 578-0188
KentuckyMcConnell, MitchLexington(859) 224-8286
KentuckyMcConnell, MitchLondon(606) 864-2026
KentuckyMcConnell, MitchLouisville(502) 582-6304
KentuckyMcConnell, MitchPaducah(270) 442-4554
KentuckyMcConnell, MitchWashington, D.C.(202) 224-2541
KentuckyPaul, RandBowling Green(270) 782-8303
KentuckyPaul, RandCrescent Springs(859) 426-0165
KentuckyPaul, RandHopkinsville(270) 885-1212
KentuckyPaul, RandLexington(859) 219-2239
KentuckyPaul, RandLouisville(502) 582-5341
KentuckyPaul, RandOwensboro(270) 689-9085
KentuckyPaul, RandWashington, D.C.(202) 224-4343
LousianaCassidy, BillAlexandria(318) 448-7176
LousianaCassidy, BillBaton Rouge(225) 929-7711
LousianaCassidy, BillLafayette(337) 261-1400
LousianaCassidy, BillLake Charles(337) 493-5398
LousianaCassidy, BillMetairie(504) 838-0130
LousianaCassidy, BillMonroe(318) 324-2111
LousianaCassidy, BillShreveport(318) 798-3215
LousianaCassidy, BillWashington, D.C.(202) 224-5824
LousianaKennedy, JohnWashington, D.C.(202) 224-4623
MaineCollins, SusanAugusta(207) 622-8414
MaineCollins, SusanBangor(207) 945-0417
MaineCollins, SusanBiddeford(207) 283-1101
MaineCollins, SusanCaribou(207) 493-7873
MaineCollins, SusanLewiston(207) 784-6969
MaineCollins, SusanPortland(207) 780-3575
MaineCollins, SusanWashington, D.C.(202) 224-2523
MaineKing, AngusAugusta(207) 622-8292
MaineKing, AngusBangor(207) 945-8000
MaineKing, AngusPresque Isle(207) 764-5124
MaineKing, AngusScarborough(207) 883-1588
MaineKing, AngusWashington, D.C.(202) 224-5344
MarylandCardin, BenBaltimore(410) 962-4436
MarylandCardin, BenBowie(301) 860-0414
MarylandCardin, BenCumberland(301) 777-2957
MarylandCardin, BenRockville(301) 762-2974
MarylandCardin, BenSalisbury(410) 546-4250
MarylandCardin, BenSouthern Maryland(202) 870-1164
MarylandCardin, BenWashington, D.C.(202) 224-4524
MarylandVan Hollen, ChrisWashington, D.C.(202) 224-4654
MassachusettsMarkey, EdBoston(617) 565-8519
MassachusettsMarkey, EdFall River(508) 677-0523
MassachusettsMarkey, EdSpringfield(413) 785-4610
MassachusettsMarkey, EdWashington, D.C.(202) 224-2742
MassachusettsWarren, ElizabethBoston(617) 565-3170
MassachusettsWarren, ElizabethSpringfield(413) 788-2690
MassachusettsWarren, ElizabethWashington, D.C.(202) 224-4543
MichiganPeters, GaryDetroit(313) 226-6020
MichiganPeters, GaryGrand Rapids(616) 233-9150
MichiganPeters, GaryLansing(517) 377-1508
MichiganPeters, GaryMarquette(906) 226-4554
MichiganPeters, GaryRochester(248) 608-8040
MichiganPeters, GarySaginaw(989) 754-0112
MichiganPeters, GaryTraverse City(231) 947-7773
MichiganPeters, GaryWashington, D.C.(202) 224-6221
MichiganStabenow, DebbieFlint/Saginaw Bay(810) 720-4172
MichiganStabenow, DebbieMid-Michigan(517) 203-1760
MichiganStabenow, DebbieNorthern Michigan(231) 929-1031
MichiganStabenow, DebbieSoutheast Michigan(313) 961-4330
MichiganStabenow, DebbieUpper Peninsula(906) 228-8756
MichiganStabenow, DebbieWashington, D.C.(202) 224-4822
MichiganStabenow, DebbieWest Michigan(616) 975-0052
MinnesotaFranken, AlDuluth(218) 722-2390
MinnesotaFranken, AlMoorhead(218) 284-8721
MinnesotaFranken, AlRochester(507) 288-2003
MinnesotaFranken, AlSaint Paul(651) 221-1016
MinnesotaFranken, AlWashington, D.C.(202) 224-5641
MinnesotaKlobuchar, AmyMetro(612) 727-5220
MinnesotaKlobuchar, AmyNortheastern(218) 741-9690
MinnesotaKlobuchar, AmyNorthwestern & Central(218) 287-2219
MinnesotaKlobuchar, AmySouthern(507) 288-5321
MinnesotaKlobuchar, AmyWashington, D.C.(202) 224-3244
MississippiCochran, ThadGulf Coast(228) 867-9710
MississippiCochran, ThadJackson(601) 965-4459
MississippiCochran, ThadOxford(662) 236-1018
MississippiCochran, ThadWashington, D.C.(202) 224-5054
MississippiWicker, RogerGulfport(228) 871-7017
MississippiWicker, RogerHernando(662) 429-1002
MississippiWicker, RogerJackson(601) 965-4644
MississippiWicker, RogerTupelo(662) 844-5010
MississippiWicker, RogerWashington, D.C.(202) 224-6253
MissouriBlunt, RoyCape Girardeau(573) 334-7044
MissouriBlunt, RoyColumbia(573) 442-8151
MissouriBlunt, RoyKansas City(816) 471-7141
MissouriBlunt, RoySpringfield(417) 877-7814
MissouriBlunt, RoySt. Louis/Clayton(314) 725-4484
MissouriBlunt, RoyWashington, D.C.(202) 224-5721
MissouriMcCaskill, ClaireCape Girardeau(573) 651-0964
MissouriMcCaskill, ClaireColumbia(573) 442-7130
MissouriMcCaskill, ClaireKansas City(816) 421-1639
MissouriMcCaskill, ClaireSpringfield(417) 868-8745
MissouriMcCaskill, ClaireSt. Louis(314) 367-1364
MissouriMcCaskill, ClaireWashington, D.C.(202) 224-6154
MontanaDaines, SteveBillings(406) 245-6822
MontanaDaines, SteveBozeman(406) 587-3446
MontanaDaines, SteveGreat Falls(406) 453-0148
MontanaDaines, SteveHardin(406) 665-4126
MontanaDaines, SteveHelena(406) 443-3189
MontanaDaines, SteveKalispell(406) 257-3765
MontanaDaines, SteveMissoula(406) 549-8198
MontanaDaines, SteveSidney(406) 482-9010
MontanaDaines, SteveWashington, D.C.(202) 224-2651
MontanaTester, JonBillings(406) 252-0550
MontanaTester, JonBozeman(406) 586-4450
MontanaTester, JonButte(406) 723-3277
MontanaTester, JonGlendive(406) 365-2391
MontanaTester, JonGreat Falls(406) 452-9585
MontanaTester, JonHelena(406) 449-5401
MontanaTester, JonKalispell(406) 257-3360
MontanaTester, JonMissoula(406) 728-3003
MontanaTester, JonWashington, D.C.(202) 224-2644
NebraskaFischer, DebKearney(308) 234-2361
NebraskaFischer, DebLincoln(402) 441-4600
NebraskaFischer, DebNorfolk(402) 200-8816
NebraskaFischer, DebOmaha(402) 391-3411
NebraskaFischer, DebScottsbluff(308) 630-2329
NebraskaFischer, DebWashington, D.C.(202) 224-6551
NebraskaSasse, BenKearney(308) 233-3677
NebraskaSasse, BenLincoln(402) 476-1400
NebraskaSasse, BenOmaha(402) 550-8040
NebraskaSasse, BenScottsbluff(308) 632-6032
NebraskaSasse, BenWashington, D.C.(202) 224-4224
NevadaCortez Masto, CatherineLas Vegas(702) 388-5020
NevadaCortez Masto, CatherineReno(775) 686-5750
NevadaCortez Masto, CatherineWashington, D.C.(202) 224-3542
NevadaHeller, DeanLas Vegas(702) 388-6605
NevadaHeller, DeanReno(775) 686-5770
NevadaHeller, DeanWashington, D.C.(202) 224-6244
New HampshireHassan, MaggieManchester(603) 622-2204
New HampshireHassan, MaggieWashington, D.C.(202) 224-3324
New HampshireShaheen, JeanneBerlin(603) 752-6300
New HampshireShaheen, JeanneClaremont(603) 542-4872
New HampshireShaheen, JeanneDover(603) 750-3004
New HampshireShaheen, JeanneKeene(603) 358-6604
New HampshireShaheen, JeanneManchester(603) 647-7500
New HampshireShaheen, JeanneNashua(603) 883-0196
New HampshireShaheen, JeanneWashington, D.C.(202) 224-2841
New JerseyBooker, CoryCamden(856) 338-8922
New JerseyBooker, CoryNewark(973) 639-8700
New JerseyBooker, CoryWashington, D.C.(202) 224-3224
New JerseyMenendez, BobBarrington(856) 757-5353
New JerseyMenendez, BobNewark(973) 645-3030
New JerseyMenendez, BobWashington, D.C.(202) 224-4744
New MexicoHeinrich, MartinAlbuquerque(505) 346-6601
New MexicoHeinrich, MartinFarmington(505) 325-5030
New MexicoHeinrich, MartinLas Cruces(575) 523-6561
New MexicoHeinrich, MartinRoswell(575) 622-7113
New MexicoHeinrich, MartinSanta Fe(505) 988-6647
New MexicoHeinrich, MartinWashington, D.C.(202) 224-5521
New MexicoUdall, TomAlbuquerque(505) 346-6791
New MexicoUdall, TomCarlsbad(575) 234-0366
New MexicoUdall, TomEastside(575) 356-6811
New MexicoUdall, TomLas Cruces(575) 526-5475
New MexicoUdall, TomSanta Fe(505) 988-6511
New MexicoUdall, TomWashington, D.C.(202) 224-6621
New YorkGillibrand, KirstenAlbany(518) 431-0120
New YorkGillibrand, KirstenBuffalo(716) 854-9725
New YorkGillibrand, KirstenHudson Valley(845) 875-4585
New YorkGillibrand, KirstenLong Island(631) 249-2825
New YorkGillibrand, KirstenNew York City(212) 688-6262
New YorkGillibrand, KirstenNorth Country(315) 376-6118
New YorkGillibrand, KirstenRochester(585) 263-6250
New YorkGillibrand, KirstenSyracuse(315) 448-0470
New YorkGillibrand, KirstenWashington, D.C.(202) 224-4451
New YorkSchumer, ChuckAlbany(518) 431-4070
New YorkSchumer, ChuckBinghamton(607) 772-6792
New YorkSchumer, ChuckBuffalo(716) 846-4111
New YorkSchumer, ChuckMelville(631) 753-0978
New YorkSchumer, ChuckNew York City(212) 486-4430
New YorkSchumer, ChuckPeekskill(914) 734-1532
New YorkSchumer, ChuckRochester(585) 263-5866
New YorkSchumer, ChuckSyracuse(315) 423-5471
New YorkSchumer, ChuckWashington, D.C.(202) 224-6542
North CarolinaBurr, RichardAsheville(828) 350-2437
North CarolinaBurr, RichardGastonia(704) 833-0854
North CarolinaBurr, RichardRocky Mount(252) 977-9522
North CarolinaBurr, RichardWashington, D.C.(202) 224-3154
North CarolinaBurr, RichardWilmington(910) 251-1058
North CarolinaBurr, RichardWinston-Salem(336) 631-5125
North CarolinaTillis, ThomCharlotte(704) 509-9087
North CarolinaTillis, ThomGreenville(252) 329-0371
North CarolinaTillis, ThomHendersonville(828) 693-8750
North CarolinaTillis, ThomHigh Point(336) 885-0685
North CarolinaTillis, ThomRaleigh(919) 856-4630
North CarolinaTillis, ThomWashington, D.C.(202) 224-6342
North DakotaHeitkamp, HeidiBismarck(701) 258-4648
North DakotaHeitkamp, HeidiDickinson(701) 225-0974
North DakotaHeitkamp, HeidiFargo(701) 232-8030
North DakotaHeitkamp, HeidiGrand Forks(701) 775-9601
North DakotaHeitkamp, HeidiMinot(701) 852-0703
North DakotaHeitkamp, HeidiWashington, D.C.(202) 224-2043
North DakotaHoeven, JohnBismarck(701) 250-4618
North DakotaHoeven, JohnFargo(701) 239-5389
North DakotaHoeven, JohnGrand Forks(701) 746-8972
North DakotaHoeven, JohnMinot(701) 838-1361
North DakotaHoeven, JohnWashington, D.C.(202) 224-2551
North DakotaHoeven, JohnWestern North Dakota(701) 580-4535
OhioBrown, SherrodCincinnati(513) 684-1021
OhioBrown, SherrodCleveland(216) 522-7272
OhioBrown, SherrodColumbus(614) 469-2083
OhioBrown, SherrodLorain(440) 242-4100
OhioBrown, SherrodWashington, D.C.(202) 224-2315
OhioPortman, RobCincinnati(513) 684-3265
OhioPortman, RobCleveland(216) 522-7095
OhioPortman, RobColumbus(614) 469-6774
OhioPortman, RobToledo(419) 259-3895
OhioPortman, RobWashington, D.C.(202) 224-3353
OklahomaInhofe, JimEnid(580) 234-5105
OklahomaInhofe, JimMcAlester(918) 426-0933
OklahomaInhofe, JimOklahoma City(405) 608-4381
OklahomaInhofe, JimTulsa(918) 748-5111
OklahomaInhofe, JimWashington, D.C.(202) 224-4721
OklahomaLankford, JamesOklahoma City(405) 231-4941
OklahomaLankford, JamesTulsa(918) 581-7651
OklahomaLankford, JamesWashington, D.C.(202) 224-5754
OregonMerkley, JeffBend(541) 318-1298
OregonMerkley, JeffEugene(541) 465-6750
OregonMerkley, JeffMedford(541) 608-9102
OregonMerkley, JeffPendleton(541) 278-1129
OregonMerkley, JeffPortland(503) 326-3386
OregonMerkley, JeffSalem(503) 362-8102
OregonMerkley, JeffWashington, D.C.(202) 224-3753
OregonWyden, RonBend(541) 330-9142
OregonWyden, RonEugene(541) 431-0229
OregonWyden, RonLa Grande(541) 962-7691
OregonWyden, RonMedford(541) 858-5122
OregonWyden, RonPortland(503) 326-7525
OregonWyden, RonSalem(503) 589-4555
OregonWyden, RonWashington, D.C.(202) 224-5244
PennsylvaniaCasey, BobCentral Pa(814) 357-0314
PennsylvaniaCasey, BobErie(814) 874-5080
PennsylvaniaCasey, BobHarrisburg(717) 231-7540
PennsylvaniaCasey, BobLehigh Valley(610) 782-9470
PennsylvaniaCasey, BobNortheastern(570) 941-0930
PennsylvaniaCasey, BobPhiladelphia(215) 405-9660
PennsylvaniaCasey, BobPittsburgh(412) 803-7370
PennsylvaniaCasey, BobWashington, D.C.(202) 224-6324
PennsylvaniaToomey, PatAllentown/Lehigh Valley(610) 434-1444
PennsylvaniaToomey, PatErie(814) 453-3010
PennsylvaniaToomey, PatHarrisburg(717) 782-3951
PennsylvaniaToomey, PatJohnstown(814) 266-5970
PennsylvaniaToomey, PatPhiladelphia(215) 241-1090
PennsylvaniaToomey, PatPittsburgh(412) 803-3501
PennsylvaniaToomey, PatScranton(570) 941-3540
PennsylvaniaToomey, PatWashington, D.C.(202) 224-4254
Rhode IslandReed, JackCranston(401) 943-3100
Rhode IslandReed, JackProvidence(401) 528-5200
Rhode IslandReed, JackWashington, D.C.(202) 224-4642
Rhode IslandWhitehouse, SheldonProvidence(401) 453-5294
Rhode IslandWhitehouse, SheldonWashington, D.C.(202) 224-2921
South CarolinaGraham, LindseyGolden Corner(864) 646-4090
South CarolinaGraham, LindseyLowcountry(843) 849-3887
South CarolinaGraham, LindseyMidlands(803) 933-0112
South CarolinaGraham, LindseyPee Dee(843) 669-1505
South CarolinaGraham, LindseyPiedmont(803) 366-2828
South CarolinaGraham, LindseyUpstate(864) 250-1417
South CarolinaGraham, LindseyWashington, D.C.(202) 224-5972
South CarolinaScott, TimLowcountry(843) 727-4525
South CarolinaScott, TimMidlands(803) 771-6112
South CarolinaScott, TimUpstate(864) 233-5366
South CarolinaScott, TimWashington, D.C.(202) 224-6121
South DakotaRounds, MikeAberdeen(605) 225-0366
South DakotaRounds, MikePierre(605) 224-1450
South DakotaRounds, MikeRapid City(605) 343-5035
South DakotaRounds, MikeSioux Falls(605) 336-0486
South DakotaRounds, MikeWashington, D.C.(202) 224-5842
South DakotaThune, JohnAberdeen(605) 225-8823
South DakotaThune, JohnRapid City(605) 348-7551
South DakotaThune, JohnSioux Falls(605) 334-9596
South DakotaThune, JohnWashington, D.C.(202) 224-2321
TennesseeAlexander, LamarChattanooga(423) 752-5337
TennesseeAlexander, LamarJackson(731) 664-0289
TennesseeAlexander, LamarKnoxville(865) 545-4253
TennesseeAlexander, LamarMemphis(901) 544-4224
TennesseeAlexander, LamarNashville(615) 736-5129
TennesseeAlexander, LamarTri-Cities(423) 325-6240
TennesseeAlexander, LamarWashington, D.C.(202) 224-4944
TennesseeCorker, BobChattanooga(423) 756-2757
TennesseeCorker, BobJackson(731) 664-2294
TennesseeCorker, BobKnoxville(865) 637-4180
TennesseeCorker, BobMemphis(901) 683-1910
TennesseeCorker, BobNashville(615) 279-8125
TennesseeCorker, BobTri-Cities(423) 753-2263
TennesseeCorker, BobWashington, D.C.(202) 224-3344
TexasCornyn, JohnCentral Texas(512) 469-6034
TexasCornyn, JohnEast Texas(903) 593-0902
TexasCornyn, JohnNorth Texas(972) 239-1310
TexasCornyn, JohnSouth Central Texas(210) 224-7485
TexasCornyn, JohnSouth Texas(956) 423-0162
TexasCornyn, JohnSoutheast Texas(713) 572-3337
TexasCornyn, JohnWashington, D.C.(202) 224-2934
TexasCornyn, JohnWest Texas(806) 472-7533
TexasCruz, TedCentral Texas(512) 916-5834
TexasCruz, TedEast Texas(903) 593-5130
TexasCruz, TedNorth Texas(214) 599-8749
TexasCruz, TedSouth Texas(956) 686-7339
TexasCruz, TedSouth/Central Texas(210) 340-2885
TexasCruz, TedSoutheast Texas(713) 718-3057
TexasCruz, TedWashington, D.C.(202) 224-5922
UtahHatch, OrrinCedar City(435) 586-8435
UtahHatch, OrrinOgden(801) 625-5672
UtahHatch, OrrinProvo(801) 375-7881
UtahHatch, OrrinSalt Lake City(801) 524-4380
UtahHatch, OrrinSt. George(435) 634-1795
UtahHatch, OrrinWashington, D.C.(202) 224-5251
UtahLee, MikeOgden(801) 392-9633
UtahLee, MikeSalt Lake City(801) 524-5933
UtahLee, MikeSt. George(435) 628-5514
UtahLee, MikeWashington, D.C.(202) 224-5444
VermontLeahy, PatrickBurlington(802) 863-2525
VermontLeahy, PatrickMontpelier(802) 229-0569
VermontLeahy, PatrickWashington, D.C.(202) 224-4242
VermontSanders, BernieBurlington(802) 862-0697
VermontSanders, BernieSt. Johnsbury(802) 748-9269
VermontSanders, BernieWashington, D.C.(202) 224-5141
VirginiaKaine, TimAbingdon(276) 525-4790
VirginiaKaine, TimManassas(703) 361-3192
VirginiaKaine, TimRichmond(804) 771-2221
VirginiaKaine, TimRoanoke(540) 682-5693
VirginiaKaine, TimVirginia Beach(757) 518-1674
VirginiaKaine, TimWashington, D.C.(202) 224-4024
VirginiaKaine, TimWashington, D.C.(202) 224-4024
VirginiaWarner, MarkAbingdon(276) 628-8158
VirginiaWarner, MarkNorfolk(757) 441-3079
VirginiaWarner, MarkRichmond(804) 775-2314
VirginiaWarner, MarkRoanoke(540) 857-2676
VirginiaWarner, MarkVienna(703) 442-0670
VirginiaWarner, MarkWashington, D.C.(202) 224-2023
WashingtonCantwell, MariaEverett(425) 303-0114
WashingtonCantwell, MariaRichland(509) 946-8106
WashingtonCantwell, MariaSeattle(206) 220-6400
WashingtonCantwell, MariaSpokane(509) 353-2507
WashingtonCantwell, MariaTacoma(253) 572-2281
WashingtonCantwell, MariaVancouver(360) 696-7838
WashingtonCantwell, MariaWashington, D.C.(202) 224-3441
WashingtonMurray, PattyEverett(425) 259-6515
WashingtonMurray, PattySeattle(206) 553-5545
WashingtonMurray, PattySpokane(509) 624-9515
WashingtonMurray, PattyTacoma(253) 572-3636
WashingtonMurray, PattyVancouver(360) 696-7797
WashingtonMurray, PattyWashington, D.C.(202) 224-2621
WashingtonMurray, PattyYakima(509) 453-7462
West VirginiaCapito, Shelley MooreBeckley(304) 347-5372
West VirginiaCapito, Shelley MooreCharleston(304) 347-5372
West VirginiaCapito, Shelley MooreMartinsburg(304) 262-9285
West VirginiaCapito, Shelley MooreMorgantown(304) 292-2310
West VirginiaCapito, Shelley MooreWashington, D.C.(202) 224-6472
West VirginiaManchin, JoeCharleston(304) 342-5855
West VirginiaManchin, JoeEastern Panhandle(304) 264-4626
West VirginiaManchin, JoeFairmont(304) 368-0567
West VirginiaManchin, JoeWashington, D.C.(202) 224-3954
WisconsinBaldwin, TammyEau Claire(715) 832-8424
WisconsinBaldwin, TammyGreen Bay(920) 498-2668
WisconsinBaldwin, TammyLa Crosse(608) 796-0045
WisconsinBaldwin, TammyMadison(608) 264-5338
WisconsinBaldwin, TammyMilwaukee(414) 297-4451
WisconsinBaldwin, TammyWashington, D.C.(202) 224-5653
WisconsinBaldwin, TammyWausau(715) 261-2611
WisconsinJohnson, RonMilwaukee(414) 276-7282
WisconsinJohnson, RonOshkosh(920) 230-7250
WisconsinJohnson, RonWashington, D.C.(202) 224-5323
WyomingBarrasso, JohnCasper(307) 261-6413
WyomingBarrasso, JohnCheyenne(307) 772-2451
WyomingBarrasso, JohnRiverton(307) 856-6642
WyomingBarrasso, JohnRock Springs(307) 362-5012
WyomingBarrasso, JohnSheridan(307) 672-6456
WyomingBarrasso, JohnWashington, D.C.(202) 224-6441
WyomingEnzi, MichaelCasper(307) 261-6572
WyomingEnzi, MichaelCheyenne(307) 772-2477
WyomingEnzi, MichaelCody(307) 527-9444
WyomingEnzi, MichaelGillette(307) 682-6268
WyomingEnzi, MichaelJackson(307) 739-9507
WyomingEnzi, MichaelWashington, D.C.(202) 224-3424

Feel free to ask your SMA expert consultant any questions you may have on this topic.
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A Straight, No Chaser Approach to Fixing Healthcare


The government may have “moved on” from healthcare, but we the people haven’t. This Straight, No Chaser addresses some very simple fixes for the Affordable Care Act (ACA). For starters, let’s operate under a few assumptions that may or may not be true, based on the recent efforts with the American Health Care Act (AHCA):

  1. The government has come to understand that the American public believes healthcare (or at least access to it) is a right.
  2. The government has come to understand that it must have a role in protecting the interests of the American public regarding how healthcare is delivered.

I also offer a third assumption that the American public would do well to understand about our nation’s healthcare product:

  1. Healthcare in the United States is an industry, not a system. With between $2-3 trillion in commerce being exchanged, the government is not going to bankrupt the insurance, hospital and pharmaceutical industries by putting in place a socialized medicine model (which frankly is not necessary to guarantee universal healthcare). Practically speaking, when speaking of a “uniquely American” solution, a heavy dose of capitalism will come into play for any reform efforts made.

Here are three principles and nine specific suggestions that members on both sides of the aisle (unless acting in a purely ideological manner, meaning either only socialized medicine – government-owned, operated or controlled hospitals, pharmaceutical, and healthcare providers – or no governmental involvement in the business of insurance companies providing health coverage and letting the free markets figure things out) could agree would improve the Affordable Care Act, or more importantly would improve healthcare under any system.

  • Expand the number of participants. The reason to do so is simple: the more individuals that are compelled to participate, the more risk sharing exists, allowing for overall cost reductions because of risk pooling. Options for doing this include the following.
    1. Continue the expansion of Medicaid. Kansas and North Carolina are already primed to become the 32nd and 33rd states to expand Medicaid under the ACA. Before President Trump was elected, Georgia, Idaho, Nebraska and South Dakota were considering Medicaid expansion, and now that the AHCA has been pulled, they will likely revisit consideration.
    2. Eliminate the individual mandate and replace it with a provision by which the government collects a tax in the same way social security and certain other taxes are collected, thus making the individual mandate “invisible.” Furthermore, means test the cost of insurance based on income and your choice of services, instead of by age. Individuals are going to need and use healthcare in the same way that police and public schools are used (Note this is not the same as forcing individuals into using public healthcare and removing choice). If people are going to use it, why not compel everyone to buy into the system? And while you’re at it, once you’ve means tested the cost of insurance based on income, then real consideration can be given to removing the employer mandate.

  • Increase competition. Yes, there is unnecessary waste in the system. Let’s work to bring costs down by embracing the capitalist construct of competition. Here’s a few simple ways how.
    1. Allow for competition by insurance companies across state lines. Competition everywhere will promote lower prices.
    2. Allow for purchase of pharmaceutical products from Canada and wherever quality can be assured.
    3. Provide a “public option.” If it is a bridge too far for the government to influence the costs of healthcare by setting prices directly to insurance companies, pharmaceutical companies and hospitals, providing an actual government-run insurance product option in which such price-setting did occur would compete with and compel these entities to fall in line.

  • Drive utilization toward less expensive, more efficient products
    1. Provide transparency in pricing. Have you ever noticed how rare it is for you to have any idea what the cost of services is? How can that make sense? For many forms of care, there are a range of services within the standard of care. Allowing patients to act as informed consumers can serve the purpose of lowering costs without reducing quality.
    2. Allow for bundling of services: Along the same lines as promoting transparency, moving away from separate fees for every individual service, medicine and gauze used and toward charging standard fees for different categories of services can create huge opportunities for savings and efficiencies.
    3. Maintain the “essential services” the “80/20 Rule”. Simply put, an ounce of prevention is worth a pound of cure. The more preventive and basic (essential) services are utilized, the better health outcomes become and the lower costs end up. The 80/20 rule (aka medical loss ratio) requires insurance companies to use 80 cents of every one of your dollars spent on your medical claims and specific activities meant to improve the quality of healthcare (if and when they don’t, you get a rebate).
    4. Rethink utilization of the emergency department and ambulance services. Millions of ambulance runs each year only represent the equivalent of taxi rides. Utilization of emergency departments occurs without any determination that other components of the healthcare system couldn’t be used, and for approximately thirty years, ERs have operated under an unfunded mandate to provide expensive varieties of the same care that could be rendered in a primary care office. This is a huge problem in that it has continually been shown that approximately 80% of ER visits could be effectively addressed by other healthcare options, and it’s also an issue because ER visits are approximately seven times the cost of using a family practitioner for the same presentation. This represents billions of dollars annually, and it’s also a major contributor to hospital costs representing the primary cause of personal bankruptcies. Just because you’re not paying upfront doesn’t mean you won’t be held responsible later. It’s time to implement some form of selective approval of ambulances and emergency room usage.

If you read back over these three principles and nine suggestions, you may find it shocking that none of these common sense suggestions is fully in place within our healthcare system except for the “80/20 Rule” and the mandate for essential services (both of which were meant to be eliminated under the recently proposed American Health Care Act). Implementing these suggestions brings us closer to coverage for all citizens, increases competition, and promotes quality. Who cares what the plan is called?
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
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Straight No Chaser In The News: The Real Costs of the American Health Care Act

This blog strives to provide medical and public health information – not to serve a political agenda or display any other forms of bias. It is not a means of generating income or serving sponsors. It is with that in mind that I ask our tens of thousands of readers and supporters to consider the following five truisms you should think about deeper that the ongoing slogans would have you do. With a Congressional vote coming today, forget what you’ve heard about the American Health Care Act (AHCA) being Obamacare-light (aka Affordable Care Act, ACA). There are monumental differences between the two. This is literally your life (and how you’ll protect it) that is being placed at risk.

  • The price of healthcare is going to continue to go up no matter what. Healthcare is an industry run by corporations, not the government. As such, corporations have a responsibility to their shareholders to generate as much profit as possible. This fact will remain the same under any plan that does not include a government-run consideration such as “Medicaid for all.”
  • The rate of rise of healthcare costs went down under the Affordable Care Act. One of the major goals and accomplishments of the ACA (aka Obamacare) is although costs continued to rise, it did so at the lowest rates in generations – this was by design. Consider this: according to FactCheck.org, during President Bush’s last six years in office, the average family insurance premiums increased 58% ($4,677). During President Obama, premiums went up by 33% ($4,154). Yes, costs went up (a lot), but the rate of rise slowed – and for what it’s worth, it’s amazing that no one ever seems to get much upset at insurance companies and other for-profit entities that actually are behind the increases in cost. The ACA never was insurance. It was an insurance marketplace where insurance companies agreed to provide insurance and compete for your business. You might as well be mad at the government for the cost of fast food. It’s a distraction.

  • A common refrain is “the costs of healthcare will go down!” Well, that’s government cost due to so many people losing their insurance. The cost of healthcare to you individually would skyrocket under the proposed AHCA (American Health Care Act). There are several reasons why. First of all, 24 million of you won’t have insurance, so you’ll be paying cash. Guess what? Cash rates are way higher than the rates charged to insurance companies. Also, those of you who don’t have insurance will be using the emergency rooms a lot. Well, the cost of ER visits is approximately seven times that of a family practice visit for the same presentations, and guess what? The cost of emergency services is one of the many items no longer to be covered under the AHCA. Also, those of you with insurance costs can expect it to skyrocket for two reasons: one, the law specifically eliminates customer protections (those nasty regulations) that fix insurance companies costs. Even if you believe in the free market’s ability to control costs, this is not that model. This will be a (not close to) free-for-all. Here’s one example: the ACA imposed a 3:1 limit on age rating, which restricted insurers from charging the elderly more than what younger citizens paid within the same area. Under the AHCA proposal; the limit will increase to 5:1. This is a huge reason why the AARP and other senior advocacy groups have come out against the AHCA. An AARP commissioned study concluded that for those over age 55 with a $25K annual income, the premium increase would be approximately $3,600/person, and a 64-year-old with the same income would see an increase of $7,000/person. If you’re 64 with an income of just $15K, your premium would cost $8,400 – more than half of your income. This is logic, math and greed. Remember the individual mandate that many seem to hate creates cost averaging. The more young, healthy people compelled to be in the ACA exchanges created a bigger pool to offset the increased costs of the elderly. With no mandate, there’s less money and no risk sharing.
  • The current conversation about healthcare is a nearly trillion-dollar tax cut in disguise (by eliminating the employer mandate), but what you really should be concerned about is the notion that the underlying “new normal” in play is Healthcare Is Not a Right. Folks, 24 million Americans are estimated to lose their insurance. That means many of you will immediately be placed in a situation in which you will have to decide whether to spend your disposable income on food or healthcare (including medicine). It means in many instances, whatever is wrong with you won’t be discovered until you’re in an emergency room and it’s too late, and/or the opportunity for a full recovery won’t be nearly what it would have been with primary care or preventive efforts. As if that’s not enough, the facade of insurance will become the norm. Your “new” AHCA insurance will not cover ER visits, hospitalizations, laboratory services, prescription drugs, maternity and newborn care, pediatric services (oral and vision care), preventive and wellness services, chronic disease management, mental health and substance use disorder services, rehabilitative services and devices. Get ready for personal bankruptcies to go through the roof.

  • There appears to be no airspace being given to the other fundamental healthcare option. As mentioned in the beginning, the narrative presuming that healthcare is not a right. The US stands alone among the civilized world in not providing universal health care. Once upon a time, the current President actually insisted that everyone needed to be covered. Where is the conversation regarding providing insurance or coverage for all in the same way police protection, education (for now) and a safety net for (some of) the most vulnerable? The goal of distraction is invariably to move away from the more important consideration.

As a reminder (or in case you didn’t know), here’s the 11th hour reason there aren’t enough votes within the Republican caucus to carry the vote at this time. President Trump’s final offered deal – a concession to replace the ACA’s mandate that insurance plans provide even a minimal level of “essential” benefits – was deemed not good enough, because the more conservative members (the “Freedom Caucus”) wanted a complete repeal of all ACA regulations, including such things as mandatory coverage for preexisting conditions and the ability to stay on one’s parents’ insurance until age 26. For the record, recent negotiations in an effort to gain passage in the House of Delegates have revised financial projections (by the non-partisan Congressional Budget Office) such that if passed, the AHCA is now expected to reduce the deficit by $150 billion over 10 years, a decrease from the $337 billion initially projected, while still forecasting a loss of insurance by 24 million people over a decade.
I really wonder if the population knowingly has empowered the Congress to completely obliterate its interests over whatever the perceived shortcomings of the Affordable Care Act are. I especially wonder if those in power actually believe they will get away with such a consequential redistribution of money to the rich and a complete destruction of the remnants of what passes for a healthcare system in this country.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: The Affordable Care Act and The Math of the US Healthcare System

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As we begin 2014 with the implementation of the Affordable Care Act and states’ implementation of Medicaid expansion (well in most of the country), it bears reviewing why this was necessary. Joining me in this conversation is Dr. Bill Vostinak, a prominent orthopedist.
Prior to approval of the Affordable Care Act, and in spite of the loud and incorrect proclamations that we have the “best healthcare system in the world,” the U.S. would have been easily challenged on its purported effectiveness of our healthcare system based on a simple review of the following objective data points. (Our apologies in advance to those who value opinions over facts—or math.)

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Let’s start by appreciating just how much the U.S. has been spending on our healthcare system and what type of access Americans have had to it.
The U.S., by a large margin, has the highest healthcare expenditures in the world. We spend approximately 17% ($1 in every $6) of our gross domestic product (GDP) on healthcare. The next closest nation spends 11%. (For clarification, that’s an incremental increase from the above chart of 2000.)
Despite our exorbitant national costs, only 84.9% of U.S. citizens have healthcare insurance. That translates to 50 million Americans who were uninsured prior to today. We rank 33rd in the world.
Have you ever heard the quote that “85% of Americans are happy with their healthcare?”  (Congratulations if that statement applies to you.) Do you realize that in a nation of over 320 million, that leaves 48 million Americans unhappy? Even if you got past the “48,000,000″ number, which is a massive number of citizens, consider the 85% number.
This is America. 85% is barely a B-grade in school. Is that the standard we seek? And … do the math. Notice the nearly exact match, likely not coincidental, between the number of individuals dissatisfied with their healthcare and the number of uninsured Americans. Basically, you’re satisfied if you have insurance, and if you don’t … not so much. Alternatively, 85% satisfaction may be based on the perception of insurance carrying the individual’s burden of medical costs.
Now let’s move to quality.
In an infamous ranking of healthcare systems around the world, the World Health Organization (WHO) ranked the U.S. system 38th based on routine outcomes-based metrics such as disability-adjusted life expectancy, speed of service, protection of privacy, quality of amenities, and fairness of financial contribution. WHO Ranking
Amid predictable criticism of the U.S. regarding the WHO study, Bloomberg performed its own analysis  and discovered that among advanced economies, the U.S. spends the most on healthcare (on a relative cost basis) with the worst outcome. Bloomberg ranked the U.S. 46th among all nations in efficiency given the average expenditure of $8,608 per year per individual. Bloomberg Report
In terms of infant mortality, about 11,300 newborns die each year within 24 hours of their birth in the U.S., with 50 percent more first-day deaths than all other industrialized countries combined. Infant Mortality
Save the Children’s 14th annual “State of the World’s Mothers” report ranked the U.S. 30th out of 168 countries in terms of best places to be a mother. Criteria included child mortality, maternal mortality, economic status of women, educational achievement and political representation of women. SaveTheChildren.org
An important distinguishing factor in comparing U.S. healthcare with other systems is tying it to employment rather than citizenship. Labor and other costs of American goods and services make it difficult for American corporation to compete in world markets. Add the large fixed cost of healthcare, and competing is nearly impossible.
It is reprehensible to suggest that the effort to cover 50 million uninsured Americans is some socialist plot or anything other than the humane thing to do. Let’s just stop with the selfishness and nonsense about there being no value to the efforts being made to improve access to/quality of healthcare (which reintroduces preventive and mental healthcare considerations) than we had previously. If you don’t believe us, just do the math. Even after a full implementation of the ACA, estimates suggest than some 20 million Americans will still be uninsured.
America is alone among the major industrial nations of the world in not having universal healthcare. That’s the collective decision of the country. Hopefully, these most recent steps through the ACA will represent significant steps toward efficiency, effectiveness and full inclusion. So, how do other countries deliver quality care for less? We’ll save that for another discussion.
Feel free to ask your SMA expert consultant if you have any questions on this topic.
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