What Fresh Hell Is This?

July 15, 2017

ANOTHER Response From Senator Pat Toomey

Like his previous responses, this one is email - saves postage and printing, I guess.

So what's this one all about? Senator Toomey's first sentence tells us:
Thank you for contacting my office about health care reform. I appreciate hearing from you.
I'm relieved that even after twenty letters, he still appreciates hearing from me. I'll take that as a Senatorial encouragement to keep the letters coming.

(That should be encouragement to any of my readers who are in the habit of writing to Toomey to keep writing to Toomey. And hey, if you have both your letter and his response in a post-able form, send it in. I'll post it here.)

Here are my five health care letters:
  • Fifth - where I pointed out the CBO of the Obamacare replacement bill written in The House of Representatives. As Toomey's letter is discussing the Senate's bill, this is probably not the letter to which he's responding.
  • Seventeenth - where I asked about his bill, the BCRA, before it was released. It was written in secret and so I asked why his constituents couldn't see it/comment on it before it was to be discussed in the Senate. This is also probably not the letter to which he's responding.
  • Eighteenth - where I pointed to some poll data showing the then level of public support for ACA (49% supported, 42% opposed) and then asked, given the lack of public support, why write the replacement bill in secret? This is also probably not the letter to which he's responding.
  • Nineteenth -  where I pointed out the CBO analysis of the BCRA and asked whether he's ok with millions of people losing their health insurance just so that the already wealthy can become a little wealthier. This is probably the letter to which he's responding.
  • Twentieth - where I asked him to comment on what Bishop David Zubik said, that "access to health care is a basic human right" and that his replacement bill is "morally unacceptable." Given that he doesn't mention Bishop Zubik at all, this is also probably not the letter to which he's responding.
That leaves the nineteenth letter.  The interesting thing about his response (posted in its entirety at the bottom of this blog post) is how familiar his opening is.  For example, his second paragraph:
Obamacare is fundamentally wrong in its approach to improving our nation's health care system. It forces people to buy overpriced health plans they do not want, hikes taxes, and puts important and personal health care decisions in the hands of politicians and bureaucrats instead of patients and their doctors.
Take a look at this from Senator Toomey, dated September of 2013:
Obamacare is fundamentally wrong in its approach to improving our nation's health care system.
Or this from only one month later:
...it is the fact that the President's health care law forces people to buy overpriced health plans they don't want, hikes taxes, and puts important, personal health care decisions in the hands of politicians and bureaucrats instead of patients and their doctors.
Toomey's response to me continues:
In Pennsylvania's individual insurance market, premiums have skyrocketed an astonishing 120 percent since 2013. Forty percent of Pennsylvanians have only one insurer from which to obtain coverage. For these reasons, Congress has begun the process to roll back this misguided experiment and address the most immediate challenges presented by Obamacare's collapse.
Is that true? Is Obamacare collapsing?

No, not according to Thomas Howell jr of the conservative Washington Times:
Obamacare in a death spiral? It’s been a mantra of Republicans, who say the law is collapsing and they are riding to the rescue.

But the Congressional Budget Office, in a little-noticed part of its report last week, said that is not the case. In fact, the CBO analysts said, Obamacare’s exchanges are likely to “be stable in most areas” under the existing law.

The analysts said the key is the tax subsidies the government provides to most of those buying plans on the exchanges. As premiums go up, so does the amount the government pays out to help people buy their coverage — meaning there will always be a pool of customers.
That last part kinda redefines Toomey's complaint about skyrocketing premiums, huh?

And that's an important part of whatever is pushing up the premiums - the issue that Senator Toomey  sees as a flaw in the law and not in how it's being sabotaged by members of his party.

Take a look:
Donald Trump has repeatedly assured the American people that their health-care system will collapse on his watch. In many instances, the president has framed this claim as a matter-of-fact assessment of Obamacare’s incurable flaws — in others, as a promise to kill the law by any means necessary.

In early April, Trump sounded the latter note. In an interview with The Wall Street Journal, the president suggested that he would cease paying out cost-sharing reductions — subsidies to insurers that defray the cost of covering low-income Obamacare enrollees — so as to engineer a crisis in the private insurance market, and, thus, generate more support for repealing Barack Obama’s signature law.
And:
By threatening to stop paying out those so-called cost-sharing reductions — while also threatening not to enforce penalties on those go without insurance — the White House sowed uncertainty that chased insurers out of Obamacare.
So when Toomey points out the lack of a big and healthy health care market, he can actually thank his party brethren for that - especially the orange vulgarity he voted for in November.

Then there's Toomey's defense of his bill's Medicare assault:
Despite inaccurate reports to the contrary, the Senate draft bill keeps Obamacare's expansion of Medicaid, the program for low-income Americans. Obamacare created a new category of eligibility: working age, able-bodied, childless adults. Under the Senate bill, both the 700,000 Pennsylvanians who signed up for this expansion and future expansion enrollees retain federal eligibility for the program. In fact, the federal government will pay at least 90 percent of their costs through 2020, with states paying the balance. Then, over a four-year phase-in period, states wishing to cover this new category of recipients will be required to pay their fair share - only 48 percent in Pennsylvania - for the Medicaid expansion. This is the same amount states currently pay for every traditional Medicaid category: the aged, disabled, children, and families.
We've already discussed this word play on the word "eligibility" in that the "eligibility" remains for people to go on Medicaid but the funding does not.

But this actually gets us at least close to the question I asked - the one that Pat Toomey failed to answer. He filled his email with lotsa stuff hoping, I guess, that I'd wouldn't notice that he didn't actually answer my question.

I noticed. but since we're talking Medicaid, I'll re-ask specifically about that:
Pat, are you OK knowing that thousands of your constituents risk losing Medicaid coverage (though not their "eligibility" just the funding) simply to allow more of your wealthy friends and supporters to get just a little wealthier?
Since that's what I asked and the page of filler is how he responded, I think it's safe to assume the answer's a quiet conservative "yes."

Senator Toomey's letter in full:
Dear David,

Thank you for contacting my office about health care reform. I appreciate hearing from you.

Obamacare is fundamentally wrong in its approach to improving our nation's health care system. It forces people to buy overpriced health plans they do not want, hikes taxes, and puts important and personal health care decisions in the hands of politicians and bureaucrats instead of patients and their doctors. In Pennsylvania's individual insurance market, premiums have skyrocketed an astonishing 120 percent since 2013. Forty percent of Pennsylvanians have only one insurer from which to obtain coverage. For these reasons, Congress has begun the process to roll back this misguided experiment and address the most immediate challenges presented by Obamacare's collapse.

On June 22, 2017, the Senate Budget Committee released the Better Care Reconciliation Act, a draft proposal to fix Obamacare's flaws. This legislation will not affect that vast majority of Pennsylvania families who receive their coverage through an employer, Medicare, or the Children's Health Insurance Program. The legislation ensures no one currently covered by Obamacare has the rug pulled out from under them. The proposal stabilizes the collapsing individual market by continuing Obamacare subsidies for all eligible Americans of modest incomes, and subsidizes high-cost enrollees via a new stabilization fund. Insurers receive some relief from Obamacare regulations to help lower premiums. More broadly, the bill's tax credits, expansion of health savings accounts, repeal of Obamacare taxes, and restoration of state insurance oversight will help to drive down costs for everyone as we transition to a more consumer-driven market.

Despite inaccurate reports to the contrary, the Senate draft bill keeps Obamacare's expansion of Medicaid, the program for low-income Americans. Obamacare created a new category of eligibility: working age, able-bodied, childless adults. Under the Senate bill, both the 700,000 Pennsylvanians who signed up for this expansion and future expansion enrollees retain federal eligibility for the program. In fact, the federal government will pay at least 90 percent of their costs through 2020, with states paying the balance. Then, over a four-year phase-in period, states wishing to cover this new category of recipients will be required to pay their fair share - only 48 percent in Pennsylvania - for the Medicaid expansion. This is the same amount states currently pay for every traditional Medicaid category: the aged, disabled, children, and families.

Perhaps most importantly, for the first time in its history, the Medicaid program will be reformed so it is sustainable for future generations and for taxpayers. For decades, Medicaid spending growth has been out of control. It is now a major driver of our federal deficits and debt. Obamacare exacerbated it by adding millions to the rolls without any reform. The draft bill begins, eight years from now, to transition from this uncontrolled, unsustainable spending growth to a slightly slower, hopefully manageable, rate of growth. It also gives states flexibility to deliver care more efficiently and effectively through Medicaid without being constrained by federal rules written by Washington, D.C. bureaucrats.

The draft bill is now publicly available, and all health care experts, patients, medical professionals, employers, and individual constituents are welcome to provide feedback. I am open to the ideas of anyone who hopes to improve the health care system. You should also know that should the legislation be brought to the floor of the full Senate, it will be subject to an open and unlimited amendment process, giving every Senator the chance to suggest changes before final passage.

Thank you again for your correspondence. Do not hesitate to contact me in the future if I can be of assistance.

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