Responding with my Wallet: Donations Following House Passage of AHCA

Angry Image

Image courtesy of jesadaphorn at FreeDigitalPhotos.net

I am disgusted that the House of Representatives passed that travesty of a bill, the AHCA, yesterday. While I know it has a long way to go to passage in the Senate, it still feels like a slap in the face the Congressional reps would put something like this together and pass it.

I’ve been angry since yesterday. I live in a blue state with a very blue rep (thank goodness for @RepRaskin) and blue Senators. When I’m mad about how Congress is acting, I have no one to call who doesn’t already share my feelings.

I was even more appalled watching @RepFredUpton, who was my rep when I was younger, putting forward an amendment to this bill that he knew did not give enough money to cover pre-existing conditions, even in high-risk pools. He has voted for many other bills that I do not agree with, but this might be his most striking vote. He can stand up for the health of our Great Lakes, particularly Lake Michigan (which is a point in his favor) but he can’t stand up for the health of his constituents? Many of my family members are still his constituents. Not all of them can access health insurance through an employer. Some of them, under this bill, would face exclusion due to pre-existing conditions. This is disgraceful.

I am mad. I felt like I did not have an outlet except for ranting on Twitter and a bit on Facebook. So I decided that my monthly donations this month would go toward pushing back against the GOP politically.

I donated through ActBlue.com to campaigns in swing districts. I also donated to VoteRiders.org. I felt it was important to push back against voter disenfranchisement. VoteRiders’ mission statement is noted below:

VoteRiders is a nonpartisan, nonprofit organization that provides practical assistance and information to ensure voters have the right kind of ID to vote in their state. VoteRiders is the leading organization focusing exclusively on voter ID.

Our current priority states, which have or are poised to enact stringent laws about which IDs are acceptable to vote, are: AL, AZ, FL, GA, IN, KS, MI, MO, ND, NH, RI, SC, TN, TX, VA and WI. Some of these states’ voter ID laws leave to others’ discretion whether a resident’s vote will count, or require documentary proof of citizenship to even register to vote. (Source: http://www.voteriders.org/what-we-do/)

I’m going to keep pushing. I’m going to keep showing up to say “This is not right! This is not ok!” I will not accept these things are normal. I will not condone them.

I am mad. And I’m going to do what I can to do something about it.

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Looking at the GOP ACA Replacement Plan

Image courtesy of smokedsalmon at FreeDigitalPhotos.net

Image courtesy of smokedsalmon at FreeDigitalPhotos.net

A number of articles came out this week discussing what the GOP put out as their replacement plan for the Affordable Care Act (ACA). The plan is in the early stages (which is honestly shocking considering they have had 7 years to work on a viable alternative), but there are several talking points they have mapped out for GOP members of Congress.

According to PBS News, the following points were part of the GOP replacement plan, and I am quoting their policy brief:

  • Modernize Medicaid
  • Utilize state innovation grants
  • Enhance Health Savings Accounts (HSAs)
  • Provide portable monthly tax credits

I was more familiar with some of these concepts than others. For example, what are these “portable monthly tax credits” and how do they work? According to the same policy brief:

 Republicans want to repeal Obamacare’s expensive and rigid system of subsidies and replace them with a simple and flexible, advanceable and refundable tax credit to help Americans who do not receive insurance through their employer or a government program…

The credit is:
• Universal for all citizens or qualifed aliens not offered other qualifying insurance
• Age-rated
• Available for dependent children up to age 26
• Portable
• Grows Over Time

…The credit can be used to purchase any eligible plan approved by a State and sold in their individual insurance market, including catastrophic coverage. Additionally, if an employer does not subsidize COBRA coverage, the individual can use the credit to help pay unsubsidized COBRA premiums while he or she is between jobs. If the individual does not use the full value of the credit, he or she can deposit the excess amount into a health savings account.

The credit is not available to be used for plans that cover abortion [emphasis added].

This raises questions of whether the tax credits will really benefit all categories of individuals in the same way and at the same rate as the ACA subsidies. NPR news noted:

The elements of the plan include replacing the subsidies that help people buy insurance through Obamacare exchanges with fixed tax credits to buy coverage on the open market.

The major difference between the two is that the Obamacare subsidies increase as premiums rise so that consumers are responsible for the same premium amount, which is tied to their income. The tax credits proposed by Ryan are not tied to income but rise as a person ages and insurance rates increase.

“The important thing on the tax credits is that they’re not income adjusted and we don’t know how big they are,” Pearson [senior vice president at Avalere, a health care consulting group] says.

She says it’s unlikely they’ll be as generous as the Obamacare subsidies.

“This likely means that low-income people will have difficulty affording individual insurance,” she says.


Then there’s the point about being able to put additional money into health savings accounts. This line of reasoning has always bothered me because it feels like something that was thought up by individuals who have never had to live paycheck-to-paycheck. In order to put funds into an HSA (or an FSA, for that matter) you have to have enough income to do so. Said another way, you have to be making enough money that taking a portion of your check to set aside for potential health costs is not going to cause you financial hardship. For low-income families, that money may be needed to pay rent or put food on the table. There may not be any extra money in their paychecks to put aside in an HSA. The GOP plan would allow individual, self contributions in an HSA to jump from $3,400 to $6,550 and family contributions to jump from $6,750 to $13,100, but again, you have to have money you can easily set aside in the first place for this plan to be beneficial to you.


On modernizing Medicaid and creating state innovation grants, the NPR article noted:

The Republicans’ plan also calls for a major restructuring of the Medicaid health care program for the poor. It would repeal the Medicaid expansion that most states adopted under the Affordable Care Act, which allowed able-bodied people with incomes just above the poverty line to become eligible for Medicaid coverage.

It also noted that under the GOP plan the federal government would only pay a certain amount per person per year to the state, meaning that the state would have to come up with the remainder of the cost. This immediately begs the question as to where additional funds will come from to cover state subsidies.

This is all at a time when, as PBS News notes, “Treatment gaps persist between low- and high-income workers, even with insurance“. Low-income workers are more likely, right now, to end up in the emergency room and hospitals for treatment rather than getting preventative treatment. Part of that is likely a need for greater education on health literacy but it also has to do with the fact that low-income individuals don’t get preventative treatment because they know if a problem is found they’ll have to pay for it and the cost of getting it taken care of (such as paying for their deductibles) is something they cannot afford.


Finally, I also caught this article by NPR about the GOP wanting to return to high-risk insurance pools. As the article mentions:

The argument in favor of high-risk pools goes like this: Separate the healthy people, who don’t cost very much to insure, from people who have pre-existing medical conditions, such as a past serious illness or a chronic condition. Under GOP proposals, this second group, which insurers fear might be expected to use more medical care, would be encouraged to buy health insurance through high-risk insurance pools that are subsidized by states and the federal government.

Something like this used to exist in Minnesota, which had a high-risk pool called the Minnesota Comprehensive Health Association (MCHA). The problem is that returning to a system like the one that existed in MN could likely mean high monthly premium costs, exactly what the GOP says it’s trying to fix.

MCHA’s monthly premiums cost policy holders 25 percent more than conventional coverage, Gildemeister [an economist with Minnesota’s health department] points out, and that left many people uninsured in Minnesota.

“There were people out there who had a chronic disease or had a pre-existing condition who couldn’t get a policy,” Gildemeister says.

…And for the MCHA, even the higher premiums fell far short of covering the full cost of care for the roughly 25,000 people who were insured by the program. It needed more than $173 million in subsidies in its final year of normal operation.

That money came from fees collected from private insurance plans –- which essentially shifted a big chunk of the cost of insuring people in MCHA program to people who get their health insurance through work.

So the high-risk pools can be very costly, both to the individuals who buy into them and to the state that runs them (which means to tax-payers).

“The rub is, where that funding is going to come from?” she says. “And is the federal government or the state government willing to put up the funding needed to make some of these fixes?”

The national plan Ryan proposes would subsidize high-risk pools with $25 billion of federal money over 10 years. The nonpartisan Commonwealth Fund estimates the approach could cost U.S. taxpayers much more than that — almost $178 billion a year.

And my question is, if it’s going to cost us taxpayers so much more annually, how does that work when the GOP wants to cut taxes? How will the increased costs be sustained over time? Is this actually an economically viable option when applied on the national scale? The MN story leaves me with a lot of reason to doubt.

I’ll be following the GOP repeal-and-replacement stories closely in the future, but I must express that I have serious concerns about what they have put out initially. It seems that no matter how I look at current plans, many individuals, particularly some of the must financially vulnerable, will lose insurance due to unaffordability.

Link

“Under the Collins-Cassidy bill, states could enroll people who would otherwise be uninsured in health plans providing basic coverage. These high-deductible health plans are intended to protect consumers against catastrophic medical expenses. They would cover generic versions of prescription drugs, and they would also have to cover recommended childhood immunizations without co-payments. States would contract with one or more insurers to offer this coverage.”

Their plan moves the decision to the states. It appears the available care would still push HSA-s. Mind you, you have to have money to put away in an HSA in the first place, something many can not afford to do. While this looks like it would cover people should a really bad medical situation arise, it doesn’t look like it provides much in the way of coverage for the day-to-day, year-to-year doctor’s visits that are so critical. I can’t tell how it would continue to support preventative treatment. I can’t see how costs would go down with this plan, either… if they auto-enroll individuals that may prevent healthy people from immediately leaving the pool but I would assume they’d drop out in time with no requirement to stay which would likely mean costs would increase.

Will be interesting to see if some version of a plan like this advances or if ACA is repealed outright with no clear plan for replacement.

My Causes

issues-important-to-me

Following my observation of all the activity during the Women’s March yesterday, I sat down and listed the causes or issues about which I am passionate. I decided to keep the list under 10 items, knowing that while I care about many topics there are only so many you can really engage in without overwhelming yourself.

After much deliberation, I came up with the following list (not in any particular order):

  • Voting Rights
    • I believe firmly that everyone should have the right to vote. I believe everyone should have easy access to voting. I believe tools such as opt-out voter registration and early voting should be put in place to encourage voter turnout. Area for further research: Voter redistricting
  • Health Care Access (and Affordability)
    • I believe that everyone should have access to affordable healthcare, though I understand that finding a middle ground on this issue is complicated. What I do not endorse is the removal of anyone’s health insurance without a clear replacement plan. I believe we must protect that most vulnerable. Affordable health care is an area we should all remind ourselves to “do unto others” before we make sweeping decisions. We should all attempt to “do no harm”. Area for continued research and inquiry: ACA repeal efforts, compromises required to achieve affordable healthcare for the greatest number of people, how to bring down health care costs.
  • Education
    • This is my industry of work, so it is critically important to me that access to quality education be made available to all. It is absolutely necessary for individual and national success. I believe that there is an important role for public education. I believe there is great value in exploring ways to shake up the status quo in academia. I believe that public dollars should not fund private, religious schools. I believe educational quality is paramount. I believe the hype about current forms of standardized tests is nonsense. (That last one is me being reactionary to all the awful tests I had to take. I recognize some will argue the benefits of these tests, but I am not a fan and haven’t yet run across data that makes me believe our current tests benefit students). Area for continued inquiry (short-term): Betsy DeVos confirmation and her desire to funnel public dollars away from public education, Betsy DeVos’ plans for higher education. (Long-term inquiry areas too numerous to list here, but will likely surface in this blog over time).
  • Investigative Journalism
    • In a time where President Trump’s administration feels comfortable using terms such as “alternative facts” (see today’s Meet the Press conversation), I believe we need investigative journalism more than ever. I believe that Dan Rather’s FB posts (see latest on the importance of truth and facts) and his organization News and Guts and so many individual journalists out there do a great service by engaging in fact-checking and calling out those who seek to obfuscate the truth. Area for action: Donate to investigative journalism organizations + subscribe to newspapers.
  • Immigrant Issues
    • As a first-generation American, I believe immigration issues require thoughtful consideration prior to action. I believe that we must consider the human sentiments of those affected by immigration activities. I believe we should have clear immigration policies but also plans for those who may have been brought to this country illegally but now wish to find pathways to citizenship. I believe this is a complicated issue but not one that can be resolved by ripping families apart. I believe building a wall will not solve anything. Areas for further research and inquiry: Plans for DACA and what impacts will be, keeping an eye on the Dream Act or future variations, watch for signs of mass deportation of non-criminals, voice loud opposition to any attempts for a registry by religious affiliation, support for easier immigration processes for those married to US Citizen, those with family in US, or wishing to study in US.
  • LGBT Issues
    • A friend of mine wrote a public post on Facebook that really resonated with me:

      Find an organization that protects and supports something that doesn’t directly make your life better. If you’re straight, pick an LGBT organization. If you’re white, pick a minority protection group. If you’re an atheist, find a local church soup kitchen. If you’re religious, pick a religious freedom protection organization. Pledge a $5 recurring monthly donation. Have it automatically withdrawn from your bank or credit card. That way, three years from now, when I have forgotten what I’ve felt for the last 6 months, I’m still “doing something”. The important parts of this are 1) the organization has to be something that doesn’t benefit you directly, 2) it is small enough for you not to consider cancelling it and 3) it is recurring…with no end date. – David Lamb

    • As a straight woman who considers herself an ally, his point in his post was one I took notice of. LGBT rights area something I am only indirectly familiar with. It’s a struggle that does not touch me directly but affects many people I love and care about. To that end, I want to continue to research and understand the concerns of the LGBT community and stand up to any who propose to deny them rights. This is an area I will constantly be looking for insight on so that I can know how to be a better ally. I will also be looking for suggestions on the best organizations to donate to, so please comment if you have thoughts on this!
  • Clean water / Protecting the Great Lakes
    • I believe that clean water is something to which all U.S. citizens should have access. The continued crisis in Flint, MI, my home state, is appalling. I would never have thought such a thing could occur in a state I still love and care about passionately. It is also the reason I believe we must voice opposition to any action that affects clean water (#NoDAPL). Also, having grown up just miles from the shores of Lake Michigan and having traveled around the Great Lakes throughout my childhood and into my adult years, I cannot stress enough how important the conservation and preservation of the Great Lakes is to me. Areas for further research and action: Remain vigilant of any efforts or actions that endanger clean water, research organizations focused on preserving the Great Lakes, continue pushing for solutions for Flint, watch environmental protection activities generally and any efforts to do away with said protections.

These are my personal feelings and my personal causes to which I’ve decided to pay more attention.

My goal is to donate to organizations supporting these causes (current plan is $50/mth split between 2 to 3 cause-related orgs a month) as well as choose as issue or two to become more active on. I am saving this here as a way to keep track of my plans and, as time goes on, my progress. I know, not being independently wealthy, that my donations will be small and that my ability to be active may be limited by a busy life schedule, but this is a start. Just getting my thoughts out of my head and into a blog post is one small step toward doing something more than just thinking and fretting.

Finally, I will reiterate that these are not all the causes that are important to me. These are just the ones on which I will actively focus. I look forward to working with all my friends who are working on so many important causes and will share those stories on here from time to time as well!

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