This Week in Health Care

Last week, Senate Republicans released a draft of their health care reform bill, the Better Care Reconciliation Act (BCRA). Like the House bill, the BCRA repeals the individual and employer mandates and rolls back the Affordable Care Act’s (ACA) Medicaid expansion. The BCRA also caps per-person Medicaid spending and gives states the ability to change essential health benefits. The ACA’s tax credits and protections for those with pre-existing conditions are largely unchanged. (Health Affairs)

Five Republican senators have announced opposition to the BCRA as written. Four don’t believe the bill does enough to repeal the ACA, while Senator Dean Heller (R-NV) expressed concerns about Medicaid cuts. Republican leadership would like to hold a vote this week, while other senators want more time to review the bill. (Washington Post)

The Congressional Budget Office (CBO) released its scoring of the BCRA. The analysis projects a $321 million deficit reduction over the next decade and 22 million more uninsured people by 2026. Average premiums are expected to rise relative to current projections until 2020, and fall thereafter. (Congressional Budget Office)

The Food and Drug Administration (FDA) is planning to hold a public hearing in July on “gaming” by brand-name drug companies. Gaming is a practice where drugmakers prevent competition by using regulatory rules to delay the approval of generic drugs. The Senate has introduced a bill that would allow generic drugmakers to sue companies who game the rules and delay approval. (Morning Consult)

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  1. Z Woof says:

    Today is the last day for Illinois highway crews working because they are broke.

    NOW – today is bad for Connecticut too. Aetna is leaving the state.

    “With Illinois facing a Friday night deadline by which it has to come up with its first fiscal budget in three years or face a downgrade to junk resulting in what a policymaker called a “death spiral“, another mini drama is taking place in Connecticut, which is also facing big budget problems as wealthy residents, hedge funds and major corporations flee the state’s high taxes and its fiscal future gets murkier by the day.

    Just today, we reported that Aetna, the insurance giant founded in Hartford where it has been for the past 164 years, announced it would move its headquarters to New York City despite intensive lobbying efforts by Connecticut officials. The move, which followed a departure by GE of its Fairfield HQ of 40 years, is a blow to the company’s hometown, which is facing severe financial problems. Hartford’s problems are a representation of the troubles facing the entire state: while Illinois’ story is familiar, Connecticut has the distinction of the third-worst ratings in the country, only behind Illinois and New Jersey after S&P, Moody’s and Fitch all downgraded the state last month in what officials described as a “call to action” for state leaders.

    “We’ve been downgraded by everybody in the last six months, and in the last year two or three times,” Senate Republican President Len Fasano said cited by Fox news. “If we don’t pass a budget, I think we will see a further downward spiral.”

    And, just like Illinois (and 14 other states), Connecticut faces a Friday day of reckoning: the state has yet to pass a fiscal 2018 budget by the June 30 deadline.”

    Democrats know how to destroy a State.

  2. Paul Nelson says:

    I understand that Detroit is in receivership, that has also applied to several counties in California and a city School district in Kansas City. Why couldn’t a citizen group petition a Federal court to place the State of Illinois in receivership? Maybe naive, I am. But, the list of incompetent governmental leadership goes on and on. It is especially troublesome for a person to understand who lives in a State with essentially NO indebtedness by the state government and a rainy-day fund of $350 per citizen. The population of my state is a few thousand less than 2 million – Nebraska. By the way, our state has a one house legislature of 50 Senators, elected on a non-partisan ballot and term-limited to 12 years.

    • Barry Carol says:

      The economy of NE, like KS, is driven mainly by agriculture. Unions are relatively weak to non-existent outside of the public sector. IL has much more manufacturing, a huge largely Democrat city, Chicago, and very strong unions. Democrat Michael Madigan has been the IL Assembly Speaker for the last 31 years, the longest tenure in the country. Every state is different not only in the economy that drives it but in its values and culture. IL isn’t NE, never will be and probably doesn’t want to be.

      • Lee benham says:

        Illinois has around 27 million farmable acres. About 75% of the size of the state.
        Illinois is where it’s at because of its past and present leadership. No excuses about unions are manufacturing . Plan and simple it failed leadership .

        • Paul Nelson says:

          I am aware of an olde adage “absolute power corrupts absolutely.” So, I Googled it and arrived at the following URL:

          Reminds me of the Robert L. Heilbroner book published in 1960 “The Future As History.”

        • Allan says:

          You hit the nail on the head, Lee. Barry likes to blame all sorts of things, but doesn’t understand that poor leadership is what creates out of control unions and all sorts of problems. In the video I just posted the CFO of Florida explains what differentiates Florida and Texas from Illinois and New Jersey. His graphs show what happens over time when the state is mismanaged no matter how many excuses are made. Take a look at it.

        • Barry Carol says:

          Republican governor Bruce Rauner has tried for the last two years to bring sensible fiscal reforms to IL but he’s been stymied by large Democrat majorities in the IL legislature where Dems have a 67-51 edge in the House and a whopping 37-22 edge in the state Senate.

          Exactly what would you have him do, Lee that he hasn’t already done or tried to do. NJ Republican governor Chris Christie and MA Republican governor Charlie Baker face the same problems.

          All three of these states have a long history of strong unions using their political power to elect and re-elect Democrats who see state and local issues their way. If reforming state and local pension and healthcare retirement obligations were easy, it would have been done a long time ago.

          Let’s see FL governor Rick Scott take over one of these three Democrat dominated states and see how well he can do with his supposed leadership skills. He wouldn’t be able to move the needle on the status quo just as Rauner, Christie, and Baker haven’t been able to do. The reality of strong unions and entrenched Democrat power is just that, it’s reality. It’s not an excuse.

          • Allan says:

            The problems faced by Illinois and New Jersey along with cities like Detroit is caused by the bankruptcy of the left and the belief that nothing could be done. Nothing could be done when Reagan was elected and fired the air traffic controllers.

            Problems cannot be solved by diddling around without strong convictions and principles behind one’s ideas. One cannot continuously make excuses.

            The damage has occurred over a long period of time due to the attitude of ‘we have to wait and see’ which is what you said when arguing in favor of the ACA. So the answer is you are correct, nothing can be done with that type of attitude.

            • Barry Carol says:

              Reagan didn’t need a Democrat Speaker or Democrat Senate Majority Leader to introduce a bill to fire the air traffic controllers and then garner the necessary votes to pass it through each chamber. He was able to fire them by decree. Governors can’t reduce future pensions or healthcare benefits by decree.

              Even Scott Walker in WI had republican majorities, albeit thin ones, to work with to push through his reform agenda and then had to fight off a recall effort to stay in power.

              • Allan says:

                The point was that Reagan acted and set the tone for the nation. He was terribly abused by the press and wasn’t the love of his own party either. He acted. No excuses. None of this ‘it can’t be done’. He didn’t pass blame around. He didn’t sit there twiddling his thumbs because he couldn’t take a position. He acted and did. That is what real leaders do.

                That is right about Scot Walker. He didn’t say it couldn’t be done or make excuses. He went ahead and did it even though he had to fight off a recall.

                Too many leaders play it safe or they play it lefty.

                • Barry Carol says:

                  Christie was aggressive early in his term too and got a few things done including eliminating pension cost of living escalators until the pension plan was at least 80% funded. Rauner in IL tried hard too but was completely stymied by his Democrat dominated state legislature. Walker couldn’t have done what he did if he had a majority Democrat legislature.

                  In our town, we took a 23 day teachers strike in 1977 in an attempt to rein in excessive wages and benefits and it accomplished nothing aside from tearing the community apart but we did try.

                  I give Reagan credit for the air traffic controller action but, again, he was able to do it on his own even though he knew he would take some heat for it. However, he didn’t need legislative consent and that’s a critical fact that you consistently ignore or downplay.

                  • Allan says:

                    Christie was a little aggressive, but was more interested in national politics than in the welfare of his own state. Illinois even worse. Let me quote from a random article. They may look forward, but at the same time make sure the crooks already existing remain in the system. That way they don’t have to take the heat.

                    “In 2011, the Chicago Tribune exposed a pair of Illinois teacher union lobbyists, Stephen Preckwinkle and David Piccioli, who substitute taught for one day and stood to collect nearly $1 million in state teacher retirement pensions from a severely underfunded system.”


                    I think your claims are weak and support the status quo.

                    • Allan says:

                      Let me say one more thing. I don’t even think Christie is a true conservative. You think you are and probably believe Christie is as well, but I think one can look at certain parts of his record to determine the truth.

                      Who did he endorse for the Supreme Court of New Jersey? I think all of them 5? are liberal. What did he say about Sotomayor? He endorsed her and though she might be a good trial judge she isn’t a good Supreme Court Judge that is supposed to decide the law based upon the Constitution instead of own personal feelings.

                      She thinks anecdotally and so do you.

    • Allan says:

      Paul, you are right, there is too much incompetent governmental leadership, but of course that requires a population base that votes these people in. My State, Florida, is also doing quite well even after facing a terrible financial and housing crisis. One might question how Florida worked its way out of such a devastating crises despite the fact Florida was hit the worst.

      Our CFO of the time describes how Florida handled itself during this crisis and why Florida did so well. He used a wonderful graph that compared Florida to other states such as the failing Illinois and NJ. I think I posted this talk before, but I will post it again in case someone wants to see the evolution of a well managed state and the set up for future destruction of states poorly managed. Once you get to the part where the graph starts to evolve I think you won’t want to close the video.

      The http below starts in the middle so you will have to manually push the arrow to the start of the event. Let me know what you think.¶ms=OAFIAVgO&v=8Xgiii_nCE0&mode=NORMAL&app=desktop

  3. Z Woof says:

    “As you probably know, the state of Illinois owes its vendors more than $15,000,000,000”

    This means that they are already not paying contractors and small businesses – citizens of their own state for services rendered and products consumed. So it’s fine to keep paying state employees and funding social programs but not to pay people they have hired and did their jobs in good faith. Just another example of nothing to lose (since they are already harming their own citizens and protecting their own workforce)

    Here is the IL comptroller video telling it kinda the way it is – really bad!

    Comment: “You wanted massive government spending, and massive government debt? Now you must deal with the consequences. The fact is, Chicago controls the entire State. You’ll notice that nearly every, single county in Illinois is Republican, with one major exception: Cook County, the county in which Chicago is located. That is where the problem lies. Chicago controls the entire State. Illinois, if you want freedom, you must separate from Chicago – just as New York State must separate from New York City,”

    Obama and the Socialists will get you an Obama phone. Hez gonna do more!

    • Allan says:

      Ron, great video. I just posted a video about how different states managed their affairs during the financial crisis and what separated our state from states like Illinois and New Jersey.

      My video showed what happened in an earlier time frame which in a way was a warning to these other states. Your video should be listened to because that is what happens when the warnings aren’t taken seriously and all sorts of excuses are made. That was their CFO speaking on your video, but apparently Illinois citizens prefer making excuses because to date only 36,000 people listened to it. Obama is Chicago all over and he tried to do to the nation what Chicago has done to Illinois.¶ms=OAFIAVgO&v=8Xgiii_nCE0&mode=NORMAL&app=desktop

      The above starts in the middle so move the arrow to the front. I may have posted it some time ago, but I posted it twice today because of Paul’s comment and now yours.

      • Z Woof says:

        Allan, in a “shocking” development, just hours remaining before the midnight deadline to pass the Illinois budget, and Illinois’ imminent loss of its investment grade rating, federal judge Joan Lefkow in Chicago ordered Illinois to come up with hundreds of millions of dollars it owes in Medicaid payments that state officials say the government doesn’t have, the Chicago Tribune reported. Judge Lefkow ordered the state to make $586 million in monthly payments (from the current $160 million) as well as another $2 billion toward a $3 billion backlog of payments – a $167 million increase in monthly outlays – the state owes to managed care organizations that process payments to providers.

        While it is no secret that as part of its collapse into the financial abyss, Illinois has accumulated $15 billion in unpaid bills, the state’s Medicaid recipients had had enough, and went to court asking a judge to order the state to speed up its payments. On Friday, the court ruled in their favor. The problem, of course, is that Illinois can no more afford to pay the outstanding Medicaid bills, than it can to pay any of its $14,711,351,943.90 in overdue bills as of June 30.

        Comptroller Susana Mendoza, a Democrat, said in an emailed statement after the ruling.

        As a result of the court decision, “payments to the state’s pension funds; state payroll including legislator pay; General State Aid to schools and payments to local governments — in some combination — will likely have to be cut.”

        In her ruling, Lefkow said the state must pay the $2 billion toward its past obligations beginning July 1 and ending June 30, 2018. She ordered the state to file monthly reports showing that it’s making the payments consistent with the ruling. The Judge said she considered submissions by managed care organizations, including The Meridian MCO and Aetna Better Health Inc., in reaching her decision. Meridian is owed $540 million and Aetna is owed $700 million, the judge said. In addition, she considered submissions from doctors and clinics.

        Adding insult to crippling financial injury, the judge also ordered the state to file monthly reports showing that they are making the payments consistent with the ruling.

        These judges are messing with IL corruption and basically ordering blood from a turnip which everybody knows is impossible.

        Let us pray!

  4. Allan says:

    It looks like New Jersey is starting to pay the price.

    “”This was completely avoidable,” Mr. Christie said in a statement.

    Under the New Jersey shutdown, only essential state employees such as state police, prison workers, and hospital employees will report to work, according to a statement from the governor’s office. The lottery, casinos and racetracks will remain open and road construction work will also continue.

    State beaches and parks would close, including Liberty State Park, which overlooks New York City and is scheduled to host more than 100,000 people for its annual Fourth of July celebration and fireworks display on Tuesday.”

  5. Z Woof says:

    Chicago gangster politicians took billions of federal Medicaid dollars and spent it on other stuff like pensions. In insurance this is called co-mingling of funds which the insurance agent loses his license and becomes a butcher.

    Late on billions of Medicaid payments, too funny.

    Lets block grant these Medicaid funds for all States and send them all to Chicago politicians so they will be safe.

    The Medicaid Mafia strikes again.

  6. Z Woof says:

    Martin in Tampa: “The Governor of California is just insane and out of control. Besides the boasting that California is its own country free to enter into treaties with Europe against the Constitution, now Governor Brown is restricting the freedom of movement of its citizens creating a list of States within the USA that California is imposing a travel ban. Here we have Governor Brown banning travel for which he had the audacity to criticize President Trump. Brown either belongs in a prison for Treason or an insane asylum. The jury should decide. This man is unqualified to be governor and is dangerous.

    In January, California Attorney General Xavier Becerra announced the state would no longer fund employee travel to four states – Kansas, Mississippi, North Carolina and Tennessee. Now, with Alabama, Kentucky, South Dakota and Texas added to the list after each passed laws California officials described as discriminatory towards the LGBT community. So in other words, any state that disagrees with California should be put on the their Travel Ban.
    Freedom of movement under United States Constitution is governed by the Privileges and Immunities Clause which states, “The Citizens of each State shall be entitled to all Privileges and Immunities of Citizens in the several States.” This issue was decided back in 1823 in an appellate decision Corfield v. Coryell, 6 Fed. Cas. 546 (1823). The freedom of movement for American citizens has been judicially recognized as a fundamental Constitutional right.

    Additionally, the Commerce Clause of the Constitution, empowers Congress “to regulate commerce with foreign nations, and among the several States” not Governor Brown. Once again, he is usurping federal powers and overruling the Constitution. He is simply out of control.

    What’s next? Governor Brown imposes requirements upon cars to be electric and bans all citizens from driving to California with a car that does not meet California standards in accord with Paris? Just secede, invite Hillary to be the President of California, and be done with it. Those who disagree with Brown’s politics, the West Coast of Florida still has the sunsets, no income tax, and far less regulation.”

    • Barry Carol says:

      The weird thing is that despite heavy regulation and the highest marginal state income tax rate (13.3%) in the country, CA is thriving economically mainly because of the strength and resilience of the SF-Silicon Valley high tech corridor. Apparently, the high tech and venture capital industries can take a lot of government abuse and still be wildly successful.

      Meanwhile, much of FL’s growth is driven by residential construction to accommodate the thousands of retirees from the Northeast and Midwest moving there each year to escape the snow and cold weather of winter. Warm weather in the winter is certainly a lot nicer than cold weather and you don’t have to worry about shoveling snow or slipping on ice either. Hot humid summers can be problematic though.

      • Z Woof says:

        Our neighbors go North in the summer and complain that it is 100 degrees and in Florida it is 90. I lived in Phoenix and there it is hot.

        Taking Children to California so they can stay up all night long worrying about how they would survive if the earthquake hit is almost child abuse. We have very few earthquakes in Tampa Bay.

        Florida real estate is a better value. If you are buying real estate in your self directed HSA in the State you wish to retire in then Florida is heads and shoulders superior to California.

        As I understand it 1,000 people more move into Florida each day than leave.

      • Allan says:

        Whatever Florida’s growth, it is doing well without the huge amounts of debt incurred by New Jersey and Illinois due to leftist policies. You seem to support the policies of NJ so I will let it be at that.

        I love the pictures of the NJ governor, Chris Christie, sitting on one of the beaches he closed for July 4th so no regular person could go. I suppose with his size he filled up the beach all by himself.

        • Barry Carol says:

          Christie is Christie. His term will be over in six months though he did some good things early in his first term. His Lt. Governor is running on the republican side to replace him and is opposed by former Goldman Sachs wealthy partner, Phil Murphy who will probably win and we’ll get another Jon Corzine who can’t wait to raise taxes especially on high income people. If he wins, it will be mainly because of labor union power and trial lawyer contributions plus his own money.

          If FL had strong unions, it would have high taxes too. I don’t think you appreciate how powerful they are at the state and local level in states where they’ve long been strong and have democrat majority legislatures that they helped to elect and re-elect.

          As a taxpayer, I want to pay state and local employees enough in compensation (salary + benefits) to attract and hold people who can perform their jobs in a competent, efficient and professional manner. I DON’T want to pay for union greed and monopoly power but that’s exactly what we have.

          IL elected z republican governor who had all the right instincts but he got nowhere with the Democrat majority legislature he was stuck with. So it goes.

          • Barry Carol says:

            Correction: elected a republican governor.

          • Z Woof says:

            Barry, Martin in Tampa says that there is no hope for IL or NJ.

            “There is absolutely no hope for Illinois. Just sell its debt for there is no long-term fix for this state of any state for that matter. We are facing a major Sovereign Debt Crisis at the state and municipal level that will eventually bring down governments on a wholesale basis.

            [[The policies of just tax’em til they die and then tax their heirs is coming to an end.]]

            Governments will collapse and the only solution is to limit government by a new constitution that it may not consume greater than 15% of GDP on a federal, state, and local level combined. Employment should primarily be outsourced and private entities should bid to run various departments. That will eliminate government pensions, which is the monumental source of the real crisis.

            We can do this, but we have to crash and burn first. Government will NEVER simply surrender power without a fight.”

            Buckle your seat-belt, it’s TIME to crash and burn!

          • Allan says:

            NJ refused to deal with the problems unions created when they were small. NJ refused to deal with the problems as they got bigger. Now NJ will have to deal with the problems until the state goes bankrupt or until a politician is elected that is willing to speak for the people of NJ instead of special interests.

            Scott Walker did that with one union and made a difference. Before Scott Walker did what he did you probably would have said that would be impossible. It takes leadership and one whose moral compass doesn’t sway with the wind. It takes principles that one can cogently state.

            Calvin Coolidge as governor said “There is no right to strike against the public safety by anybody, anywhere, any time.” and he called in the national guard. Public servants have no right to threaten the public. If a union is threatening the public take that union on even if there is total disruption and the national guard has to be called in. Coolidge wasn’t the only one to do this. We have had Presidents and Mayors doing similar things.

            Your problem is that you have a never ending list of excuses or you delay making decisions. That is exactly what has brought NJ the problems it faces today.

            • Barry Carol says:

              Walker had a republican legislature to work with. You either keep forgetting that or don’t think it matters. It does matter.

              • Allan says:

                There was an attempted removal of Walker that failed. That is how strong the opposition was.

                You always can find an excuse why things can’t be done or you use the tactic that we have to wait and see. So far NJ is following your type of actions and its budget is out of control.

                • Barry Carol says:

                  Sure the recall failed but without a republican majority to work with, he never would have gotten his agenda through the legislature just as IL governor Rauner was unable to get his through.

                  • Allan says:

                    There you go with excuses again. It has to do with political will and ability plus the ability to get the people to stand with you.

                    People don’t stand behind people that are always making excuses while blaming the other guy or just stand there saying we have to wait and see.

  7. Barry Carol says:

    The IL assembly overrode Governor Rauner’s veto of the budget bill yesterday. The legislation raises IL’s state income tax rate from 3.75% back to 4.95% among other changes.

    For perspective, here are the marginal income tax rates for joint filers in Wisconsin under Scott Walker’s leadership helped by a republican majority state legislature: The lowest rate on the first dollar of taxable income is 4%. The marginal rate moves up to 5.84% at $14,820 and increases to 6.27% at $29,640. WI’s top marginal rate is 7.65% on income above $326,330.

    Here are the comparable rates for NJ for joint filers again for 2016-2017. The lowest rate is 1.4%. The rate moves up to 1.75% at $20K, then to 2.45% at $50K, 3.5% at $70K, 5.53% at $80K, 6.5% at $150K and tops out at 8.97% above $500K.

    It’s worth noting that IL does not have a state level estate tax nor does high tax CA for that matter. NJ’s estate tax will be eliminated on January 1, 2018 though the inheritance tax will remain but it doesn’t apply to immediate relatives like spouses, children, brothers and sisters, grandparents, etc.

    • Allan says:

      What are you trying to say? That we can tax ourselves into prosperity?

      • Barry Carol says:

        I’m not saying that. I am saying that moderate tax increases within reason don’t spell doom and tax cuts don’t always produce robust economic growth as KS governor Brownback found out.

        • Z Woof says:

          Barry, the Socialists are getting out of hand all over the world, not only here in the States. Down with capitalism seems to be your new battle cry.

          In Europe the left is engaging in violent protests at the G20 Summit in Hamburg, Germany. Both the police and G20 opponents were mutually responsible for the escalation of violence, as politicians are demanding harsh punishments for the violent protests with many arguing for prison time.

          The protesters blocked the routes of the delegations in several places. Other places attacked the police and they erected barricades. The protesters have been smashing windows in the city as well. A police helicopter was attacked with a laser pointer nearly blinding the pilot. The heavy riots had began on Thursday evening and so far some nearly 160 police officers have been injured. This morning, some 60 mobs in the Altona district attacked police officers with bombs and stones. The protesters are throwing Molotov cocktails setting cars on fire.

          The G20 opponents made a statement: “We have reached our goal and set a clear signal against the madness of the G20.” Most are wearing masks to hide their faces. We should expect to see increasing civil unrest especially in Europe going forward.

          Ministers elected to the European Parliament have now actual power. They get paid extra if they actually show up. What you see are MPs swiping their cards to get that extra pay and then turn around and leave. Well the EU Commission President Jean-Claude Juncker criticized the Parliament MPs for not showing up to listen to a speech by the Maltese president. Only 30 of the 751 elected members bothered to show up at all. What emerged was a lot of name calling back and forth and Parliament members argued that the commission was not empowered to watch over Parliament.

          They are supposed to monitor themselves.

        • Allan says:

          In other words you are saying nothing. Tax cuts may or may not help. Tax cuts may or may not produce growth. You lay out the economics of a situation, but that is where you end the dialogue because at that point you don’t act. You never stop waiting and seeing.