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In Health Bill’s Defeat, Medicaid Comes of Age

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Article source: https://www.nytimes.com/2017/03/27/health/medicaid-obamacare.html

Detroit, public safety unions talking health care

In what some say is a first in city-employee relations, Detroit officials are working with the city’s four public safety unions to hammer out a new health care plan for police officers, firefighters and emergency medical technicians.

In the past, the city dictated which health care options were available to first responders, but Mayor Mike Duggan agreed to let the four union heads have input as the city decides which plan to adopt. The parties have been meeting every two weeks since January to come up with a plan that will cover members in 2018.

“For the first time in the history of unions and the city, we’re working together on one side of the table to put a plan together that best serves our public safety employees,” Detroit Firefighters Association President Mike Nevin said. “That’s huge. When all sides come together as adults, instead of insulting each other, a lot can get accomplished.”

Representatives from the city’s four public safety unions — which also include the Detroit Police Officers Association, Lieutenants and Sergeants Association, and Command Officers Association — spoke with the mayor in January about crafting a new health care plan.

“Duggan could have told us to pound sand, and there isn’t anything we could have done about it,” Nevin said. “But he agreed to open it up and look at it, to see if we can’t figure out a better deal. I give the man credit; he’s willing to work with us.”

Denise Starr, the city’s director of human resources, said: “It’s always healthy to have the input of the unions and employees, and for us to be open about what we can and cannot do.”

The city sent out surveys earlier this month to the 6,500 city employees covered under the city’s health insurance plans, Starr said. There are about 9,000 city employees, but some don’t have health care because they’re part time or are covered under a spouse’s plan, she said.

“The survey is to see what the employees want,” Starr said. “And since we were going to survey police and fire employees anyway, we decided to survey the entire city.”

Starr said about 1,000 employees have already responded to the survey, and she expects to have all the forms completed within three weeks.

Currently, city employees may choose between Blue Cross and Health Alliance Plan. Until last year, public safety employees also could choose the Coalition of Public Safety Employees health plan, which had been available to Detroit first responders since 1999.

But in November, COPS Trust, which charged no premiums, decided to stop offering coverage.

“The people at COPS Trust saw an increase in costs, and decided there was a solvency issue,” said police Cmdr. Aric Tosqui, president of the Command Officers Association. “A large percentage of union members were forced off COPS Trust and onto Blue Cross.

“The four unions came back with a plan for the city to look at, to offer health care through Blue Cross that had a similar high deductible/no premium plan COPS Trust offered,” Tosqui said. “The city put it out for bid, and came back and told us they couldn’t do it because it was not cost neutral. The city doesn’t want this to cost them more money.”

Starr said there’s a chance whatever new plan is adopted also will offer a choice for no premium. “There are several options, and we’ll look at them to see which one works best.”

The plan adopted for public safety employees could eventually cover all city employees, Starr said.

Starr added whatever plan is chosen must be approved by the Financial Review Commission, the state-appointed board put in place to monitor Detroit’s budget three years after the city declared bankruptcy in 2013.

There are health care issues that are particularly concerning to public safety workers, Lieutenants and Sergeants Association President Mark Young said.

“There’s a lot of stress on first responders, and all the health issues that come with that,” Young said. “My officers work crazy shifts, and so their sleeping and eating patterns are off. That has health consequences as well. And then there are the nagging injuries you get on the job. It all adds up.”

Part of coming up with a plan will be trying to address the various union heads’ concerns.

“I’ve been pushing for a health care savings account,” Tosqui said. “To me, that’s important, because the probability is that retiree health care will probably not return. A health savings account allows people to put money aside for later, although it has a high deductible on the front end.”

Young said he didn’t want that kind of plan. “I’m concerned about members having high co-pays and deductibles, because we don’t make that much money now as it is,” he said. “If you don’t make any money today, how are you going to put money up for tomorrow?”

ghunter@detroitnews.com

(313) 222-2134

Twitter: GeorgeHunter_DN

Article source: http://www.detroitnews.com/story/news/local/detroit-city/2017/03/28/detroit-safety-workers-health-care/99711704/

After Health Care Loss, What’s Next for a Divided Republican Congress?

Political parties often have moments of introspection after an electoral defeat but now House Republicans are experiencing one following a stinging legislative bruising.

GOP members regrouped in Washington Monday still raw after a bitter loss in their high-profile attempt to repeal and replace a health care law they have spent more than seven years fighting. There they continued to point fingers over who was to blame for the bill’s failure and to face the reality of how the episode might impact their aggressive legislative agenda going forward.



Some Republicans are rethinking any previous plans to pass a Republican agenda with just GOP votes, saying that it’s not possible in a House of Representatives with a caucus so ideologically diverse and a conservative faction so opposed to government that they vote against most attempts at legislating.

That was the recipe that scuttled health care.

“You can’t do anything that’s big and controversial that is going to require Republican votes,” said Rep. Mario Diaz Balart, R-Florida, an ally of Republican leadership. “The reality is we don’t have 218 Republican votes. We don’t.”

The number 218 is the number of votes needed to pass legislation (when all House seats are filled.) Republicans hold 237 seats but last week’s implosion of the health care legislation made some members realize that two dozen Republican votes potentially aren’t reliable.

Related: After Health Care Defeat, Trump’s Two Options Are Bad and Worse

The next major legislative goal after repealing the Affordable Care Act is tax reform and coming up in April is must-pass government funding for the rest of 2017. Both are big items in the Republican must-pass and wish-to-pass agenda.

If a funding bill isn’t passed, the government would shut down. And tax reform is so complex that the last time Congress passed major changes to the tax code was more than 30 years ago.

Such hard questions have only been made more complicated since the party was unable to pass its signature legislation — the repeal of Obamacare — because moderate and conservatives were too far apart and Trump and leadership were unable to bring enough votes to the table.

The original plan was to pass health care repeal and tax reform under a process called reconciliation. The reason is because under reconciliation, only a simple majority is needed in the Senate, and with a simple majority, only Republicans are needed for passage. But after the House failed to pass health care under reconciliation requirements, some members are suggesting to let go of the plan to pass tax reform under reconciliation.

Rep. Tom Cole, R-Okla., said reconciliation for tax reform should be “re-examined.”

“If you’re doing that, you’re saying you can do that with all Republican votes and dealing the Democrats out from the beginning. That’s fine as long as you’re sure you can get those votes, but nothing I’ve seen so far assures me of that,” Cole said.



When asked about the possibility of a “revolt” if Republicans work with Democrats instead of trying to bring along their most conservative members, Cole said, “I’m sorry, we had a revolt without a bipartisan approach.”

One issue likely to complicate government funding is money for Planned Parenthood. Conservatives intent on defunding it have been willing to bring the government to a brink of a government shutdown under a Democratic president. Some Republicans worry that the same group would be willing to do the same under a Republican president, something Cole called “stupid.”

On tax reform, one component that signifies how difficult it could be to pass is the border adjustability tax, which is a tax on any good or product brought into the U.S. House Speaker Paul Ryan says it will incentivize companies to manufacture products in the U.S. to avoid the tax, but President Donald Trump has given mixed messages on his support. And many Republicans in the Senate have been strongly opposed, saying it would start a trade war.

Rep. Mike Coffman, who represents a swing district in Colorado, blamed the House Freedom Caucus as well for the failure of health care, but said that tax reform would be ideologically easier, except the health care flap has made it more difficult.

“I think tax reform is easier to do but not having this done makes it harder to do,” Coffman said. “It’s a momentum issue. The fact is you came out of the fact and you stumbled. I think it slows the momentum and makes it harder.”

Rep. Ted Poe, R-Texas, who just rescinded his membership to the conservative House Freedom Caucus over the weekend because of their dogmatic approach to legislating, said tax reform is going to be difficult.

“I think that is going to be more difficult to change the tax structure of the country than replacing and repealing Obamacare,” Poe said on CNN, adding that the conservatives are going to be inclined to vote against Republican priorities.

Rep. Chris Collins, R-N.Y. and one of President Donald Trump’s closest allies in Congress, insists that tax reform will be far easier than health care.

“The issues surrounding tax reform are easier,” Collins said. “They are not as emotionally charged as the health care debate.”

But Collins also admitted that tax reform might not be as comprehensive anticipated.

“We’ll get tax reform. Maybe not as quite as grand as we’ve hoped for,” he said.



One option is to work with Democrats instead of relying on just Republicans to pass legislation, which is what moderate Rep. Charlie Dent of Pennsylvania suggested, which is why he says Republicans should take up infrastructure reform before tax reform.

“It seems like there will be a little bit of a pivot right now from healthcare to something else. If they asked my opinion, I would tell them, they should pivot to infrastructure,” Dent said. “Why? Because I think it is easier to assemble a bipartisan coalition to do infrastructure than tax reform.”

Many Republicans aren’t as interested in infrastructure as they are in taxes, especially with Trump’s proposed $1 billion price tag. Infrastructure wasn’t in Speaker Ryan’s priority list of agenda items, but it was added at the insistence of the president who campaigned on rebuilding roads, bridges, trains and airports.

Rep. Justin Amash, R-Mich., one of the most hardline members of the Freedom Caucus who was punished by previous House Speaker John Boehner for his unwillingness to cooperate with the party, dismissed the idea that conservatives are going to make tax reform more difficult.

“We can do tax reform. Nothing’s impossible. We can do anything that’s allowed under our Constitution,” he said. “We can move forward and work on these issues with the American people.”

Article source: http://www.nbcnews.com/politics/congress/after-health-care-loss-what-s-next-divided-republican-congress-n739266

Global markets slip on Trump’s health-care failure; Dow set for triple-digit losses

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Market reaction to failed GOP health care plan


Wall Street futures underlined a global market sell-off on Monday as investors fretted over the potential knock-on effects of U.S. President Donald Trump’s surprise failure to deliver on health-care reform.

Dow futures were set for triple-digit losses, down around 150 points at 8:45 a.m. ET, after Republicans dramatically pulled their health-care bill on Friday.

“The market’s patience is wearing thin,” Vasileios Gkionakis, head of global FX strategy at Unicredit, told CNBC on Monday.

“It definitely doubts the U.S. administration’s ability to push forward (with) this so much talked and discussed agenda including the fiscal stimulus, tax deregulation, tax cuts,” Gkionakis added.



Markets are down but not out after failed health-care bill: Pro


Trump’s perceived inability to garner enough support from his own Republican party to repeal and replace Obamacare appeared to dent the president’s image as someone who could get deals done, which prompted concern among traders for future economic policies.

“Failure to pass the health-care bill doesn’t mean that President Trump’s entire agenda is in tatters but it’s a huge setback all the same and the market mood reflects as much,” Kit Juckes, macro strategist at Societe Generale, said in a note Monday.

The depressed mood for investors was far-reaching as European markets, led by the U.K.’s FTSE 100 and German Xetra DAX, which fell over 0.7 percent.

Elsewhere, Asia markets were mostly lower. The Japanese benchmark Nikkei 225 dropped by more than 1.44 percent as risk-off sentiment spurred a rush to safe-haven assets such as gold and the yen. Spot gold was trading at highs not seen for over a month as the commodity spiked to hit $1.258 an ounce.



Like upside call options on equities: SocGen


The dollar index fell to its lowest level since mid-November as it weakened from a high of 100.00 on Friday to 99.02 against a basket of currencies.

“The dollar for example is quite fascinating, right now the dollar has pretty much wiped out all the gains that (were made) on the back of this Trump-euphoria related trade. I don’t want to call it Trump reflation trade because I think the reflation trade has started before Trump was actually elected,” Gkionakis said.

Meanwhile, U.S. government debt prices were also higher on Monday morning. The yield on the benchmark 10-year Treasury note, which moves inversely to price, was lower at around 2.366 percent, while the yield on the 30-year Treasury bond was also lower at 2.977 percent.

“Bond bears need some barnstorming data to remind us that the economy is in decent share,” Juckes added.

On the economic data front Monday, the Dallas Fed survey for March is scheduled to be released at around 10:30 a.m ET.

Monday will also see Red Hat and Synnex among the major companies due to report after the market close.

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Democrats, Buoyed by GOP Health Defeat, See No Need to Offer Hand

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Article source: https://www.nytimes.com/2017/03/26/us/politics/democrats-health-care-bill-trump.html

Schumer jumps at chance to work with Trump on health care, other issues

Senate Minority Leader Chuck Schumer on Sunday jumped at a chance to find common ground with President Trump on coming up with a solution to a new health care bill, as Trump’s aides opened the door to working with moderate Democrats on health care and other pressing issues.

Schumer, D-N.Y., said Trump must be willing to drop attempts to repeal Barack Obama’s signature achievement, warning that Trump was destined to “lose again” on other parts of his agenda if he remained obligated to appease conservative Republicans.

“If he changes, he could have a different presidency,” Schumer said on ABC’s “This Week.” “But he’s going to have to tell the Freedom Caucus and the hard-right special wealthy interests who are dominating his presidency … he can’t work with them, and we’ll certainly look at his proposals.”

Trump turned the blame for the failure of the health care law from the Democrats to conservative lawmakers Sunday, tweeting: “Democrats are smiling in D.C. that the Freedom Caucus, with the help of Club For Growth and Heritage, have saved Planned Parenthood Ocare!” The bill was pulled from the House floor Friday in a defeat for the Trump, having lacked support from conservative Republicans, some moderate Republicans and Democrats.

Trump aides made it clear Sunday that the president could seek support from moderate Democrats on upcoming legislative battles ranging from budget and tax cuts to health care, leaving the door open on possibly revisiting new health care legislation.

White House chief of staff Reince Priebus scolded conservative Republicans, explaining that Trump had felt “disappointed” with a “number of people he thought were loyal to him that weren’t.”

“It’s time for the party to start governing,” Priebus told “Fox News Sunday”. “I think it’s time for our folks to come together, and I also think it’s time to potentially get a few moderate Democrats on board as well.”

The health-care bill’s failure caused a ripple effect in the Freedom Caucus.

Rep. Ted Poe, R-Texas, resigned from the group. Poe intended to vote in favor of the bill and personally told Trump last week that he would support the measure. He resigned hours after Trump’s tweet.

Rep. Mark Meadows, R-N.C., chairman of the Freedom Caucus, told ABC’s “The Week” that he was doing a lot of “self-critiquing” after the health care defeat. He insisted the GOP overhaul effort was not over and that he regretted not spending more time with moderate Republicans and Democrats “to find some consensus.”

Much of the blame has been directed at the conservative group and its roughly 35 members, after House Speaker Paul Ryan realized that he didn’t have enough support for the bill in the GOP-led chamber and canceled the final vote Friday.

Ryan purportedly needed about 20 more votes, mostly from Freedom Caucus members and a handful of GOP House moderates.

Trump and Ryan spoke Saturday and Sunday. Ryan spokeswoman AshLee Strong said the leaders spoke Saturday for roughly an hour about “moving forward on (their) agenda” and that their relationship is “stronger than ever right now.”

The Associated Press contributed to this report.

Article source: http://www.foxnews.com/politics/2017/03/27/schumer-jumps-at-chance-to-work-with-trump-on-health-care-other-issues.html

Health Bill’s Failure Leaves Supporters in a Political Jam Back Home

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Article source: https://www.nytimes.com/2017/03/25/us/trump-supporters-gop-health-bill.html

Worries About Health, Prejudice And Immigration Swirl At LA Clinic …

Dr. Cesar Barba (right), a family physician at the UMMA Community Clinic’s Fremont Wellness Center in South Los Angeles, treats Lourdes Flores Valdez, 42, for her diabetes and other health issues.

Maya Sugarman/KPCC


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Dr. Cesar Barba (right), a family physician at the UMMA Community Clinic’s Fremont Wellness Center in South Los Angeles, treats Lourdes Flores Valdez, 42, for her diabetes and other health issues.

Maya Sugarman/KPCC

Lourdes Flores Valdez says she got her diabetes under control after she was able to sign up for Medi-Cal, California’s version of Medicaid, under the Affordable Care Act’s expanded eligibility rules. Sitting in an exam room at the UMMA Community Clinic’s Fremont Wellness Center in South Los Angeles, she suddenly veers away from discussing the health law and starts talking about her husband, who is in the United States illegally.

“If the president takes away my husband’s job, or he deports him, what will happen?” asks Flores, who cleans houses for a living. “How am I going to take care of the children?”

Clinic staff say they’re hearing such worries a lot these days from their mainly Latino clientele, about a third of whom are unauthorized immigrants. Many patients are worried about losing their access to health care and about possible deportation.

Dr. Cesar Barba says he’s had to spend more time since the November election teaching patients coping skills to deal with stress that can affect their health. Many are on Medicaid and some are immigrants.

Maya Sugarman/KPCC


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Dr. Cesar Barba says he’s had to spend more time since the November election teaching patients coping skills to deal with stress that can affect their health. Many are on Medicaid and some are immigrants.

Maya Sugarman/KPCC

Some patients have stopped coming in, says Dr. Yousef Turshani, UMMA’s chief medical officer.

“They’re worried that we may be a target and are concerned to even come get their health care, because there may be a raid,” he says in an interview at the group’s main clinic, less than two miles away from the Wellness Center.

Some patients worried about losing their Medi-Cal are stockpiling medications, says Turshani.

The clinic had been planning to expand its mental health services before the last election, but now that Donald Trump is president, Turshani says, the need for those services is even greater than before. The clinic has a backlog of people waiting to see a therapist.

“The worry is so deep for some patients that they feel it’s almost like another medical problem, because it contributes so much to their daily stress,” says Dr. Cesar Barba, a family physician and UMMA provider.

Turshani says despite the uncertainty in the country, he and the health staff strive to make their clinics safe places for all patients. A group of American Muslim doctors and medical students opened the clinic 20 years ago, motivated by a desire to help the community in the wake of the 1992 Rodney King riots.

Some of the walls at UMMA’s main clinic are decorated with paintings featuring Arabic scripture. Turshani translates one phrase: ” ‘In the name of God, most gracious, most merciful.’ It’s something that’s placed in rooms to welcome people,” he explains, “to say that this is a place where you’ll be treated well.”

The community clinic is a nonprofit founded by Muslim Americans, the children of immigrants, to bring good health care to the poor of South Los Angeles more than 20 years ago. Today, four of the clinic’s nine health care providers are Muslim.

Maya Sugarman/KPCC


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The community clinic is a nonprofit founded by Muslim Americans, the children of immigrants, to bring good health care to the poor of South Los Angeles more than 20 years ago. Today, four of the clinic’s nine health care providers are Muslim.

Maya Sugarman/KPCC

Patients need reassurance, and so do some of the doctors. Four of UMMA’s nine physicians are Muslim.

Dr. Sahar Abdelrahman, a pediatrician and the daughter of Sudanese immigrants, was born in the U.S. and raised in Madison, Wis. She says Trump’s attempted travel ban was upsetting.

Dr. Sahar Abdelrahman, an internist and pediatrican at the UMMA clinic, was raised in Madison, Wisc., where she also studied medicine. Her parents were Sudanese immigrants — her father has a green card — and the proposed travel ban has been upsetting, she says.

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Dr. Sahar Abdelrahman, an internist and pediatrican at the UMMA clinic, was raised in Madison, Wisc., where she also studied medicine. Her parents were Sudanese immigrants — her father has a green card — and the proposed travel ban has been upsetting, she says.

Maya Sugarman/KPCC

“This is the only country I know,” Abdelrahman says. “This is my home, and to not feel like you’re welcome here — it’s hard.”

Miriam Vega, a social psychologist and UMMA’s CEO, agrees that the policy and rhetoric coming out of Washington has been stressful for the clinic’s patients and staff. “We’re kind of like a snow globe, or a microcosm of what’s occurring at the national level,” she says.

Turshani says his religion provides a guide for how the clinic’s physicians should juggle their patients’ stress and their own anxieties.

“There’s actually a teaching in Islam which is, when God wants to reward someone, he puts them through a challenge,” Turshani says. “There are analogous sayings — like what doesn’t kill you makes you stronger.”

This story is part of NPR’s reporting partnership with local member stations and Kaiser Health News. Rebecca Plevin is a health reporter at KPPC.

Article source: http://www.npr.org/sections/health-shots/2017/03/25/520813613/los-angeles-health-clinic-a-microcosm-of-the-nations-anxieties

Sources: Trump learned a lesson on dealmaking

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Article source: http://www.cnn.com/2017/03/25/politics/donald-trump-lesson-deal-making-health-care/

Republicans Land a Punch on Health Care, to Their Own Face

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Article source: https://www.nytimes.com/2017/03/24/us/politics/house-republicans-health-care-paul-ryan.html