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.

State Senator Office Location Phone Number
Alabama Strange, Luther Birmingham (205) 731-1500
Alabama Strange, Luther Huntsville (256) 533-0979
Alabama Strange, Luther Mobile (251) 414-3083
Alabama Strange, Luther Montgomery (334) 230-0698
Alabama Strange, Luther Washington, D.C. (202) 224-4124
Alabama Strange, Luther Wiregrass (334) 792-4924
Alabama Shelby, Richard Birmingham (205) 731-1384
Alabama Shelby, Richard Huntsville (256) 772-0460
Alabama Shelby, Richard Mobile (251) 694-4164
Alabama Shelby, Richard Montgomery (334) 223-7303
Alabama Shelby, Richard Tuscaloosa (205) 759-5047
Alabama Shelby, Richard Washington, D.C. (202) 224-5744
Alaska Murkowski, Lisa Anchorage (907) 271-3735
Alaska Murkowski, Lisa Fairbanks (907) 456-0233
Alaska Murkowski, Lisa Juneau (907) 586-7277
Alaska Murkowski, Lisa Kenai (907) 283-5808
Alaska Murkowski, Lisa Ketchikan (907) 225-6880
Alaska Murkowski, Lisa Mat-Su Valley (907) 376-7665
Alaska Murkowski, Lisa Washington, D.C. (202) 224-6665
Alaska Sullivan, Dan Anchorage (907) 271-5915
Alaska Sullivan, Dan Fairbanks (907) 456-0261
Alaska Sullivan, Dan Juneau (907) 586-7277
Alaska Sullivan, Dan Kenai (907) 283-4000
Alaska Sullivan, Dan Ketchikan (907) 225-6880
Alaska Sullivan, Dan Mat-Su Valley (907) 357-9956
Alaska Sullivan, Dan Washington, D.C. (202) 224-3004
Arizona Flake, Jeff Phoenix (602) 840-1891
Arizona Flake, Jeff Tucson (520) 575-8633
Arizona Flake, Jeff Washington, D.C. (202) 224-4521
Arizona McCain, John Phoenix (602) 952-2410
Arizona McCain, John Prescott (928) 445-0833
Arizona McCain, John Tucson (520) 670-6334
Arizona McCain, John Washington, D.C. (202) 224-2235
Arkansas Boozman, John El Dorado (870) 863-4641
Arkansas Boozman, John Fort Smith (479) 573-0189
Arkansas Boozman, John Jonesboro (870) 268-6925
Arkansas Boozman, John Little Rock (501) 372-7153
Arkansas Boozman, John Lowell (479) 725-0400
Arkansas Boozman, John Mountain Home (870) 424-0129
Arkansas Boozman, John Stuttgart (870) 672-6941
Arkansas Boozman, John Washington, D.C. (202) 224-4843
Arkansas Cotton, Tom El Dorado (870) 864-8582
Arkansas Cotton, Tom Jonesboro (870) 933-6223
Arkansas Cotton, Tom Little Rock (501) 223-9081
Arkansas Cotton, Tom Springdale (479) 751-0879
Arkansas Cotton, Tom Washington, D.C. (202) 224-2353
California Feinstein, Dianne Fresno (559) 485-7430
California Feinstein, Dianne Los Angeles (310) 914-7300
California Feinstein, Dianne San Diego (619) 231-9712
California Feinstein, Dianne San Francisco (415) 393-0707
California Feinstein, Dianne Washington, D.C. (202) 224-3841
California Harris, Kamala Fresno (916) 448-2787
California Harris, Kamala Los Angeles (213) 894-5000
California Harris, Kamala Sacramento (916) 448-2787
California Harris, Kamala San Diego (619) 239-3884
California Harris, Kamala San Francisco (213) 894-5000
California Harris, Kamala Washington, D.C. (202) 224-3553
Colorado Bennet, Michael Arkansas Valley (719) 542-7550
Colorado Bennet, Michael Denver Metro (303) 455-7600
Colorado Bennet, Michael Four Corners (970) 259-1710
Colorado Bennet, Michael Northern Colorado (970) 224-2200
Colorado Bennet, Michael Northwest/I-70W (970) 241-6631
Colorado Bennet, Michael Pikes Peak (719) 328-1100
Colorado Bennet, Michael San Luis Valley (719) 587-0096
Colorado Bennet, Michael Washington, D.C. (202) 224-5852
Colorado Gardner, Cory Colorado Springs (719) 632-6706
Colorado Gardner, Cory Denver (303) 391-5777
Colorado Gardner, Cory Fort Collins (970) 484-3502
Colorado Gardner, Cory Grand Junction (970) 245-9553
Colorado Gardner, Cory Greeley (970) 352-5546
Colorado Gardner, Cory Pueblo (719) 543-1324
Colorado Gardner, Cory Washington, D.C. (202) 224-5941
Colorado Gardner, Cory Yuma (970) 848-3095
Connecticut Blumenthal, Richard Bridgeport (203) 330-0598
Connecticut Blumenthal, Richard Hartford (860) 258-6940
Connecticut Blumenthal, Richard Washington, D.C. (202) 224-2823
Connecticut Murphy, Chris Hartford (860) 549-8463
Connecticut Murphy, Chris Washington, D.C. (202) 224-4041
Delaware Carper, Tom Dover (302) 674-3308
Delaware Carper, Tom Georgetown (302) 856-7690
Delaware Carper, Tom Washington, D.C. (202) 224-2441
Delaware Carper, Tom Wilmington (302) 573-6291
Delaware Coons, Chris Dover (302) 736-5601
Delaware Coons, Chris Washington, D.C. (202) 224-5042
Delaware Coons, Chris Wilmington (302) 573-6345
Florida Nelson, Bill Broward (954) 693-4851
Florida Nelson, Bill Fort Myers (239) 334-7760
Florida Nelson, Bill Jacksonville (904) 346-4500
Florida Nelson, Bill Miami-Dade (305) 536-5999
Florida Nelson, Bill Orlando (407) 872-7161
Florida Nelson, Bill Tallahassee (850) 942-8415
Florida Nelson, Bill Tampa (813) 225-7040
Florida Nelson, Bill Washington, D.C. (202) 224-5274
Florida Nelson, Bill West Palm Beach (561) 514-0189
Florida Rubio, Marco Jacksonville (904) 398-8586
Florida Rubio, Marco Miami (305) 418-8553
Florida Rubio, Marco Naples (239) 213-1521
Florida Rubio, Marco Orlando (407) 254-2573
Florida Rubio, Marco Palm Beach (561) 775-3360
Florida Rubio, Marco Pensacola (850) 433-2603
Florida Rubio, Marco Tallahassee (850) 599-9100
Florida Rubio, Marco Tampa (813) 287-5035
Florida Rubio, Marco Washington, D.C. (202) 224-3041
Georgia Isakson, Johnny Atlanta (770) 661-0999
Georgia Isakson, Johnny Washington, D.C. (202) 224-3643
Georgia Perdue, David Atlanta (404) 865-0087
Georgia Perdue, David Washington, D.C. (202) 224-3521
Hawaii Hirono, Mazie Hawaii (808) 522-8970
Hawaii Hirono, Mazie Washington, D.C. (202) 224-6361
Hawaii Schatz, Brian Honolulu (808) 523-2061
Hawaii Schatz, Brian Washington, D.C. (202) 224-3934
Idaho Crapo, Mike Eastern Idaho, North (208) 522-9779
Idaho Crapo, Mike Eastern Idaho, South (208) 236-6775
Idaho Crapo, Mike Idaho State (208) 334-1776
Idaho Crapo, Mike North Idaho (208) 664-5490
Idaho Crapo, Mike North-Central Idaho (208) 743-1492
Idaho Crapo, Mike South-Central Idaho (208) 734-2515
Idaho Crapo, Mike Washington, D.C. (202) 224-6142
Idaho Risch, Jim Boise (208) 342-7985
Idaho Risch, Jim Coeur D’Alene (208) 667-6130
Idaho Risch, Jim Idaho Falls (208) 523-5541
Idaho Risch, Jim Lewiston (208) 743-0792
Idaho Risch, Jim Pocatello (208) 236-6817
Idaho Risch, Jim Twin Falls (208) 734-6780
Idaho Risch, Jim Washington, D.C. (202) 224-2752
Illinois Duckworth, Tammy Chicago (312) 886-3506
Illinois Duckworth, Tammy Washington, D.C. (202) 224-2854
Illinois Durbin, Richard Carbondale (618) 351-1122
Illinois Durbin, Richard Chicago (312) 353-4952
Illinois Durbin, Richard Rock Island (309) 786-5173
Illinois Durbin, Richard Springfield (217) 492-4062
Illinois Durbin, Richard Washington, D.C. (202) 224-2152
Indiana Donnelly, Joe Evansville (812) 425-5813
Indiana Donnelly, Joe Fort Wayne (260) 420-4955
Indiana Donnelly, Joe Hammond (219) 852-0089
Indiana Donnelly, Joe Indianapolis (317) 226-5555
Indiana Donnelly, Joe Jeffersonville (812) 284-2027
Indiana Donnelly, Joe South Bend (574) 288-2780
Indiana Donnelly, Joe Washington, D.C. (202) 224-4814
Indiana Young, Todd Evansville
Indiana Young, Todd Fort Wayne
Indiana Young, Todd Indianapolis (317) 226-6700
Indiana Young, Todd New Albany (812) 542-4820
Indiana Young, Todd Washington, D.C. (202) 224-5623
Iowa Ernst, Joni Cedar Rapids (319) 365-4504
Iowa Ernst, Joni Council Bluffs (712) 352-1167
Iowa Ernst, Joni Davenport (563) 322-0677
Iowa Ernst, Joni Des Moines (515) 284-4574
Iowa Ernst, Joni Sioux City (712) 252-1550
Iowa Ernst, Joni Washington, D.C. (202) 224-3254
Iowa Grassley, Chuck Cedar Rapids (319) 363-6832
Iowa Grassley, Chuck Council Bluffs (712) 322-7103
Iowa Grassley, Chuck Davenport (563) 322-4331
Iowa Grassley, Chuck Des Moines (515) 288-1145
Iowa Grassley, Chuck Sioux City (712) 233-1860
Iowa Grassley, Chuck Washington, D.C. (202) 224-3744
Iowa Grassley, Chuck Waterloo (319) 232-6657
Kansas Moran, Jerry Hays (785) 628-6401
Kansas Moran, Jerry Manhattan (785) 539-8973
Kansas Moran, Jerry Olathe (913) 393-0711
Kansas Moran, Jerry Pittsburg (620) 232-2286
Kansas Moran, Jerry Washington, D.C. (202) 224-6521
Kansas Moran, Jerry Wichita (316) 631-1410
Kansas Roberts, Pat Dodge City (620) 227-2244
Kansas Roberts, Pat Overland Park (913) 451-9343
Kansas Roberts, Pat Topeka (785) 295-2745
Kansas Roberts, Pat Washington, D.C. (202) 224-4774
Kansas Roberts, Pat Wichita (316) 263-0416
Kentucky McConnell, Mitch Bowling Green (270) 781-1673
Kentucky McConnell, Mitch Ft. Wright (859) 578-0188
Kentucky McConnell, Mitch Lexington (859) 224-8286
Kentucky McConnell, Mitch London (606) 864-2026
Kentucky McConnell, Mitch Louisville (502) 582-6304
Kentucky McConnell, Mitch Paducah (270) 442-4554
Kentucky McConnell, Mitch Washington, D.C. (202) 224-2541
Kentucky Paul, Rand Bowling Green (270) 782-8303
Kentucky Paul, Rand Crescent Springs (859) 426-0165
Kentucky Paul, Rand Hopkinsville (270) 885-1212
Kentucky Paul, Rand Lexington (859) 219-2239
Kentucky Paul, Rand Louisville (502) 582-5341
Kentucky Paul, Rand Owensboro (270) 689-9085
Kentucky Paul, Rand Washington, D.C. (202) 224-4343
Lousiana Cassidy, Bill Alexandria (318) 448-7176
Lousiana Cassidy, Bill Baton Rouge (225) 929-7711
Lousiana Cassidy, Bill Lafayette (337) 261-1400
Lousiana Cassidy, Bill Lake Charles (337) 493-5398
Lousiana Cassidy, Bill Metairie (504) 838-0130
Lousiana Cassidy, Bill Monroe (318) 324-2111
Lousiana Cassidy, Bill Shreveport (318) 798-3215
Lousiana Cassidy, Bill Washington, D.C. (202) 224-5824
Lousiana Kennedy, John Washington, D.C. (202) 224-4623
Maine Collins, Susan Augusta (207) 622-8414
Maine Collins, Susan Bangor (207) 945-0417
Maine Collins, Susan Biddeford (207) 283-1101
Maine Collins, Susan Caribou (207) 493-7873
Maine Collins, Susan Lewiston (207) 784-6969
Maine Collins, Susan Portland (207) 780-3575
Maine Collins, Susan Washington, D.C. (202) 224-2523
Maine King, Angus Augusta (207) 622-8292
Maine King, Angus Bangor (207) 945-8000
Maine King, Angus Presque Isle (207) 764-5124
Maine King, Angus Scarborough (207) 883-1588
Maine King, Angus Washington, D.C. (202) 224-5344
Maryland Cardin, Ben Baltimore (410) 962-4436
Maryland Cardin, Ben Bowie (301) 860-0414
Maryland Cardin, Ben Cumberland (301) 777-2957
Maryland Cardin, Ben Rockville (301) 762-2974
Maryland Cardin, Ben Salisbury (410) 546-4250
Maryland Cardin, Ben Southern Maryland (202) 870-1164
Maryland Cardin, Ben Washington, D.C. (202) 224-4524
Maryland Van Hollen, Chris Washington, D.C. (202) 224-4654
Massachusetts Markey, Ed Boston (617) 565-8519
Massachusetts Markey, Ed Fall River (508) 677-0523
Massachusetts Markey, Ed Springfield (413) 785-4610
Massachusetts Markey, Ed Washington, D.C. (202) 224-2742
Massachusetts Warren, Elizabeth Boston (617) 565-3170
Massachusetts Warren, Elizabeth Springfield (413) 788-2690
Massachusetts Warren, Elizabeth Washington, D.C. (202) 224-4543
Michigan Peters, Gary Detroit (313) 226-6020
Michigan Peters, Gary Grand Rapids (616) 233-9150
Michigan Peters, Gary Lansing (517) 377-1508
Michigan Peters, Gary Marquette (906) 226-4554
Michigan Peters, Gary Rochester (248) 608-8040
Michigan Peters, Gary Saginaw (989) 754-0112
Michigan Peters, Gary Traverse City (231) 947-7773
Michigan Peters, Gary Washington, D.C. (202) 224-6221
Michigan Stabenow, Debbie Flint/Saginaw Bay (810) 720-4172
Michigan Stabenow, Debbie Mid-Michigan (517) 203-1760
Michigan Stabenow, Debbie Northern Michigan (231) 929-1031
Michigan Stabenow, Debbie Southeast Michigan (313) 961-4330
Michigan Stabenow, Debbie Upper Peninsula (906) 228-8756
Michigan Stabenow, Debbie Washington, D.C. (202) 224-4822
Michigan Stabenow, Debbie West Michigan (616) 975-0052
Minnesota Franken, Al Duluth (218) 722-2390
Minnesota Franken, Al Moorhead (218) 284-8721
Minnesota Franken, Al Rochester (507) 288-2003
Minnesota Franken, Al Saint Paul (651) 221-1016
Minnesota Franken, Al Washington, D.C. (202) 224-5641
Minnesota Klobuchar, Amy Metro (612) 727-5220
Minnesota Klobuchar, Amy Northeastern (218) 741-9690
Minnesota Klobuchar, Amy Northwestern & Central (218) 287-2219
Minnesota Klobuchar, Amy Southern (507) 288-5321
Minnesota Klobuchar, Amy Washington, D.C. (202) 224-3244
Mississippi Cochran, Thad Gulf Coast (228) 867-9710
Mississippi Cochran, Thad Jackson (601) 965-4459
Mississippi Cochran, Thad Oxford (662) 236-1018
Mississippi Cochran, Thad Washington, D.C. (202) 224-5054
Mississippi Wicker, Roger Gulfport (228) 871-7017
Mississippi Wicker, Roger Hernando (662) 429-1002
Mississippi Wicker, Roger Jackson (601) 965-4644
Mississippi Wicker, Roger Tupelo (662) 844-5010
Mississippi Wicker, Roger Washington, D.C. (202) 224-6253
Missouri Blunt, Roy Cape Girardeau (573) 334-7044
Missouri Blunt, Roy Columbia (573) 442-8151
Missouri Blunt, Roy Kansas City (816) 471-7141
Missouri Blunt, Roy Springfield (417) 877-7814
Missouri Blunt, Roy St. Louis/Clayton (314) 725-4484
Missouri Blunt, Roy Washington, D.C. (202) 224-5721
Missouri McCaskill, Claire Cape Girardeau (573) 651-0964
Missouri McCaskill, Claire Columbia (573) 442-7130
Missouri McCaskill, Claire Kansas City (816) 421-1639
Missouri McCaskill, Claire Springfield (417) 868-8745
Missouri McCaskill, Claire St. Louis (314) 367-1364
Missouri McCaskill, Claire Washington, D.C. (202) 224-6154
Montana Daines, Steve Billings (406) 245-6822
Montana Daines, Steve Bozeman (406) 587-3446
Montana Daines, Steve Great Falls (406) 453-0148
Montana Daines, Steve Hardin (406) 665-4126
Montana Daines, Steve Helena (406) 443-3189
Montana Daines, Steve Kalispell (406) 257-3765
Montana Daines, Steve Missoula (406) 549-8198
Montana Daines, Steve Sidney (406) 482-9010
Montana Daines, Steve Washington, D.C. (202) 224-2651
Montana Tester, Jon Billings (406) 252-0550
Montana Tester, Jon Bozeman (406) 586-4450
Montana Tester, Jon Butte (406) 723-3277
Montana Tester, Jon Glendive (406) 365-2391
Montana Tester, Jon Great Falls (406) 452-9585
Montana Tester, Jon Helena (406) 449-5401
Montana Tester, Jon Kalispell (406) 257-3360
Montana Tester, Jon Missoula (406) 728-3003
Montana Tester, Jon Washington, D.C. (202) 224-2644
Nebraska Fischer, Deb Kearney (308) 234-2361
Nebraska Fischer, Deb Lincoln (402) 441-4600
Nebraska Fischer, Deb Norfolk (402) 200-8816
Nebraska Fischer, Deb Omaha (402) 391-3411
Nebraska Fischer, Deb Scottsbluff (308) 630-2329
Nebraska Fischer, Deb Washington, D.C. (202) 224-6551
Nebraska Sasse, Ben Kearney (308) 233-3677
Nebraska Sasse, Ben Lincoln (402) 476-1400
Nebraska Sasse, Ben Omaha (402) 550-8040
Nebraska Sasse, Ben Scottsbluff (308) 632-6032
Nebraska Sasse, Ben Washington, D.C. (202) 224-4224
Nevada Cortez Masto, Catherine Las Vegas (702) 388-5020
Nevada Cortez Masto, Catherine Reno (775) 686-5750
Nevada Cortez Masto, Catherine Washington, D.C. (202) 224-3542
Nevada Heller, Dean Las Vegas (702) 388-6605
Nevada Heller, Dean Reno (775) 686-5770
Nevada Heller, Dean Washington, D.C. (202) 224-6244
New Hampshire Hassan, Maggie Manchester (603) 622-2204
New Hampshire Hassan, Maggie Washington, D.C. (202) 224-3324
New Hampshire Shaheen, Jeanne Berlin (603) 752-6300
New Hampshire Shaheen, Jeanne Claremont (603) 542-4872
New Hampshire Shaheen, Jeanne Dover (603) 750-3004
New Hampshire Shaheen, Jeanne Keene (603) 358-6604
New Hampshire Shaheen, Jeanne Manchester (603) 647-7500
New Hampshire Shaheen, Jeanne Nashua (603) 883-0196
New Hampshire Shaheen, Jeanne Washington, D.C. (202) 224-2841
New Jersey Booker, Cory Camden (856) 338-8922
New Jersey Booker, Cory Newark (973) 639-8700
New Jersey Booker, Cory Washington, D.C. (202) 224-3224
New Jersey Menendez, Bob Barrington (856) 757-5353
New Jersey Menendez, Bob Newark (973) 645-3030
New Jersey Menendez, Bob Washington, D.C. (202) 224-4744
New Mexico Heinrich, Martin Albuquerque (505) 346-6601
New Mexico Heinrich, Martin Farmington (505) 325-5030
New Mexico Heinrich, Martin Las Cruces (575) 523-6561
New Mexico Heinrich, Martin Roswell (575) 622-7113
New Mexico Heinrich, Martin Santa Fe (505) 988-6647
New Mexico Heinrich, Martin Washington, D.C. (202) 224-5521
New Mexico Udall, Tom Albuquerque (505) 346-6791
New Mexico Udall, Tom Carlsbad (575) 234-0366
New Mexico Udall, Tom Eastside (575) 356-6811
New Mexico Udall, Tom Las Cruces (575) 526-5475
New Mexico Udall, Tom Santa Fe (505) 988-6511
New Mexico Udall, Tom Washington, D.C. (202) 224-6621
New York Gillibrand, Kirsten Albany (518) 431-0120
New York Gillibrand, Kirsten Buffalo (716) 854-9725
New York Gillibrand, Kirsten Hudson Valley (845) 875-4585
New York Gillibrand, Kirsten Long Island (631) 249-2825
New York Gillibrand, Kirsten New York City (212) 688-6262
New York Gillibrand, Kirsten North Country (315) 376-6118
New York Gillibrand, Kirsten Rochester (585) 263-6250
New York Gillibrand, Kirsten Syracuse (315) 448-0470
New York Gillibrand, Kirsten Washington, D.C. (202) 224-4451
New York Schumer, Chuck Albany (518) 431-4070
New York Schumer, Chuck Binghamton (607) 772-6792
New York Schumer, Chuck Buffalo (716) 846-4111
New York Schumer, Chuck Melville (631) 753-0978
New York Schumer, Chuck New York City (212) 486-4430
New York Schumer, Chuck Peekskill (914) 734-1532
New York Schumer, Chuck Rochester (585) 263-5866
New York Schumer, Chuck Syracuse (315) 423-5471
New York Schumer, Chuck Washington, D.C. (202) 224-6542
North Carolina Burr, Richard Asheville (828) 350-2437
North Carolina Burr, Richard Gastonia (704) 833-0854
North Carolina Burr, Richard Rocky Mount (252) 977-9522
North Carolina Burr, Richard Washington, D.C. (202) 224-3154
North Carolina Burr, Richard Wilmington (910) 251-1058
North Carolina Burr, Richard Winston-Salem (336) 631-5125
North Carolina Tillis, Thom Charlotte (704) 509-9087
North Carolina Tillis, Thom Greenville (252) 329-0371
North Carolina Tillis, Thom Hendersonville (828) 693-8750
North Carolina Tillis, Thom High Point (336) 885-0685
North Carolina Tillis, Thom Raleigh (919) 856-4630
North Carolina Tillis, Thom Washington, D.C. (202) 224-6342
North Dakota Heitkamp, Heidi Bismarck (701) 258-4648
North Dakota Heitkamp, Heidi Dickinson (701) 225-0974
North Dakota Heitkamp, Heidi Fargo (701) 232-8030
North Dakota Heitkamp, Heidi Grand Forks (701) 775-9601
North Dakota Heitkamp, Heidi Minot (701) 852-0703
North Dakota Heitkamp, Heidi Washington, D.C. (202) 224-2043
North Dakota Hoeven, John Bismarck (701) 250-4618
North Dakota Hoeven, John Fargo (701) 239-5389
North Dakota Hoeven, John Grand Forks (701) 746-8972
North Dakota Hoeven, John Minot (701) 838-1361
North Dakota Hoeven, John Washington, D.C. (202) 224-2551
North Dakota Hoeven, John Western North Dakota (701) 580-4535
Ohio Brown, Sherrod Cincinnati (513) 684-1021
Ohio Brown, Sherrod Cleveland (216) 522-7272
Ohio Brown, Sherrod Columbus (614) 469-2083
Ohio Brown, Sherrod Lorain (440) 242-4100
Ohio Brown, Sherrod Washington, D.C. (202) 224-2315
Ohio Portman, Rob Cincinnati (513) 684-3265
Ohio Portman, Rob Cleveland (216) 522-7095
Ohio Portman, Rob Columbus (614) 469-6774
Ohio Portman, Rob Toledo (419) 259-3895
Ohio Portman, Rob Washington, D.C. (202) 224-3353
Oklahoma Inhofe, Jim Enid (580) 234-5105
Oklahoma Inhofe, Jim McAlester (918) 426-0933
Oklahoma Inhofe, Jim Oklahoma City (405) 608-4381
Oklahoma Inhofe, Jim Tulsa (918) 748-5111
Oklahoma Inhofe, Jim Washington, D.C. (202) 224-4721
Oklahoma Lankford, James Oklahoma City (405) 231-4941
Oklahoma Lankford, James Tulsa (918) 581-7651
Oklahoma Lankford, James Washington, D.C. (202) 224-5754
Oregon Merkley, Jeff Bend (541) 318-1298
Oregon Merkley, Jeff Eugene (541) 465-6750
Oregon Merkley, Jeff Medford (541) 608-9102
Oregon Merkley, Jeff Pendleton (541) 278-1129
Oregon Merkley, Jeff Portland (503) 326-3386
Oregon Merkley, Jeff Salem (503) 362-8102
Oregon Merkley, Jeff Washington, D.C. (202) 224-3753
Oregon Wyden, Ron Bend (541) 330-9142
Oregon Wyden, Ron Eugene (541) 431-0229
Oregon Wyden, Ron La Grande (541) 962-7691
Oregon Wyden, Ron Medford (541) 858-5122
Oregon Wyden, Ron Portland (503) 326-7525
Oregon Wyden, Ron Salem (503) 589-4555
Oregon Wyden, Ron Washington, D.C. (202) 224-5244
Pennsylvania Casey, Bob Central Pa (814) 357-0314
Pennsylvania Casey, Bob Erie (814) 874-5080
Pennsylvania Casey, Bob Harrisburg (717) 231-7540
Pennsylvania Casey, Bob Lehigh Valley (610) 782-9470
Pennsylvania Casey, Bob Northeastern (570) 941-0930
Pennsylvania Casey, Bob Philadelphia (215) 405-9660
Pennsylvania Casey, Bob Pittsburgh (412) 803-7370
Pennsylvania Casey, Bob Washington, D.C. (202) 224-6324
Pennsylvania Toomey, Pat Allentown/Lehigh Valley (610) 434-1444
Pennsylvania Toomey, Pat Erie (814) 453-3010
Pennsylvania Toomey, Pat Harrisburg (717) 782-3951
Pennsylvania Toomey, Pat Johnstown (814) 266-5970
Pennsylvania Toomey, Pat Philadelphia (215) 241-1090
Pennsylvania Toomey, Pat Pittsburgh (412) 803-3501
Pennsylvania Toomey, Pat Scranton (570) 941-3540
Pennsylvania Toomey, Pat Washington, D.C. (202) 224-4254
Rhode Island Reed, Jack Cranston (401) 943-3100
Rhode Island Reed, Jack Providence (401) 528-5200
Rhode Island Reed, Jack Washington, D.C. (202) 224-4642
Rhode Island Whitehouse, Sheldon Providence (401) 453-5294
Rhode Island Whitehouse, Sheldon Washington, D.C. (202) 224-2921
South Carolina Graham, Lindsey Golden Corner (864) 646-4090
South Carolina Graham, Lindsey Lowcountry (843) 849-3887
South Carolina Graham, Lindsey Midlands (803) 933-0112
South Carolina Graham, Lindsey Pee Dee (843) 669-1505
South Carolina Graham, Lindsey Piedmont (803) 366-2828
South Carolina Graham, Lindsey Upstate (864) 250-1417
South Carolina Graham, Lindsey Washington, D.C. (202) 224-5972
South Carolina Scott, Tim Lowcountry (843) 727-4525
South Carolina Scott, Tim Midlands (803) 771-6112
South Carolina Scott, Tim Upstate (864) 233-5366
South Carolina Scott, Tim Washington, D.C. (202) 224-6121
South Dakota Rounds, Mike Aberdeen (605) 225-0366
South Dakota Rounds, Mike Pierre (605) 224-1450
South Dakota Rounds, Mike Rapid City (605) 343-5035
South Dakota Rounds, Mike Sioux Falls (605) 336-0486
South Dakota Rounds, Mike Washington, D.C. (202) 224-5842
South Dakota Thune, John Aberdeen (605) 225-8823
South Dakota Thune, John Rapid City (605) 348-7551
South Dakota Thune, John Sioux Falls (605) 334-9596
South Dakota Thune, John Washington, D.C. (202) 224-2321
Tennessee Alexander, Lamar Chattanooga (423) 752-5337
Tennessee Alexander, Lamar Jackson (731) 664-0289
Tennessee Alexander, Lamar Knoxville (865) 545-4253
Tennessee Alexander, Lamar Memphis (901) 544-4224
Tennessee Alexander, Lamar Nashville (615) 736-5129
Tennessee Alexander, Lamar Tri-Cities (423) 325-6240
Tennessee Alexander, Lamar Washington, D.C. (202) 224-4944
Tennessee Corker, Bob Chattanooga (423) 756-2757
Tennessee Corker, Bob Jackson (731) 664-2294
Tennessee Corker, Bob Knoxville (865) 637-4180
Tennessee Corker, Bob Memphis (901) 683-1910
Tennessee Corker, Bob Nashville (615) 279-8125
Tennessee Corker, Bob Tri-Cities (423) 753-2263
Tennessee Corker, Bob Washington, D.C. (202) 224-3344
Texas Cornyn, John Central Texas (512) 469-6034
Texas Cornyn, John East Texas (903) 593-0902
Texas Cornyn, John North Texas (972) 239-1310
Texas Cornyn, John South Central Texas (210) 224-7485
Texas Cornyn, John South Texas (956) 423-0162
Texas Cornyn, John Southeast Texas (713) 572-3337
Texas Cornyn, John Washington, D.C. (202) 224-2934
Texas Cornyn, John West Texas (806) 472-7533
Texas Cruz, Ted Central Texas (512) 916-5834
Texas Cruz, Ted East Texas (903) 593-5130
Texas Cruz, Ted North Texas (214) 599-8749
Texas Cruz, Ted South Texas (956) 686-7339
Texas Cruz, Ted South/Central Texas (210) 340-2885
Texas Cruz, Ted Southeast Texas (713) 718-3057
Texas Cruz, Ted Washington, D.C. (202) 224-5922
Utah Hatch, Orrin Cedar City (435) 586-8435
Utah Hatch, Orrin Ogden (801) 625-5672
Utah Hatch, Orrin Provo (801) 375-7881
Utah Hatch, Orrin Salt Lake City (801) 524-4380
Utah Hatch, Orrin St. George (435) 634-1795
Utah Hatch, Orrin Washington, D.C. (202) 224-5251
Utah Lee, Mike Ogden (801) 392-9633
Utah Lee, Mike Salt Lake City (801) 524-5933
Utah Lee, Mike St. George (435) 628-5514
Utah Lee, Mike Washington, D.C. (202) 224-5444
Vermont Leahy, Patrick Burlington (802) 863-2525
Vermont Leahy, Patrick Montpelier (802) 229-0569
Vermont Leahy, Patrick Washington, D.C. (202) 224-4242
Vermont Sanders, Bernie Burlington (802) 862-0697
Vermont Sanders, Bernie St. Johnsbury (802) 748-9269
Vermont Sanders, Bernie Washington, D.C. (202) 224-5141
Virginia Kaine, Tim Abingdon (276) 525-4790
Virginia Kaine, Tim Manassas (703) 361-3192
Virginia Kaine, Tim Richmond (804) 771-2221
Virginia Kaine, Tim Roanoke (540) 682-5693
Virginia Kaine, Tim Virginia Beach (757) 518-1674
Virginia Kaine, Tim Washington, D.C. (202) 224-4024
Virginia Kaine, Tim Washington, D.C. (202) 224-4024
Virginia Warner, Mark Abingdon (276) 628-8158
Virginia Warner, Mark Norfolk (757) 441-3079
Virginia Warner, Mark Richmond (804) 775-2314
Virginia Warner, Mark Roanoke (540) 857-2676
Virginia Warner, Mark Vienna (703) 442-0670
Virginia Warner, Mark Washington, D.C. (202) 224-2023
Washington Cantwell, Maria Everett (425) 303-0114
Washington Cantwell, Maria Richland (509) 946-8106
Washington Cantwell, Maria Seattle (206) 220-6400
Washington Cantwell, Maria Spokane (509) 353-2507
Washington Cantwell, Maria Tacoma (253) 572-2281
Washington Cantwell, Maria Vancouver (360) 696-7838
Washington Cantwell, Maria Washington, D.C. (202) 224-3441
Washington Murray, Patty Everett (425) 259-6515
Washington Murray, Patty Seattle (206) 553-5545
Washington Murray, Patty Spokane (509) 624-9515
Washington Murray, Patty Tacoma (253) 572-3636
Washington Murray, Patty Vancouver (360) 696-7797
Washington Murray, Patty Washington, D.C. (202) 224-2621
Washington Murray, Patty Yakima (509) 453-7462
West Virginia Capito, Shelley Moore Beckley (304) 347-5372
West Virginia Capito, Shelley Moore Charleston (304) 347-5372
West Virginia Capito, Shelley Moore Martinsburg (304) 262-9285
West Virginia Capito, Shelley Moore Morgantown (304) 292-2310
West Virginia Capito, Shelley Moore Washington, D.C. (202) 224-6472
West Virginia Manchin, Joe Charleston (304) 342-5855
West Virginia Manchin, Joe Eastern Panhandle (304) 264-4626
West Virginia Manchin, Joe Fairmont (304) 368-0567
West Virginia Manchin, Joe Washington, D.C. (202) 224-3954
Wisconsin Baldwin, Tammy Eau Claire (715) 832-8424
Wisconsin Baldwin, Tammy Green Bay (920) 498-2668
Wisconsin Baldwin, Tammy La Crosse (608) 796-0045
Wisconsin Baldwin, Tammy Madison (608) 264-5338
Wisconsin Baldwin, Tammy Milwaukee (414) 297-4451
Wisconsin Baldwin, Tammy Washington, D.C. (202) 224-5653
Wisconsin Baldwin, Tammy Wausau (715) 261-2611
Wisconsin Johnson, Ron Milwaukee (414) 276-7282
Wisconsin Johnson, Ron Oshkosh (920) 230-7250
Wisconsin Johnson, Ron Washington, D.C. (202) 224-5323
Wyoming Barrasso, John Casper (307) 261-6413
Wyoming Barrasso, John Cheyenne (307) 772-2451
Wyoming Barrasso, John Riverton (307) 856-6642
Wyoming Barrasso, John Rock Springs (307) 362-5012
Wyoming Barrasso, John Sheridan (307) 672-6456
Wyoming Barrasso, John Washington, D.C. (202) 224-6441
Wyoming Enzi, Michael Casper (307) 261-6572
Wyoming Enzi, Michael Cheyenne (307) 772-2477
Wyoming Enzi, Michael Cody (307) 527-9444
Wyoming Enzi, Michael Gillette (307) 682-6268
Wyoming Enzi, Michael Jackson (307) 739-9507
Wyoming Enzi, Michael Washington, 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


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.)


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.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) offers. Please share our page with your friends on WordPress. We are also on Facebook at SterlingMedicalAdvice.com and Twitter at @asksterlingmd.

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