Joanne pre-NYMHM: 16 Dec 2016 (Repeal and Replace)

President-Elect Trump and the Republican-led Congress are talking about repealing the Affordable Care Act, and then letting it sort of sit around still being in effect until they come up with something to replace it. This means a vote to repeal will happen in a policy vacuum.

They’re not going to simultaneously repeal it and replace it like they promised during the general election, because it turns out that you need something to replace it *with* in order to do that, and all they have right now is a piece of paper on which Trump has scrawled, “this is going to be so great you guys it’s the best healthcare the greatest.”

Trump’s big ideas that he talked about during the election were: make healthcare premiums tax-deductible, eliminate the individual mandate, retain the ban on pre-existing condition clauses, retain keeping people on their parents’ insurance until age 26, convert Medicaid into a block-grant program, and remove barriers to selling health insurance across state lines.

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Let’s talk about his ideas a little bit, ranked best to worst. (First off, a caveat: I work in healthcare as a frontline admin, and I read a lot because I’m interested in these issues, but I’m not an expert.)

Retain keeping people on their parents’ insurance until age 26:

This is good. (Oh god oh god I agree with Trump on something.)

Make healthcare premiums tax-deductible:

This is great for me and other people who pay taxes and have employers who provide good insurance, and kind of meaningless for the uninsured people who already don’t make enough money to pay taxes. It would help those small business owners and freelancers who have the cash liquidity to allow them to pay the premiums and then get paid back in a lump sum tax return. It would help the economy every April since people do tend to spend their tax rebates pretty quickly. It might make our deficit larger because of taking in fewer net taxes, I don’t know. I’m not against it, but as a proposed solution to a lack of coverage, it’s interesting as an example of Republicans (and Trump especially) not understanding what it’s like for people who live paycheck to paycheck.

Remove barriers to selling health insurance across state lines:

The theory is that insurers who can offer national plans regardless of where the patient lives will save money and reduce the price of insurance. One of the arguments against this is the “race to the bottom” one: insurers in states with a lot of tight regulations will get outbid by insurers in states with lax regulation, so effectively everybody in the country ends up under the laxest regulations. That’s not good, but I’m not sure that would actually happen – there’s no federal law (as far as I could find) preventing insurers from doing this, and there are some states that already allow out-of-state insurers but nonetheless have very few, so I presume insurers aren’t already doing it because it’s more hassle than it’s worth.

It’s a ton of work to set up the networks that would be needed in each location for this to work. I mean, my costs go way up if I try to see an out-of-network doctor. Just because somebody in (let’s say) New Hampshire has a really amazing insurance plan that’s cheap and includes every doctor in the state doesn’t mean that that plan would work for me, no matter how cheap it is, because I don’t want to travel to New Hampshire for care and that insurer may not have a good network of doctors set up in Tennessee.

I was able to find endorsements for this idea from Ted Cruz, Rand Paul, Marco Rubio, Rick Santorum, and Scott Walker, who all like to talk about states’ rights except for when they don’t care about states’ rights, like with this idea, which tramples all over states’ desire to regulate their own stuff.

Eliminate the individual mandate, and retain the ban on pre-existing condition clauses:

I’ve put these two ideas together even though Trump isn’t talking about them together, because the individual mandate (which I think a lot of people object to on individual-liberties grounds, including me) is what makes retaining the ban possible. The entire idea of insurance is to insure a population against adverse events. If you allow people to *enter* the insurance pool when they *have just had* an adverse event, there’s no particular incentive for young, generally healthy people (who don’t need a lot of care outside of emergencies and other adverse events) to maintain insurance coverage when they’re well. They can wait until they need it and buy it then, and because there’s no pre-existing condition clause, there’s nothing to prevent them from coming and going from the pool of insureds as it’s convenient for them. If the pool of insured people doesn’t include people who are generally healthy, then the cost of insurance inevitably goes up. So, I’m in the awkward position of defending the individual mandate, not because I like it, but because I can do math.

Convert Medicaid into a block-grant program:

Right now, the federal government requires states to cover certain groups and to provide certain benefits, and in return, it helps cover costs. Block grants would convert Medicaid into 50 programs (one per state) with the feds providing a pre-set amount of money to each one, and the states deciding how to run their own programs but also having to cover any costs over and above the grant. Trump is correct that block grants can be structured to save the federal government money – but in order for that to happen, either people have to lose coverage who currently have it, or states have to absorb the costs of those “savings.” Trump claims that money can be saved by “streamlining,” but creating 50 sets of administrators with 50 sets of rules which all gazillion insurers and hospitals have to now deal with is the opposite of streamlining. This is just a terrible idea from beginning to end.

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So what’s going to happen?

Paul Ryan loves block grants, and Trump loves making other people pay for things that are his responsibility, so Medicaid might be screwed, unless Republican Governors talk them out of it. Probably we should all be calling our governors’ offices to express our opinions about this.

If the Republicans do some math, they’ll realize that the individual mandate is necessary unless we bring back pre-existing conditions clauses, which are very unpopular. Either they’ll retain the individual mandate, call it something else, and declare victory, or they’ll bow to the insurance companies and bring back pre-existing conditions clauses.

Mostly I expect them to fumble around with a few changes, but basically pass something that looks a lot like the ACA (which, let’s remember, started as Romneycare). They’ll rebrand it and swear up and down that it’s totally different.

The changes they do make will make insurers (/campaign donors) an absolute fuckton of money, and whether or not that makes things more expensive or less accessible to the general public won’t really factor into their decisions unless we hammer them on it as an electability issue. So we need to do that, because they’re about to turn a mediocre law into a terrible one.

[Note from the future: NYMHM grew out of these public posts from Joanne Merriam’s Facebook account. We retain them here in archives to provide a record going back to the beginning of Trump’s presidency.]

Joanne pre-NYMHM: 13 Dec 2016

  1. “…it has become clear that 75,000 votes in the counties with highly Democratic populations came back with no vote for President – but with votes for candidates lower down the ballot. This is what is referred to as an ‘undervote’ and is largely attributed to malfunctioning ballot reader machines. In a state that Trump won by 11,000 votes, this large number of undervotes could easily change the outcome of who won here.
    Incredibly, Michigan laws prohibit a recount if there are discrepancies in reconciling the numbers of votes against the poll books. Which is insane, of course. . . . Under pressure from Trump’s extensive and expensive legal team, a federal judge stopped the Michigan recount yesterday.” Why Every American Should Care About Michigan’s Canceled Recount
  2. Electoral College members demand information on Russian election hacking before Donald Trump vote,” Independent.
  3. U.S. Energy Department balks at Trump request for names on climate change,” Reuters: “This feels like the first draft of an eventual political enemies list,” a Department of Energy employee, who asked not to be identified because he feared a reprisal by the Trump transition team, had told Reuters.

[Note from the future: NYMHM grew out of these public posts from Joanne Merriam’s Facebook account. We retain them here in archives to provide a record going back to the beginning of Trump’s presidency.]

Joanne pre-NYMHM: 5 Dec 2016

1.

Holy crap you guys. Battle not won but nonetheless some champagne popping is in order. “Army Will Not Grant Easement for Dakota Access Pipeline Crossing,” Army.mil.

2.

“This is a victory for organizing, and it doesn’t stop now. We are asking our supporters to keep up the pressure, because while President Obama has granted us a victory today, that victory isn’t guaranteed in the next administration. More threats are likely in the year to come, and we cannot stop until this pipeline is completely and utterly defeated, and our water and climate are safe.”

Sacred Stone Camp

3.

Woah. “Sarah Palin: Trump’s Carrier deal is ‘crony capitalism’,” Politico.

[Note from the future: NYMHM grew out of these public posts from Joanne Merriam’s Facebook account. We retain them here in archives to provide a record going back to the beginning of Trump’s presidency.]

Joanne pre-NYMHM: 25 Nov 2016

The Corps sent a letter to Standing Rock Tribal Chairman Dave Archambault Nov. 25, saying the decision is to protect the general public from violent confrontations between protesters and law enforcement in that area.

Hey, law enforcement aren’t like grizzly bears or coyotes or something, the government could actually just tell them not to be violent, and that would ALSO protect the general public from violent confrontations between protesters and law enforcement in that area.

This is such horseshit.

You can contact the regulatory complaint line of the Army Corps of Engineers at (202) 761-5903.

ETA 28 Nov: Read “CHEYENNE RIVER SIOUX TRIBE REACTS TO U.S. ARMY CORPS OF ENGINEERS EVICTION NOTICE: YOUR LETTER MAKES A GRAVE & DANGEROUS MISTAKE

[Note from the future: NYMHM grew out of these public posts from Joanne Merriam’s Facebook account. We retain them here in archives to provide a record going back to the beginning of Trump’s presidency.]

Joanne pre-NYMHM: 22 Nov 2016

1.

Law enforcement officials in North Dakota have deployed tear gas and water hoses against hundreds of activists protesting against the Dakota Access Pipeline.” In freezing temperatures. This is not ok.

The more I think about this, the angrier I get. The police say this is justified because the protesters are setting fires (which the protesters say are bonfires to keep warm, which I believe, but I’m just looking at what the police themselves are claiming). How is that a justification? Even if you take the police at 100% face value, ARSON IS NOT A CAPITAL CRIME.

2.

Wisconsin legislative map ruled illegally partisan; case will go to Supreme Court,” WaPo.

3.

I’m in a doctor’s office, so no control over the tv. They’re playing The View, and this is the first time I’ve watched it. They’re talking about the alt-right and calling it explicitly white supremacist. That’s good to see.

[Note from the future: NYMHM grew out of these public posts from Joanne Merriam’s Facebook account. We retain them here in archives to provide a record going back to the beginning of Trump’s presidency.]

Joanne pre-NYMHM: 15 Nov 2016

Good news! “Statement Regarding the Dakota Access Pipeline“:

Today, the Army informed the Standing Rock Sioux Tribe, Energy Transfer Partners, and Dakota Access, LLC, that it has completed the review that it launched on September 9, 2016. The Army has determined that additional discussion and analysis are warranted in light of the history of the Great Sioux Nation’s dispossessions of lands, the importance of Lake Oahe to the Tribe, our government-to-government relationship, and the statute governing easements through government property.

Timely reminder why pipelines are dangerous: “Mapping 7 million gallons of crude oil spills,” High Country News (from 2015).

[Note from the future: NYMHM grew out of these public posts from Joanne Merriam’s Facebook account. We retain them here in archives to provide a record going back to the beginning of Trump’s presidency.]

Joanne pre-NYMHM: 12 Nov 2016

If Trump doesn’t change his mind again, we might be able to keep coverage for children up to age 26 and for people with pre-existing conditions. I don’t know how we’ll pay for these things without the mandate, unless we get single payer. That would be amazing but I don’t see a Republican congress approving it.

[Note from the future: NYMHM grew out of these public posts from Joanne Merriam’s Facebook account. We retain them here in archives to provide a record going back to the beginning of Trump’s presidency.]

Joanne pre-NYMHM: 9 Nov 2016

If you feel like you need to do something, give money and/or time to Standing Rock or Black Lives Matter or the Innocence Project or the Government Accountability Project or Amnesty International or Human Rights Watch or your local library or your local soup kitchen.

The world hasn’t ended. This is an armistice, not a defeat.

If you feel like all you can do today is build a blanket fort and watch Jane Austen movies, do that. Be kind to yourself. Be kind to your neighbours. Let’s be gentle with each other. Let’s be there for each other. Every small kindness matters. I’m so glad you are all here with me and I’m sending you all love and resilience.

Joanne pre-NYMHM: 2 Nov 2016

2016 continues to be bonkers.

  1. The Irrational Downfall of Park Geun-hye [Ask a Korean]
  2. “He has solemnly told the country to trust him while refusing to produce any records to prove whether he speaks the truth or has utter contempt for it.” [Newsweek, “Donald Trump’s Companies Destroyed Emails in Defiance of Court Orders“]
  3. “For instance, could his judicial appointments be influenced by his own court cases? . . . Would lawyers, parties in cases and even judges seek to curry favor with a powerful individual in a way that might alter the outcome?” [USA Today, “How 75 pending lawsuits could distract a Donald Trump presidency“]
  4. Another great story from David A. Fahrenthold with this amazing anecdote:

In the fall of 1996, a charity called the Association to Benefit Children held a ribbon-cutting in Manhattan for a new nursery school serving children with AIDS. The bold-faced names took seats up front …[with] a seat saved for Steven Fisher, a developer who had given generously to build the nursery.

Then, all of a sudden, there was Donald Trump.

“Nobody knew he was coming,” said Abigail Disney, another donor sitting on the dais. “There’s this kind of ruckus at the door, and I don’t know what was going on, and in comes Donald Trump. [He] just gets up on the podium and sits down.”

Trump was not a major donor. He was not a donor, period. . . . So they warbled into the first song on the program, “This Little Light of Mine,” alongside Trump and a chorus of children — with a photographer snapping photos, and Trump looking for all the world like an honored donor to the cause.

Afterward, Disney and Buchenholz recalled, Trump left without offering an explanation. Or a donation. Fisher was stuck in the audience. The charity spent months trying to repair its relationship with him.

[Note from the future: NYMHM grew out of these public posts from Joanne Merriam’s Facebook account. We retain them here in archives to provide a record going back to the beginning of Trump’s presidency.]

Joanne pre-NYMHM: 28 Oct 2016

Strong words from the Sierra Club:

We’ve seen North Dakota, in particular, put out messaging that says folks are violent, that we’re aggressive, that we are antagonizing the situation and somehow necessitating this militarized response. The reality is, if you’re here and you’re seeing the grassroots media coming out, it’s people who are gathered together in prayer and unity and coming together for the first time, really, in history. This is a historic moment for tribal nations to come together like this. We’ve got people who are historic enemies camping alongside each other, learning to live together and be together in this space . . . . People are out exercising their first amendment rights and being met with militarized response in incredibly dangerous situations: guns drawn, mace, planes flying overhead.

Amnesty International is to “monitor the response of law enforcement to protests by Indigenous communities.”

[Note from the future: NYMHM grew out of these public posts from Joanne Merriam’s Facebook account. We retain them here in archives to provide a record going back to the beginning of Trump’s presidency.]