In thinking about the United States response to Hurricane Maria’s devastation of Puerto Rico and the US Virgin Islands, I began to wonder why they cannot vote in Presidential elections, and why their representatives cannot vote in the House of Representatives or the Senate. These policies appear to be vestiges of our short imperial quest to acquire colonies during the late 19th and early 20th century, keeping up with the Europeans.
The Romans built great roads and bridges to transport commerce and armies, and great aqueducts and arches to transport water and baths and sewers for hygiene; they were so well built that they remain today throughout Europe. This is/was the eternal city. What will be the American legacy in 2000 years?
The non-partisan Tax Policy Center reports that the Republican tax plan will increase the federal deficit by $2.4 billion over the next ten years and then another $3.2 billion over the following decade. Over the first decade, it would reduce business taxes by $2.6 trillion, eliminate estate and gift taxes for the extremely wealthy by $240 billion and increase individual income taxes by $470 billion.
President Trump is doing what he can to sabotage the federal and state Exchanges and the individual health insurance market. Here is the context, what he has been doing, the countermeasures some states are taking, and the need for and prospects of Affordable Care Act fixes.
Senate Republicans are planning to vote next week on a Budget Resolution for 2018. It includes $500 billion in cuts to Medicare and $1 trillion in budget reductions to Medicaid. Their goal is to finance $1.5 trillion in tax cuts – the bulk of whose benefits go to the extremely wealthy, the top 1% of Americans receive 80% of the benefits of the tax cuts.
Recently I joined the Board of Directors of Vision y Compromiso – a training and advocacy network for more than 6,000 promotoras and community health workers, led by a great friend and wonderful leader, Maria Lemus. http://visionycompromiso.org/
In the United States public and private financing of the nation’s health care are split 50/50. In California in 2015, a total of $292 billion was spent on personal health care services. Of that total, $104 billion was spent on private insurance), $62 billion on Medicaid, $64 billion on Medicare and $61 billion comprised all other health spending (including a range of expenditures from the Veterans Administration, Prisons, personal out of pocket, Workers Compensation and Auto insurance). In California, we have a smaller percentage of residents with private coverage and a higher share with public coverage than most states in the Midwest and Northeast.
California has made great progress implementing the Affordable Care Act (ACA), with over 6 million people newly enrolled in either Medi-Cal or Covered California since December 2013. The ACA offers major opportunities for states to meet these goals with a §1332 waiver using different approaches. There may be bi-partisan interest in reviving and revising §1332 waivers in the wake of the failure of the Graham Kennedy bill to secure the votes needed to repeal the ACA.
They have saved the worst for last or next to last or maybe a never-ending nightmare of repeal efforts (Groundhog Day). The salient points of Graham Cassidy are: a shift and reduction of the ACA’s financial resources from the federal government to the states as a time limited block grant; a shift of federal resources from the leader states to the most resistant Southern states that have done little or nothing beyond obstruction; waivers to allow states to disenfranchise and/or insurers to charge higher premiums to those with pre-existing conditions and a per capita cap on the federal match for the Medicaid program. For California, these proposals could not be more damaging. A recent report from the CDC (Centers for Disease Control) found that the uninsured rate in California had fallen from 17% to 7% due to the state’s successful implementation of the ACA. This bill will erase all that progress and do far more extensive damage to states' budget and health care system. Over 30 million Americans would lose their coverage.