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What’s Next for Health Care?


In early March, Republicans in the House of Representatives released their health care legislation. Intending to live up to their promises to repeal and replace the Affordable Care Act (or Obamacare), Republican congressmen and President Trump tried to get majority support to pass the American Health Care Act (AHCA), which they said would improve America’s health care system.


Ultimately, they failed to persuade enough Republicans to get a winning margin in Congress. However, they said that reform efforts weren’t over with the failure of this bill.


It is unclear what will happen now. There are differing perspectives on this issue from conservatives and liberals. With the GOP controlling Congress, the conservative direction seems more likely to prevail if some health care bill emerges in the legislative branch. But with an election occurring next year, it is possible that Democratic wins in 2018 could produce a liberal direction on health care reform in future years.

Here are some of the options being discussed in DC now:


Conservative ideas


Replace Obamacare: This is what the AHCA tried to do. It would have repealed some of Obamacare’s provisions and then enacted new provisions that tried to meet different health care goals. With the demise of the AHCA, President Trump and members of Congress have said they are continuing to work on ideas that would approach this issue from a different direction.


Repeal Obamacare: On the surface, this option is simple – all Congress has to do is repeal the legislation passed in 2010. Then, in theory, the health care marketplace would go back to its pre-Obamacare days. However, a lot has changed in the health care world in the past seven years. Individuals and companies have taken steps to comply with the ACA. Even in the world before ACA, there was heavy government involvement in health care. Many conservatives would like to see reforms that deal with the problems they saw in 2010 with the level of government regulation at the time. Repealing the ACA will not be enough for them.


Block-grant Medicaid: Instead of a wholesale repeal and/or replacement of the ACA, some conservatives would like Congress to focus on block granting Medicaid. The Medicaid program provides health coverage for people with disabilities, the poor and the near-poor. As a joint state-federal program, some conservatives see Medicaid as an opportunity to give states an ability to experiment with different methods of providing health care. Right now, the federal government provides funds to states based on the state’s income level and enrollment. Under a block grant, states would receive a set amount of money, but in return would have more freedom to innovate.


Liberal ideas


Single-payer: Under “Medicare for All” legislation, the federal government would pay for every American’s health care. Private companies could offer supplemental insurance, but health care would largely be a government-run system.


Expanded Medicaid: Under the ACA, the federal government provides incentives for states to expand their Medicaid programs to cover people who make up to 138% of the federal poverty level. Some liberals have called on the federal government to raise that cap, which would likely lead to more states expanding Medicaid to larger groups of people.


The status quo


Until Congress passes legislation, the ACA is still the law of the land. Its provisions will continue to be in effect. The federal government will enforce the law. However, that raises some issues, since the executive branch tasked with overseeing the ACA is headed by President Trump.


The new president has two options. One would be to do all he can to make the law work efficiently. Another would be to direct federal agencies not to fix issues as they come up with the law. The second seems more likely, as the president has tweeted “ObamaCare will explode…” However, it’s unclear exactly what path the Trump Administration will take when it comes to implementing the ACA. Regardless, the ACA will exist and be operational until there is a change in federal health care law.


What do you think Congress should do about health care reform?


Do Soda Taxes Hurt or Help Consumers?


Philadelphia rang in the new year with a tax on soda and other drinks. With city residents living under this tax for three months, we can begin to see its impact. Some observers are happy with the changes it has brought to consumer behavior, but others are calling for an end to the soda tax.


One effect is clear: beverage sales are down. This makes sense, of course. Generally, if the price of a product goes up, sales decrease. Public health experts are no fans of sugar-sweetened drinks, so this could have a positive impact on health. However, some experts question whether the Philadelphia tax is written in a way that will have a significant impact, since it taxes drink volume (not sugar content) and also covers sugar-free and zero-calorie drinks.


The economics of the tax may be as unclear as its health effects. What is apparent is drink companies and other businesses are reporting a negative fallout from the tax:


  • Pepsi has stopped selling 2-liter bottles and 12-packs in the city. Pepsi also laid off 80 to 100 workers at a local distribution plant.
  • Temple University increased the price of its meal plan by almost 5%.
  • Canada Dry distributor announced it would cut its workforce by 20%.
  • A grocery chain said it would lay off 300 workers.


What do you think about soda taxes? Should government target these drinks to improve public health? Or should consumers (and workers) not be penalized for choosing certain drinks over others?


Colorado House Bill 1143: Audit government communications with Medicaid recipients


Check out this key bill recently passed by elected officials in Colorado, check-in to the VoteSpotter app to see how your legislators voted, and comment below to share what you think!


House Bill 1143, Audit government communications with Medicaid recipients: Passed 63 to 0 in the state House on February 21, 2017


To audit correspondence between the government and recipients of Medicaid for readability, understandability, and accuracy.


Comment below to share what you think of Colorado House Bill 1143!


U.S. Senate Concurrent Resolution 3: Move Forward with Obamacare Repeal


Donald Trump made repealing the Affordable Care Act, or Obamacare, a central part of his winning campaign for president. Congressional Republicans have been working for years to repeal the law. Will 2017 be the year that Obamacare goes away?


In January, the Senate laid the groundwork for repeal legislation to proceed. It adopted a budget resolution for the U.S. Congress that makes it easier for Obamacare repeal legislation to proceed through the Senate. During consideration of this resolution, Democrats offered numerous amendments that, if adopted, would have effectively prevented Obamacare from being repealed. Senator Rand Paul also offered an amendment that would have capped federal spending, leading to a balanced budget by 2024.


These amendments all failed. It is doubtful the sponsors thought they would pass. Instead, they were likely offered as a way of putting senators on the record as opposing or supporting certain aspects of the Affordable Care Act. Here are some of the key votes that occurred during this early skirmish over Obamacare:


U.S. Senate Concurrent Resolution 3, Move forward with Obamacare repeal: Passed 51 to 48 in the U.S. Senate on January 12, 2017


To approve a Senate budget that allows committees to prepare legislation to repeal portions of the Affordable Care Act, or Obamacare. Under this resolution, votes to repeal certain parts of Obamacare could occur by majority vote instead of being subject to a filibuster which would have to be overcome by 60 votes.


U.S. Senate Concurrent Resolution 3, Kaine amendment to stop Obamacare repeal: Failed 48 to 52 in the U.S. Senate on January 5, 2017


To prevent the Senate from considering legislation to eliminate the Affordable Care Act's insurance subsides, its Medicaid enrollment expansion and more. This amendment would have changed Senate rules to effectively halt consideration of legislation to repeal or modify the Affordable Care Act using a budget reconciliation process that does not require a three-fifths majority to end debate and pass the bill.


U.S. Senate Concurrent Resolution 3, Sanders amendment to prevent changes to entitlement programs: Failed 49 to 49 in the U.S. Senate on January 10, 2017


To prohibit the Senate from considering legislation that would reduce Social Security benefits, privatize Social Security, increase the Social Security retirement age, or reduce Medicare and Medicaid benefits.


U.S. Senate Concurrent Resolution 3, Paul amendment to balance the budget: Failed 14 to 83 in the U.S. Senate on January 9, 2017


To amend a Senate budget resolution by adding provisions intended to generate a balanced federal budget by 2024 by capping federal spending. The amendment would also allow for the repeal of the Affordable Care Act, or Obamacare, and its replacement simultaneously.


U.S. Senate Concurrent Resolution 3, Klobuchar amendment to allow re-importing Canadian drugs: Failed 46 to 52 in the U.S. Senate on January 11, 2017


An amendment to the Senate budget bill that would allow legislation to permit pharmacists, wholesalers, or Americans with a valid prescription to buy drugs in Canada and bring them into the United States.


U.S. Senate Concurrent Resolution 3, Menendez amendment to prevent Medicaid funding cuts: Failed 48 to 50 in the U.S. Senate on January 11, 2017


To prohibit the Senate from considering legislation that would reduce Medicaid funding for states that expanded their Medicaid programs in compliance with the Affordable Care Act, or Obamacare. This expansion was not mandatory for states. The federal government covered over 90% of the share of enrolling new Medicaid recipients who were able-bodied and made more than 138% of the federal poverty level. The federal government generally covers 43% of the cost of traditional Medicaid enrollees.


U.S. Senate Concurrent Resolution 3, Gillibrand amendment to prevent repeal of Obamacare contraceptive mandate: Failed 49 to 49 in the U.S. Senate on January 12, 2017


To prevent the Senate from considering legislation that would end the mandate in the Affordable Care Act that requires insurance coverage of reproductive health services such as contraception, birth control, or maternity care.


Ohio Governor Pushes to Preserve Medicaid


A major part of the Affordable Care Act, or Obamacare, is expanding the Medicaid program. As Republicans in Congress consider their plans to repeal Obamacare, one Republican governor is asking them to preserve this Medicaid expansion: Governor John Kasich of Ohio.


In mid-January, he urged Congress not to eliminate Medicaid expansion during an Obamacare repeal. Medicaid is the joint state/federal program that provides health care coverage to lower-income individuals. In the traditional Medicaid program, the federal government generally pays 43% of the total cost (rates vary by state). Under Obamacare, states would receive federal funds covering 90% of the cost of expanding coverage to childless, able-bodied adults with incomes up to 133% of the federal poverty level.


According to Gov. Kasich, “Thirty-one states — more than half of them with Republican governors — extended Medicaid coverage. Those that did are experiencing significant positive benefits.”


The majority of people who received coverage under Obamacare have done so through Medicaid. Preserving Medicaid expansion would mean preserving this aspect of Obamacare, which troubles some Republicans in Congress. Senator Rand Paul of Kentucky, who has been pushing Congress to replace Obamacare at the same time it repeals the law, said:


A lot of these people actually qualified for Medicaid already so the interesting thing is they thought they were getting something new and they already qualified. My main point is we have to take care of those who can't take care of themselves. But it should be paid for. If we need to expand Medicaid every state needs to decide how much they're going to raise taxes to pay for Medicaid.


If Congress did not preserve the Medicaid expansion, states would still be free to design their programs to continue covering those eligible under Obamacare. However, states would not receive the 90% federal match, but would instead receive the lower matching rate for the traditional Medicaid program.


Supporters of Medicaid expansion worry about what will happen to enrollees if Congress does not preserve the higher federal matching rate. Those who want to end the expansion point to the long-term budget issues that could result from Medicaid spending.


Do you think that Congress should preserve Medicaid expansion as it debates repealing Obamacare?


Iowa Senate Bill 2: End taxpayer Funding for Planned Parenthood


Check out this key bill recently passed by elected officials in Iowa, and go to to signup and see how your legislators voted.


Senate Bill 2, End taxpayer funding for Planned Parenthood: Passed 30 to 20 in the state Senate on February 2, 2017


To direct the state health department to not spend Medicaid money on organizations that perform abortions, and to set up a new state program to give family planning services. This is known in the press as the "defund Planned Parenthood" bill.


Medicare Heats Up NC Senate Race

 In North Carolina, the Senate race between incumbent Richard Burr and challenger Deborah Ross is increasingly focusing on Medicare. Will Republican control of the Senate hinge on what North Carolinians think about Medicare reform?

At issue is Senator Burr’s 2012 proposal (never actually put in bill for) to restructure Medicare. When he announced it, Burr said, “We made a promise to our seniors that Medicare will be there when they need it most, but the program as it currently stands is broken. We have a moral obligation to our parents, children, and all Americans to take steps now to save Medicare. The Medicare program in its current form is unsustainable, and we have an obligation and opportunity to improve it for our nation's seniors within the next few years.”

Ross is charging that Burr introduced his plan to help insurance companies, not seniors. According to Ross, “some politicians in Washington want to fundamentally change Medicare by privatizing it and putting the insurance companies in charge. For example, Richard Burr has taken more than $1 million from insurance companies. In turn, he wrote a plan that would raise the retirement age, privatize Medicare, and give seniors a voucher that may or may not cover their health care costs. While this may help private insurers' profits, it will force seniors to pay more.”

Senator Burr has said he stands by his proposal. However, he also distances himself from it, saying, “We threw that out as an option as to what could be considered. Until you decide what you’re going to do with the Affordable Care Act, there’s no sense in even having a debate on what Medicare in the future looks like or how you make Social Security sustainable.”

What would Burr’s Medicare plan, dubbed “The Seniors’ Choice Act,” actually do?

  • Limit out-of-pocket expenses for seniors in traditional Medicare Parts A and B
  • Provide targeted care coordination for seniors in traditional Medicare
  • Increase the age of eligibility from 65 to 67 over 12 years
  • Starting in 2016, this proposal would have allowed seniors to receive funds from the government to choose a private Medicare plan

The last part is the most controversial part of the legislation. Senator Burr contends that allowing seniors to have choice for their Medicare plans will give seniors a “choice of a better benefit that meets their individual health care needs.” Ross calls it “privatization.”

Ross has also released a Medicare plan, which includes:

  • Paying doctors based on quality, not quantity, of care
  • Cracking down on inefficiencies, errors, and abuse
  • Giving consumers information and incentives to make better health care decisions
  • Ending the FDA backlog for generic drug approval

When Senator Burr says that Medicare is unsustainable, he is talking about the program’s future unfunded liabilities. The Senate Finance Committee’s Republican staff sum up the issue in a 2015 analysis: “Assuming current law remains unchanged, the Trustees project Medicare’s 75 year total spending in excess of dedicated revenues is $27.9 trillion. Again, using the CMS Actuary’s more realistic alternative scenario, that figure soars to $36.8 trillion.”

What do you think? Should Medicare be reformed along the lines of what Senator Burr has suggested? Or is Ross right to focus on minor fixes to the program?

What’s the Holdup for Zika Funding?


With 42 Floridians catching Zika, there is concern there and in neighboring states that the virus could spread. In Congress, both Democrats and Republicans say they want to provide federal funds to combat the virus. And yet, no funds have been approved.

The culprit, as is so often the case, can be blamed on partisan gridlock.

Funding for combatting Zika is contained in one of the thirteen appropriations, or spending, bills that Congress must pass every year to fund the government. This bill contains funding not only for Zika efforts, but also for other government functions.

The House of Representatives passed this legislation with a vote of 239-17 on June 23. Senate Democrats, however, are refusing to allow the bill come to a vote in that chamber. Although a majority of Senators voted to proceed with a final vote in late June by a vote of 52-48, that vote was not enough to reach the 60-vote threshold to overcome the Democrats’ filibuster.

Why are they blocking the bill?

It’s not because of the Zika funding, but because of the other items in the bill. Among their issues of concern:
• Defunding the Affordable Care Act, or Obamacare – the legislation would remove $500 million in funding for this program
• Defunding Planned Parenthood
• Allowing wider use of pesticides to destroy mosquitoes
• Continuing to allow Confederate flags to fly in military cemeteries

Republicans contend that Democrats are so fixated on these unrelated issues that they will allow Zika to spread in order to protect Obamacare and Planned Parenthood. Democrats, on the other hand, say that Republicans are holding Zika funding hostage to get their way on these contentious social issues.

This situation is why Congress recessed for its summer break without coming to agreement on an issue that both Republicans and Democrats, in essence, agree on.

Should the Senate pass this legislation, even with these controversial provisions? Or should Senate Democrats insist that Republicans remove the contentious sections of the spending bill before Zika funding is approved?


More ways for lawmakers to exhibit warm-and-fuzzy

Last week explored methods lawmakers use to associate their names with certain interests or causes: Granting specialty license plate fundraising privileges toselect nonprofits. This edition expands on that theme, looking at bills in the current legilslature that grant select nonprofits additional privileges including state income tax fundraising privileges and property tax breaks.


House Bill 5225: Authorize income tax checkoff for prostate awareness group

Introduced by Rep. Paul Muxlow (R), to allow an individual to choose to automatically contribute $5 or more from his or her state income tax refund, which the state would give to a particular foundation named in the bill that does various things related to prostate cancer (PCUPS Foundation). Referred to committee, no further action at this time.

House Bill 4817: Authorize income tax checkoff for Junior Achievement organization

Introduced by Rep. Brandt Iden (R), to allow an individual to choose to automatically contribute $5 or more from his or her state income tax refund to provide grants to local Junior Achievement organizations. Signed into law by Gov. Rick Snyder on June 15.

House Bill 4647: Authorize income tax checkoff for Boy Scouts

Introduced by Rep. Phil Potvin (R), to allow an individual to choose to automatically contribute $5 or more from his or her state income tax refund to a state Scouts Fund. House Bill 4648 would convert an existing state Girl Scouts Fund into a Scouts Fund to benefit both organizations. Advanced from committee, pending before the full House.

House Bill 4892: Authorize Lions Club income tax checkoff

Introduced by Rep. Wendell Byrd (D), to allow an individual to choose to automatically contribute $5 or more from his or her state income tax refund to provide grants to the Lions Club organizations. Referred to committee, no further action at this time.

Senate Bill 428: Authorize Red Cross income tax checkoff

Introduced by Sen. Rick Jones (R), to allow an individual to choose to automatically contribute $5 or more from his or her state income tax refund to provide grants to the mid-Michigan Chapter of the American Red Cross. Signed into law by Gov. Rick Snyder on June 15, 2016.

Senate Bill 570 and House Bill 5109: Give tax break to some conservation clubs

Introduced by Sen. Peter MacGregor (R) and Rep. Jim Tedder (R), to exempt from property taxes conservation clubs that allow their facilities to be used for charitable purposes at least 55 days a year. SB 570 has been advanced from committee and is pending before the full Senate.

Senate Bill 732: Exempt Masons lodges from property tax

Introduced by Sen. Rick Jones (R), to allow local governments to exempt property owned by Masons' lodges from most property tax levies if the property is used for charitable purposes. Advanced from committee, pending before the full Senate.

Wisconsin To Drug Test People For Unemployment Benefits

A new Wisconsin law will allow the use of drug testing for unemployment benefits. Drug testing for government programs has been tried in other states with mixed results. Do you think it is a good idea to require drug tests for unemployment insurance or food stamps? Or is this type of program too costly with too few benefits?

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