Tag Archives: Medicare

Renee Hoagenson (D) in the 4th Congressional District – we get mail

30 Tuesday Oct 2018

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This arrived today:

Vicky Hartzler Hurts Missouri Families

Voted to cut Medicare and end protections for pre-existing condition coverage

Abandoned the family farmer to falling price, rising costs, and destructive tariffs

Cosponsored H.R. 785, the National Right to Work Act, when 2 our of 3 Missourians voted no on Prop A

Hey, we recognize that image.

Roy Blunt hustles to hide his healthcare history

10 Tuesday Jul 2018

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I can remember back in the day, when Obamacare was just a gleam in the of the Democratic-majority  congress and GOP Senator Roy Blunt was one of the point persons in the GOP House effort to preserve the status quo of the American healthcare mess. Nor do I remember that he bucked House or Senate leadership, or, more recently, the Trump administration in any of their efforts to destroy or destabilize healthcare delivery to Americans. He, in fact, continues to spout misleading and dishonest claims about the ACA.

All of which made me scratch my head in wonderment when I received a couple of glossy mailers touting Blunt, who was on the record as saying a few years ago that he thought Medicare was a mistake,  as a “champion of Medicare access,” and as a “healthcare champion.” Whew!  Do you, like me, think that somebody’s shoveling some of that old time barnyard fragrance producer that’s so prevalent in the GOP political world?

Maybe ol’ Roy heard the folks who were making all that noise when Trump and his collection of more or less ornamental GOP congressional garden gnomes actually went after the ACA last summer. Perhaps, as a result, he’s decided that he needs to make some adjustments to his messaging and cover his tracks.

Consider  his message on coverage for pre-existing conditions back in 2010 when he was actively carrying water for GOP forces fighting against improved healthcare delivery:

Access for kids who have pre-existing conditions, who would be against that? But access for adults, who have done nothing to take care of themselves, who actually will have as I’ve just described every incentive not to get insurance until the day that you know that you’re going to have medical expenses, that’s, that’s a very different kind of story.

Now contrast that bit of flim-flam  with ol’ Roy’s line in 2017:

Since my days in the House, I have supported providing insurance options for people with pre-existing conditions. As we move forward, I’ll work with my colleagues to be sure that no one is denied the care they need based on a pre-existing condition.

Admittedly, if you parse this phrase carefully, there’s lots of weasel language. But it’s equally hard to deny that he wants Missourians to believe that he supports the popular Obamacare provision. More importantly, it essentially contradicts his 2010 “personal responsibility” attempt to divert folks from the tragedies that typified healthcare for the millions of Americans suffering from chronic disease – through no fault of their own, contrary to Blunt’s claim.

So where does the “tight-lipped” (for a reason) Senator really stand? For instance, has anyone heard him endorse or condemn fellow-GOPer Josh Hawley’s participation in a court fight that would end protections for those with pre-existing conditions? Shouldn’t that be the next test for the wooden-faced guy who talks out of both sides of his mouth so adeptly.

 

Roy Blunt uses the GOP tax bill to give a Christmas present to his lobbyist son

04 Monday Dec 2017

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Most Americans, even conservative Americans whether or not they admit it, know that the big tax cut Christmas gift President Moron has promised will be delivered directly to the fat cats who support the GOP, while the gifts the GOP pretends to be giving most other Americans will metamorphose into gigantic lumps of coal either immediately or by 2027 when the crumbs tossed to the hoi polloi will vanish into the realm of Christmas past. The easy – and true – explanation is that the Republicans who preach fiscal responsibility were long ago purchased by the beneficiaries of a system that increases the growing inequality among Americans.

However, the extent to which some GOP pols are indulging in a little personal gift-giving on the side has been mostly ignored. As an article in The Intercept makes clear, some elected Republicans have used the tax cut baloney to enhance their or their families’ bottom lines – and one of the most notable examples is Missouri’s own always-on-the-take politician, Roy Blunt:

The tax plan before Congress, though sold as broad legislation to reduce rates and end favoritism in the tax code, contains targeted provisions designed to benefit special interest groups, many of which maintain close ties to senior Republican lawmakers.

Take the special tax cut for the alcohol industry hidden in the bill.

The tax cut legislation includes a provision that cuts taxes on beer, wine, and liquor produced or imported into the country, saving companies involved around $4.2 billion over 10 years. The provision mirrors language from the Craft Beverage Modernization and Tax Reform Act, or S. 236, introduced by Sen. Roy Blunt, a Republican from Missouri and a member of the Senate GOP leadership team. (While the legislation does benefit craft, or small breweries, it extends the cuts to larger companies and the industry as a whole.)

Key GOP lawmakers maintain close ties to individuals connected to the booze industry.

Sen. Blunt’s son Andy Blunt is a registered lobbyist for MillerCoors, a brewing company that has worked to build support on Capitol Hill for the exact same targeted brewer tax cuts now included in the tax bill. …

For the record, Arizona GOP Sen. John McCain, whose wife’s fortune comes from Hensley Brewing and Sen. Ron Portman, who has close ties to a lobbying firm that represents the industry, are also implicated as per The Intercept. Might go a long way to explaining why McCain, who objected to the procedure used to concoct and attempt to force passage of the ill-fated Republican healthcare demolition effort, was far more obliging this time around. It seems that procedure can be damned as long as the sweeteners are liberally bestowed.

Meanwhile, back at the working folks’ ranch, the Community Oncology Alliance warned Congress that the tax cut bill will mandate a huge cut in Medicare spending:

The Congressional Budget Office (CBO) has warned that “pay-as-you-go” rules require a 4% sequester cut to Medicare to offset the deficit increases triggered in the current tax bill. This would double the ongoing 2% sequester cut to Medicare payments implemented when Congress was unable to solve the nation’s budget deficit in 2011.

Policymakers in Washington should note that blunt budget cutting gimmicks like the sequester cut backfire. They have terrible unintended consequences and do more harm than good for patients and taxpayers. According to the 2016 Community Oncology Practice Impact Report, in the five years since the last Medicare sequester went into effect, 91 cancer treatment clinics have closed and 130 independent community cancer practices, typically comprised of multiple treatment sites, have been forced to merge into hospitals.

Community oncology practices are where the majority of Americans with cancer are treated. Closing them creates problems with access to cancer care and consolidation into more expensive hospital systems, driving up costs for seniors with limited mobility and fixed incomes, as well as all taxpayers who fund Medicare. The actuarial firm Milliman found that the consolidation of independent community cancer practices with hospitals cost Medicare and taxpayers $2 billion in 2014 alone. In addition, Medicare beneficiaries responsible for the 20% copayment saw their bills rise by $500 million in that same year.

As a person suffering from chronic cancer, I owe my survival over the past few years to Medicare and my excellent Medicare supplement. Now, however, since the barbarians have stormed the gates of Washington and the looting has started, I can’t helping wondering how long it can last – which is another way of asking how long I can last. I also know that I’m not in the worst position among my fellow-suffers – who won’t have to worry about what is going to happen because there’s only one answer: treatment will definitely soon be put out of reach for them if this bill in finally enacted. It’ll be a grim December for lots of us.

But hey, we can be sure that it’ll be a jolly Christmas in the Blunt family home. Sen. Blunt will have contributed to a “major victory for hardworking Missourians,” by his own account. And he may not be entirely dishonest. Andy Blunt is a Missourian and I’m sure that it’s possible that he’s truly a hard-working lobbyist. And there are probably a few more like him.

Ann Wagner wants us to know that when the GOP tax cuts beggar us, we can still get an adoption credit

18 Saturday Nov 2017

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Rep. Ann Wagner (R-2) voted for the House GOP tax cut sham bill. And she’s flaunting that fact. She thinks we’re stupid.

Don’t hold your breath waiting for Annie to come clean about what she actually voted for – there’s lots of undeniable details that she will try to deny apparently doen’t want you to know.

First, this bill is a veritable cornucopia of goodies for the 1%. It gives big tax cuts to rich folks – some permanent since it abolishes the estate tax, the Alternative Minimum tax that insures rich folks pay some taxes, and changes rules for pass-through income and investment income. It cuts corporate tax rates permanently from 35% to 20% without closing many of the loopholes that allowed most big corporations to actually pay somewhere in the neighborhood of 0 – 18%. Can you imagine how much less they’ll pay since they”ll be applying a plethora of tax breaks to an even lower rate?We’ll probably end up paying them.

Second, although the bill does give a few breaks to middle and lower income taxpayers with one hand, it mostly takes them away with the other. Many of the deductions and credits that are eliminated under the rubric “simplification” are those relied upon by middle class families. Some middle income earners will see higher tax bills right away, but even those who end up with a lower tax bill now may ultimately end up getting the shaft. GOPers usually neglect to point out that many of the goodies designated for the middle class are, for the most part, temporary.

Oh – crucial fact, given Rep. Wagner’s former concern for the national debt – the sham tax cut bill also adds $1.5 trillion dollars to the deficit. That’s why middle class folks don’t get permanent tax cuts and lose lots of exemptions and tax breaks they rely on – they can’t let that deficit go past the aforementioned $1.5 trillion and still pass the bill with only GOP votes.  It’s all smoke and mirrors (albeit thin smoke and murky mirrors) that lets rich investors make out like the proverbial bandit on the backs of those of us who aren’t rich enough to invest in a pet congressman. Or woman.

It’s hard to touch on all the mischief the sloppily written grab-bag of crony pleasing giveaways manages to do in its effort to please the more vicious members of the far right. It does away with the individual mandate of the ACA, a feature that will likely result in premium increases for all of us and eventually deprive 13 million people of insurance coverage. In a bid to convince dumb-as-dirt evangelicals (i.e. those who still try to excuse Roy Moore) that big gifts to GOP cronies a good thing, it does away with the provisions of the Johnson Amendment that stipulated that churches could retain tax-exempt status only by refraining from political advocacy from the pulpit. Now thanks to the corrupt GOP, we get to subsidize the efforts of some more authoritarian religious types to impose their religious views on the rest of us.

Another thing Republicans like Wagner aren’t telling us is that sooner rather than later, there will almost certainly be a $25 billion cut to Medicare:

Thanks to laws created by the Tea Party’s infamous 2010 sequester showdown over government spending, automatic cuts spring into action anytime Congress passes a bill that balloons the federal deficit, as the tax bill would. The approximately $136 billion in cuts spurred by the GOP tax bill would hit a number of government programs—including farm subsidies and the Border Patrol—but would cut most deeply into Medicare. Medicaid, Social Security, and food stamps are protected.

So if Wagner’s keeping quiet about what the GOP tax sham bill really does, what has she actually said about this travesty to justify her vote? Two words: mendacious fantasy (a.k.a. lies). Here’s an excerpt from her floor speech (I assume that the presentation of the word “yes” in all capitals means that our Annie is still screeching every time she votes for something that is bad for her constituents – her tell maybe? :

I vote YES to fix our broken tax system; I vote YES to help reignite the American economy; I vote YES to make it a little bit easier for that single mother of two, that firefighter, that teacher, shop owner, family of four, that Veteran; I vote YES for bigger paychecks, better savings and a more secure future. I ran for Congress to fight for the people of Missouri and to ensure that every hard-working American can realize their own American Dream,”

Broken economy? Not to hear economists tell it. And that nonsense about cutting corporate taxes to fix this “broken economy,” create jobs and raise wages? No one believes that trickle-down nonsense anymore. For example, when asked recently to affirm that the tax cut would inspire them to invest more, even a panel of CEOs of major companies bluntly shot that idea down. As for rich-folk goodies like eliminating the estate tax, write-offs for private jets? Like to hear how Wagner thinks that’ll help that “single mother of two” that she’s so worried about.

But hey! Annie’s has got a middle-class card up her sleeve. In her latest email newsletter she enthused about one feature of the bill that she voted for in particular: “This bill also protects the Adoption Tax Credit which I fought to protect. For decades this pro-family provision has helped provide children with loving families and stable homes.”

So that leaves us with the Adoption Tax Credit.  All this misery, but we get to keep a small-potatoes adoption tax credit that wouldn’t be in danger if Rep. Wagner and her GOP pals didn’t desperately need to please their donors in order to keep the money flowing.

Whoopee!

CORRECTION: The House Bill that Wagner voted on did not, as implied above, eliminate the ACA’s individual mandate – that provision is currently only included in the Senate version although many GOP House members have indicated that they will support its inclusion in the final legislation.

Claire McCaskill, moral obligation, and the existential threat of the Trump presidency.

05 Monday Dec 2016

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In my opinion Democratic Senator Claire McCaskill wants to be a good person as well as a good politician. She’s a Democrat because of the former and a temporizing centrist because of the latter. It’s not her fault that a raging red river flooded Missouri after she (and the first black president) were elected. But she dropped her talk about “progressive” values and began to sing the praises of “bipartisanship” shortly after the Tea Party began mobbing her Town Halls. The choice between good person and good politician are not necessarily opposed, but McCaskill’s case is complicated by demographics.

With the election of Donald Trump, though, things have changed. We stand to lose almost a century of progress while the Great Kleptocrat loots the nation and GOPers, in the pay of the Dark Money boys, stand by silently and let it happen as long as their wealthy patrons get theirs. We have to hope that as a good person McCaskill understands that she cannot choose to go along to get along in the new environment, nor will it buy her much political capital if she decides that she has to be less of a good person in order to be a good politician. There are plenty of folks with a respectable veneer who are a little further right (like, perhaps, Ann Wagner) who can far more convincingly fill the niche into which McCaskill’s been trying to squeeze herself .

The first test will likely be Obamacare and Medicare.  So far, McCaskill is saying the right things about Medicare without feeling compelled to add her thoughts about how to reform it in ways that hurt poor and middle class Missourians. The Obamacare test may be pushed further down the road if, as TPM’s Lauren Fox suggests, Republicans decide to repeal it, delay implementation of the repeal until after the midterms, and rely on compliant Democrats to pass a fifth-rate GOP replacement – and blame them for the repeal if they don’t. McCaskill’s been a sucker for this type of bait and switch in the past.

An even more immediate test, however, will be whether or not McCaskill is willing to go along with some of Donald Trump’s more unqualified and potentially destructive cabinet nominees. Democrats need to make it clear that Trump’s designated wrecking and looting crew will not waltz their way past the Senate. Although cabinet nominees only require fifty-one votes for confirmation, Democrats – and, who knows, maybe a few principled Republicans, if that isn’t an oxymoron – can make the confirmation process into what Politico calls a “slog” and tie up destructive policy moves on the part of the Trump Mafia.

We need McCaskill to stand with other Senate members who are now signaling that they aren’t going to roll over and confirm unqualified candidates who stand well outside even the conservative mainstream. According to Politico, “Democrats are likely to require roll call votes and possibly delay the nominations of Betsy DeVos to be secretary of education and Tom Price to to be Health and Human Services secretary, in addition to Mattis, Mnuchin and Sessions.” Early signs are that McCaskill is waiting for a little push to go either way. Politico quotes her as cautiously tending to support the emerging Democratic line:

“I’ve heard no conversations about the kind of obstruction that Mitch McConnell specialized in,” said another endangered Democrat, Claire McCaskill of Missouri. “But there may be some where there are real questions about their qualifications and some of the things in their backgrounds.”

Damn straight there is, Claire.

It’s a good sign, though, that McCaskill is trying to point out that lots of the nominees are genuinely dreadful; she seems to be trying to anticipate accusations that slowing the more outrageous nominations down in order to thoroughly vet questionable candidates is simply tit-for-tat against GOPers who, for purely partisan reasons, denied confirmation to a Supreme Court candidate that all admitted to be more than qualified.

Standing up against nominations that will be bad for the country is not by any measure the same type of political game that Republicans played all through the Obama presidency. They routinely obstructed the nominations of qualified judicial and agency candidates and slow-rolled the nomination of perfectly qualified cabinet level candidates like Loretta Lynch. Expect qualified Trump nominees like Elaine Chao to be easily confirmed.

As Nancy LeTourneau writes in response to charges of what she calls “both-siderism” in the Politico article:

Barack Obama didn’t nominate an Attorney General who had been rejected for a federal judgeship because of his history of racism. Nor did he nominate a Defense Secretary who violated the restrictions on the time between military service and serving in that capacity. He also didn’t nominate a woman with no training or experience in education to be Secretary of Education. Nor did he nominate someone who had been involved in the most egregious practices leading up to the Great Recession to be Treasury Secretary. In other words, the Cabinet Trump is proposing is extremist in a way that is unprecedented. As such, both the Senate and the American public need to seriously consider their capacity to harm the institutions on which so many of our citizens depend.

So let’s just hope that Claire McCaskill can put the good of the country before political expediency. Democrats are going to have to play a long game, and it’s likely that there are some who will have to take one for the team.

*Spelling of Elaine Chao’s name corrected (12/6, 11:54 am)

Which members of the Missouri congressional delegation are for or against Paul Ryan’s Medicare phase out plan.

19 Saturday Nov 2016

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I have written here about the fact that House Speaker Rep. Paul Ryan is planning to take advantage of Trump’s election to push his Medicare privatization plan, a plan that will essentially destroy Medicare as we know it. Please find below a checklist of Missouri politicians categorized by their response to  Ryan’s privatization plan.

This list will be updated and reposted as politicians make their positions clear (or don’t).

Note that even if a particular politician indicates that they don’t support Ryan’s privatization phase out, it doesn’t mean that they aren’t open to fiddling with the system in often destructive ways. I also indicate which House members voted for or against the Ryan plan earlier when it was included in the proposed 2015 House budget and which have negative or positive voting records in regard to Medicare related issues.

Members of Missouri’s U.S. Congressional delegation who will oppose Ryan’s latest effort to destroy Medicare:

Senator Claire McCaskill (D) (see here for source and discussion).

Members of Missouri’s U.S. Congressional delegation who have been contacted but have not committed to a position on Rep. Ryan’s phase out plan at at this point.

Roy Blunt (R) (Source: TPM list as per 11/19).Blunt has a record of voting for legislation that undercuts Medicare.

Rep. Sam Graves (R) (Source: TPM list as per 11/19 (list up dated regularly)). Graves  voted for the 2015 Budget proposal that included a similar privatization plan. He has a record of mostly voting to weaken Medicare.

Rep. Emmanuel Cleaver (D-5) (Source: TPM list as per 11/19) Cleaver voted against the 2015 Budget proposal that included a similar privatization plan. His voting record is mostly pro-Medicare.

Members of Missouri’s U.S. Congressional delegation who have not yet been contacted about their current position on Ryan’s Medicare phase out plan.

Rep. Lacy Clay (D-1) Clay voted against the 2015 Budget proposal that included a similar privatization plan. His voting record is mostly pro-Medicare.

Rep. Vicky Hartzler (R-4) Hartzler voted for the 2015 Budget proposal that included a similar privatization plan. She has a record of mostly voting to weaken weaken Medicare.

Rep. Billy Long (R-7) Long  voted for the 2015 Budget proposal that included a similar privatization plan. He has a record of mostly voting to weaken Medicare.

Rep. Blaine Luetkemeyer (R-3) Luetkemeyer  voted for the 2015 Budget proposal that included a similar privatization plan. He has a record of mostly voting to weaken Medicare.

Rep. Jason Smith (R-8) Smith  voted for the 2015 Budget proposal that included a similar privatization plan. He has a record of mostly voting to weaken Medicare.

Rep. Ann Wagner (R-4) Wagner  voted for the 2015 Budget proposal that included a similar privatization plan. She has a record of mostly voting to weaken weaken Medicare.

McCaskill on Ryan’s Medicare phase out plans.

18 Friday Nov 2016

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TPM’s checklist of those who support or oppose House Speaker Paul Ryan’s phaseout of Medicare has been updated to show that Claire McCaskill is positioning herself as part of the opposition “according to a TPM reader who called her office.” She was quoted on an NPR local news spot today saying that she opposed the Ryan plan. We need to give her kudos and lots of support for taking this position. I’ll be calling and writing her to thank for her for making this unequivocal statement, and I hope lots of others do so too.

But, as well, I’ll be asking some questions about her level of commitment to Medicare.

Keep in mind that McCaskill is speaking to the Ryan privatization plan exclusively. In the past, in her deficit alarmist persona, she has signed on to benefit cuts and other mechanisms for restructuring the program. In 2013 she and GOP Senator Tom Coburn of Oklahoma introduced legislation that would institute Medicare means-testing to raise co-payments and co-insurance. We need her to elaborate on just what type of future she is supporting for Medicare.

Keep in mind, too, how she takes progressives for granted and tries to impress conservative Missourians with her “independence,” leaving her open to poorly considered, one-sided “bipartisan” initiatives. She confirmed today that she’s definitely running in 2016, probably against Rep. Ann Wagner (R-2), who will, given the lay of the ground in this northernmost outpost of the Trump confederate empire, be a tough challenge. And how has McCaskill responded to such challenges in the past. With more of the “independence” GOP-lite chatter.

A New York Magazine article by Ed Kilgore entitled “Why there Probably won’t be a ‘Tea Party of the Left'” offers a disturbing take on the forces that are in play around McCaskill:

The obvious targets for either a bipartisan Trump outreach or for disciplinary efforts by progressives are the Democratic senators up for reelection in 2018 who represent states carried by Trump. There are ten of them: Bob Casey (Pennsylvania), Joe Manchin (West Virginia), Bill Nelson (Florida), Sherrod Brown (Ohio), Debbie Stabenow (Michigan), Joe Donnelly (Indiana), Tammy Baldwin (Wisconsin), Claire McCaskill (Missouri), Heidi Heitkamp (North Dakota), and Jon Tester (Montana). You might imagine some of these states are not reliably Republican in the future, but the flip back to the Democrats won’t be automatic, either, in a midterm election when the turnout dynamics have recently favored Republicans.

Now, Sherrod Brown and Tammy Baldwin and probably Debbie Stabenow are not the sort of Democrats who will be hankering for a way to show Trump voters they’re not all bad, and Bob Casey has his own appeal to white working-class voters that doesn’t necessarily depend on bipartisanship. But the rest of these vulnerable Democratic senators could waver.

And if they do, what exactly is “the tea party of the left” going to do about it? Joe Manchin, for one, would probably pay for left-bent protests against his “centrist” heresies in West Virginia, and would definitely welcome a progressive primary opponent to triangulate against. Heitkamp’s state went for Trump by 36 points; Tester’s, McCaskill’s, and Donnelly’s by 20 points or slightly less. Does anyone think a candidate more progressive or partisan than any of these worthies has a prayer of carrying their states in the immediate future?

At some point, would-be members of a “tea party of the left” need to come to grips with the fact that the “tea party of the right” had more geographical material to work with. …

This narrative is the sort of thing that has resonance with politicians – and for good reason. Prospects for the type of opposition party solidarity that we need if we are to hold off and undo the damage done by the Trump election may very likely be undermined by politicians like McCaskill who are not only skilled at playing the odds, but believe it is their only option apart from self-sacrifice.

But then again, nothing’s ever a done deal until its done. McCaskill might surprise us all and go down trying to hold the bridge. She might not even go down if she gets some help and does a good job on that bridge.

Will the Missouri congressional delegation help Paul Ryan and Donald Trump gut Medicare?

17 Thursday Nov 2016

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Anyone watching the election campaign picked up pretty fast on the fact that Donald Trump has no real policy beliefs or understanding of the policy process, but rather relies on emotive slogans and the insights of whomever is momentarily ascendant among his inner group of sycophants. We’ve gleaned from bits and pieces of what he has told folks that he doesn’t intend to get his hands dirty with actual presidential work. Which means that when it comes to policy, we’re likely going to be dealing with co-presidents-in-all-but-title, Paul Ryan and Mike Pence.

And for House Speaker Ryan that means that he may finally have the means to put the social safety net out of the misery the GOP has tried to inflict on it over the years. It looks like Medicare is going to get the ax first. As TPM reports, Ryan has “proposed to privatize the current Medicare system, within the earliest days of the impending Trump administration.”

Ryan’s hoping to phase out our highly efficient Medicare insurance system in favor of a voucher system which, in the long term, is not likely to cover the cost of buying comprehensive insurance in an uncontrolled private market. Though Ryan touts the savings to be realized from privatizing Medicare, economics journalist Michael Hiltzik shows that that the savings would be “illusory,” with costs “shifted from government to seniors.”

Ryan’s new strategy seems to be to phase Medicare out as part of the process of fulfilling The Donald’s promise to kill Obamacare. Ryan’s already started a propaganda blitz tying the two together as part of a deceptively titled “reform.” As Hitzlick points out:

Ryan has surrounded his Medicare proposal with a bodyguard of lies. In his Fox News appearance, he said Medicare is “going broke” and ascribed its problems to the Affordable Care Act. Neither is true.

Medicare faces fiscal problems, but it’s not going broke, and according to both the Medicare trustees and the Congressional Budget Office, the Affordable Care Act has in fact alleviated those problems rather than caused them. The trustees reported in 2010 that passage of Obamacare had postponed the projected exhaustion date of the Medicare trust fund by 12 years — to 2029 from 2017. Projections of Medicare spending growth have consistently come down, year after year, at least in part due to changes in the program imposed through Obamacare.

The program’s fiscal situation would be “substantially improved,” the trustees said, because the ACA instituted new cost controls and provided new tax revenues for the program. Both those features would disappear if the GOP repeals the ACA, as is its intention.

Voila – Ryan guts Medicare while simultaneously deep-sixing another of the social welfare programs so despised by Republicans.

But Ryan can’t do this all on his lonesome, you say – and you’re right. It’ll take a majority of the congress to make it happen, but, with Republicans dominant in both houses, he has a very good chance. And don’t forget, he’s got The Donald.

So, comes the next question. How does our Missouri congressional delegation stand on the issue of killing the Medicare program?

Fortunately for us, Danielle Keeton-Olsen of TPM is keeping a list (and updating it regularly) of who’s naughty and nice. And so far, none of our Missouri delegation is definitely on either list. Instead, the two who’ve been contacted to date, GOP Senator Roy Blunt and Rep. Sam Graves (R-6), are listed with those who have refused to commit either way or, as Keeton-Olsen wryly notes, claim they didn’t even know it was an issue. Yeah, right.

Blunt has been on record as opposing Medicare in the past, although he has also tried to pose as a savior of aspects of the program when it has been expedient. If his past behavior is any indicator, he will hem and haw and say nothing as long as he can, and then come down firmly on the side of the GOP Senate leadership of which he is a junior member. The guy knows where his bread is buttered, and we know what that means as far as Medicare goes. And I would guess that Sam Graves isn’t going to go to any great lengths to save Medicare either since he voted yes on an earlier Ryan Budget that included the same privatization plan.

If, like me, you’re concerned about your Medicare and whether or not the program will be around for your children and their children – and there’s no objective, fiscal reason it should not be – call or write your congressmen or women today to find out where they stand and let them know where you stand.

Making your point of view known will be especially important when it comes to our only Democratic Senator, Claire McCaskill. The Senate may well be our only bulwark against Ryan’s attack on Medicare, and Senator McCaskill, who now finds herself representing a blood-red constituency, has never been a profile in courage. She’s up for re-election in two years. We’ve got to let her know that if she doesn’t defend Medicare with all she’s got, this time we really won’t forget.

Meanwhile, you can check TPM for updates – and also consider letting them know what you find out when/if you call your congressman or woman by using the “Send Comments & News Tips” link on the TPM Masthead. And I’ll update here on SMP as I learn more about the Medicare druthers of our shy Missouri pols.

Blunt was against Medicare before he he was for it

17 Wednesday Aug 2016

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A new ad from a dark money group, One Nation, associated with the one-time master of political duplicity, Karl Rove, paints Roy Blunt as a stalwart defender of Medicare. The same group tried to scam Missourians last fall with a message about how Blunt, who usually comes off as a slick Washington operator, really cares about the folks at home, veterans in that case. The motivation for both ads is probably the fact that Blunt seems to have a real competitor this election year. And it follows that this new ad is as bogus as the earlier one.

The new Medicare ad reflects widespread concern about a proposed trial of a new Medicare reimbursement formula – and, on the part of Republicans, no doubt, opposition to anything put forward by the Obama administration. Democrats are also concerned, but willing to critique and, if necessary, improve the proposed experiment.

As Politico describes it, “the Obama administration’s Medicare experiment would test whether the program’s payment system encourages doctors to prescribe more expensive drugs, since they’re paid a set percentage of a drug’s price — therefore getting more for a higher-cost drug.” It’s potentially a big deal since, according to Politico, “Medicare’s Part B program spends nearly $20 billion on drugs every year, and advocacy organizations are pouring millions of dollars into campaigns for and against the experiment.” Pouring money, did they say … enter Roy Blunt.

The issue is not black or white. The experiment has its advocates as well as its detractors within the affected communities:

Peter Bach, a Memorial Sloan Kettering researcher and drug pricing critic, told POLITICO’s podcast that Medicare’s planned pilot is a necessary reform. He argued that lobbyists have dramatically distorted the administration’s goal of reducing doctors’ incentives to prescribe high-cost drugs.

“This has been a highly coordinated effort to misinform the electorate, to frighten patients and to misinform policymakers about even the basic math,” Bach said.

Ted Okon, the executive director of the Community Oncology Alliance, countered that Medicare’s pilot is a dramatic overreach that would short-change doctors. He also warns the overly broad scope of the Medicare experiment could set a precedent for a future president — say, Trump — to circumvent Congress to make changes to Obamacare.

“If this is not changed appreciably, the only recourse will … be to pursue legal action,” Okon said. “There’s too much riding [on it]. It’s not just a reimbursement cut.”

Bach argued that Medicare’s current reimbursement system is set up to reward doctors, like oncologists, when they prescribe more expensive medicines. And whether that’s a good idea depends on how you view the doctor’s role, Bach said.

“Do you view them as a real estate broker,” he asked, “where if the real estate broker sells an expensive house, they make more money than a cheap house? Or do you view them more like the UPS delivery guy — it doesn’t matter what’s inside the box, whether it’s a stuffed bunny or a bunch of diamonds, they get paid the same amount to bring the box.”

Bach thinks it’s time physicians move toward the latter model, arguing that reducing doctors’ incentive to prescribe high-cost drugs would help tamp down drug spending, the fastest-rising sector of health care.

Okon cautioned that changing how doctors get paid could backfire and potentially keep patients from receiving drugs they need.

I’m a cancer patient so I’ve got, to use one of the GOP’s favorite terms, skin in the game. I trust my doctor and I’m not too concerned about the new proposal. I’m sure, based on my own research, that the drugs used in my chemotherapy are bedrock for my diagnosis, and, when they no longer work – a likely development with my type of cancer – I can’t see that this provision will prevent me from getting the drugs I need to combat my disease. I should also add that my experience with Medicare during my treatment has been excellent.

Roy Blunt’s advocacy for the status quo – and, incidentally, the folks lobbying to preserve a generous revenue stream – makes me even more skeptical about whether or not the revised rule’s impact will be negative. Why? Just consider Blunt’s past record on Medicare. After all, he’s the guy who said Medicare never made anyone healthier and that establishing the program was a mistake. Most recently, he cut money from the Medicaid program that helps vulnerable seniors navigate the program:

The State Health Insurance Assistance Program (SHIP) that provides seniors with a better understanding of Medicare and saves them millions, would be eliminated by a budget bill approved by the Senate Appropriations Committee, reported Kaiser Health News. In a statement by Sen. Roy Blunt (R-MO), chairman of the appropriations committee’s health and labor committee, said that ending SHIP could save $52 million and would help pay for a $2 billion increase for the National Institutes of Health, increase resources for opioid abuse prevention, and restore year-round Pell Grants. “Medicare is very complicated,” said Howard Bedlin, vice president for public policy and advocacy at the National Council on Aging. “Last year SHIPs helped 7 million people navigate this program and without those services, people will not be able to make well-informed choices. That’s going to cost them money.”

I’d say that when it comes to this newfound zeal for Medicare, Blunt ought to put his mouth where his money is except that he seems to be doing just that when you consider that health care industries that stand to loose money by these new rules are also big Blunt campaign donors; health industry PACs have gifted him with $174,000 this cycle alone. Absent that incentive, as his stinginess in regard to the SHIP program indicates, he isn’t that interested in helping folks on Medicare. As this new ad campaign underlines, Roy Blunt may be putting his mouth where his money is, but he’s also trying to confuse seniors about there that “is” is.

Does Roy Blunt really want to run on his record?

13 Saturday Aug 2016

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Contrary to my earlier speculation that Roy Blunt may be warming to The Donald, Jim Salter at TPM thinks that Blunt is still trying to tread the treacherous GOP waters and avoid going under:

It’s tough enough for the political veteran seeking re-election against up-and-coming Democrat Jason Kander, Missouri’s secretary of state who is showing surprising strength in the polls and in raising money. The string of recent controversies involving Donald Trump, who Blunt has endorsed, doesn’t help.

Like many of his Senate GOP colleagues, Blunt, who served seven terms in the House before his election to the Senate in 2010, prefers to talk about his own record and agenda, not Trump’s.

Blunt’s record and agenda? Good luck with that.

Blunt’s got a record for sure, stretching from his glory days as Tom Delay’s bagman to his more recent efforts to assist his corporate donors. Take for example, Blunt’s relationship to Montsanto, one of his biggest funders. In 2013 Blunt covertly slipped a controversial goodie for Montsanto, a rider now known as the Montsanto Protection Act, into a totally unrelated bill. And he’s still at it, having recently used his position on the Senate Appropriations Committee to block a vote to repeal a second Montsanto Protection Act.

Of course, since his Democratic opponent, Jason Kander, has been gaining on him during the past year, he’s made some effort to soften his reputation. For instance, Kander served in Afghanistan while Blunt evaded service in Vietnam, his generations’ Asian war. Not a good resume bullet in patriotic Missouri. So what does Blunt do? He makes a big deal about supporting veterans, such as joining the GOP’s exaggerated VA pile-on, huffing and puffing about the agency’s supposed shortcomings although he conveniently forgot to remind folks that he voted to withhold funds from the over-stressed VA that would have alleviated its staffing and service problems.

Or take Medicare. Blunt did a favor for the Federation of American Hospitals, a for-profit hospital lobbying group, and in return the organization ran an ad in the St. Louis Post Dispatch lauding him as a savior of seniors and Medicare – a doubtful proposition in itself, and even more bogus when viewed in conjunction with Blunt’s past record on Medicare (see also here and here) which is, to say the least, dismal.

What else is there?  He supports the NRA’s worst excesses and wants to destroy corporate and financial regulations that protect Americans. Depending on your point of  view that might comprise either an acceptable or a frightening agenda.

So let Blunt shine a light on his record and agenda while he attempts to diminish the Trump phenomenon. But tell me again – how does that record and agenda separate him from the dishonest, NRA-loving,  anti-regulation, corporate deal-making Trump?