OPINION - Shields and Brooks 6/26/2020

"Shields and Brooks on Trump’s poll numbers, health care in a pandemic" PBS NewsHour 6/26/2020

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SUMMARY:  Syndicated columnist Mark Shields and New York Times columnist David Brooks join Judy Woodruff to discuss the week in politics, including polling on President Trump’s job performance, the federal response to a surging coronavirus pandemic, the administration’s effort to strike down the Affordable Care Act, congressional divergence on police reform and whether Washington, D.C., will become a state.

Judy Woodruff (NewsHour):  And now we turn to the analysis of Shields and Brooks.  That's syndicated columnist Mark Shields and New York Times columnist David Brooks.

So good to see both of you.  Thank you for being here this Friday.

So, let's start with some interesting poll numbers.  They show not only President Trump running somewhere between eight, 12, even 14 points behind Joe Biden, but the President's disapproval ratings are at record highs.

This is from the new Marist poll the "NewsHour" does with NPR and Marist, 58 percent disapproval for President Trump, the highest it has ever been.  And then you see on this second graph his ratings, disapproval ratings higher than President Obama at his — at this stage of his presidency or President Bush 43 at this point in their first term in office.

David, how significant is this?

David Brooks, New York Times:  Oh, pretty significant.

The numbers are devastating for the President.  But, you know, big things have happened.  We're looking at possible really serious and long economic recession or depression.  We're losing the battle against COVID.  We're having a racial reckoning.

And a lot of white Americans are learning what daily life is like for African Americans.  These are just gigantic things that are happening in the country.  And on each one of them, Donald Trump is considered an inadequate leader by a lot of people.  So he's losing college-educated women.  He's losing some high school-educated white men, just across the board.

In our New York Times poll this week, Biden was winning by 14 percentage points.  These are — there's no way, other than to say that some seismic shift is happening in the electorate right now, and a lot of people want to fire Donald Trump.

Judy Woodruff:  Mark, what do you see in these numbers, and how significant do you think they are?

Mark Shields, syndicated columnist:  Well, I think they're encouraging for the Democrats.

But, at the same time, Judy, for those who want to put the champagne on ice, I would remind them of the wisdom of Ann Richards, the late governor of Texas, who said, July results do not make a November election.

And, you know, this is not the first time that Democrats have had a large lead in the summer, and not managed to win in November.

But I think for Donald — I think David's absolutely right about Donald Trump.  He — right now, this election is a referendum on him.  And he is failing that test on virtually every major ground.

There's only two times it's good to be a United States President, one, when things are going so swimmingly, prosperity, and there's peace in the world, and you get to that — bask in that warmth of the era of good feeling.

The second time is, strangely enough, when there's a catastrophe not of your making, an earthquake or a pandemic, as we're having now.  And that's when a President can console and lead and comfort a nation and be really a figure who brings everybody together.  Donald Trump has failed that, and failed it miserably, and I don't see a recovery.

Judy Woodruff:  And, David, the President, though, is having his first rallies.  He was out in Tulsa last weekend.  He was in Arizona a few days ago getting thousands of people to show up, in Tulsa, what is it, 6,000.

He's dismissing, if you will, the COVID virus, though.  I mean, he's saying that, if more testing — if there were more testing done, there wouldn't be a virus.  He is trying play to his base.

David Brooks:  To some part of his base.

There's some of the base that likes him.  They like the showmanship of the rallies.  They like the jokes.  They like him spending 20 minutes talking about walking down a ramp, which he did in Tulsa.

But there's a part of his base — and these are people who have supported him in the past — who hate all that stuff.  They vote for him for judges or for some other issue, or because they think he's decent on the economy.  But now he's not decent on the economy.

And they really don't like the idea of voting for a President who seems racist.  And so they might be with him on other issues, but — so you're seeing him — people flake away from him for really serious issues, for really serious reasons, not for some temporary tweet.

And so I agree with Mark.  This is not the time to celebrate.  But we have had such a stable set of polls over the last three years, where Trump has just hung basically solid vis-a-vis other people.  And now things look different.  And they look different because big things are happening.

Judy Woodruff:  Mark, I mean, could his arguments about the virus appeal to enough people to somehow persuade them that he's got the right argument going here?

Mark Shields:  I doubt it, Judy.

He [Trump] has not been a national leader on this issue.  I mean, in fact, he's been a sniper on the sidelines too much, criticizing governors in Michigan and Minnesota and Virginia for taking measures to — in their states to lead to a lockdown, in hopes of curtailing it.

Somehow, there seems to have emerged a choice between public health and a strong economy.  And Donald Trump says, well, I'm for a strong economy.  Open up that economy.

But the reality is, we will not have a strong economy without restored public health.  I mean, that's the route and the road to it.  And I just think that he's going down a dead end.  And it shows terrible indifference to the people who are his most loyal supporters.

Those 3,000 kids in Arizona without masks, without any social distancing, that's a — that's a terrible prospect of illness forthcoming.

Judy Woodruff:  And that's the image that the administration's projecting, David.

The vice President today defending those rallies, saying there's a First Amendment right to assembly, people have a right to go out and support the candidate of their choice.

David Brooks:  Well, I sort of have some sympathy for that.

If we're going to have the George Floyd protests, which I think we should have had, you can't say to one group of people, you can protest, but, to another, you can't, obviously, once that precedent was set.

Judy Woodruff:  Right.

David Brooks:  Though, you know, the more I think about this whole administration, there was a crucial moment, when the President basically chose Jared Kushner over Steve Bannon.

And what's interesting about the Bannon populist wing is, they were very quick on this COVID situation.  They were saying, this is a major crisis way back in February.  They were: Let's take this seriously.  Let's be the side of order.  Let's be the side of the health hawks, if you want to put them that way.

And Trump went the other way early in his administration, away from the populists, and toward more Wall Street people.  And he said:  No, it's nothing, because I don't want to hurt the market.

And that shift in the administration, looking back on it, was one of the pivotal shifts in the administration.  And I hate to be a praiser of Steve Bannon, but I think, frankly, the President would be a — in better shape, both substantively and politically, if he had listened to people on that wing.

Judy Woodruff:  Interesting.  We have forgotten about that.

And, Mark, on top — to top it all off, it's what we talked about early in the program, the administration going to the Supreme Court to try to yet again do away with the Affordable Care Act.

Is this something that's likely to win him friends and admirers at this stage of his reelection effort?

Mark Shields:  No, Judy.

John Boehner, the former Republican Speaker of the House, was very candid on this subject, said, 25 years as a Republican in the House, not once, never once did Republicans ever agree on a health care plan.  And he was absolutely right.

There's never been a Republican health care plan.  They're trying to repeal, replace the — the Affordable Care Act, but at a time when 20 million people are turning to it, having lost their jobs, and at a time when it is more popular than it ever was when Barack Obama was President, and with every health care group of any significance and hospitals and doctors and — except the American Nurses Association — opposing the administration this.

What happens if they win and there is no Affordable Care Act, and there is no preexisting condition coverage?  And I just — it's an absolute political folly.

Judy Woodruff:  I want to ask you about that, David.  And then — and then I have got two or three other things I want to ask.

So, go ahead, if you want to comment — comment for us on the Affordable Care Act and the administration trying to — yet again to get rid of it.

David Brooks:  Well, just quickly, if you're a Republican Senate candidate in Arizona or Georgia or wherever these close races are, suddenly, you have got to defend the idea of taking away this insurance for preexisting conditions, at a moment when having had COVID-19 could become a preexisting condition.

It's political poison for any Republican Senate candidate in a close race.

Judy Woodruff:  David, I'm going to stay with you.

Police reform.  After all these rallies around the country, it's clear there's a lot of sentiment for looking at ways to improve policing in this country, the House and the Senate completely — Republicans and Democrats completely at odds over this.  What's going on?

David Brooks:  On this one, I blame the Democrats, frankly.

I think Tom (sic) Scott, the Republican from South Carolina, who was the Republican sponsor, put together a good-faith bill.  It had not everything the Democrats wanted, obviously, but it had some stuff.  It had the — making lynching a federal hate crime.  It had — against choke holds, more transparency for police misconduct.

And then Scott said, we're going to let you vote on amendments.  And so maybe — and he said that maybe I'd support some of these amendments.

And so he had a pretty open process.  I'm a big believer, if you can take half a cake, take half a cake.  And then, if Democrats win November, they can get the whole cake.  I think they should have compromised on this and accepted half a cake.  It would have been a step forward to a better police force.

Judy Woodruff:  Mark, should the Democrats have tried to sit down with Tim Scott or any of the other Republicans?

Mark Shields:  Well, I think Tim Scott (R-S.C.)— I think Tim Scott, who is an authentic figure on this and absolutely a man of reality, talked about his own personal experience of being stopped seven times by Capitol Hill Police, he, a United States senator, and being asked for identification and papers.

And so he showed a sensitivity to it.  But I think there was a skepticism about how much he could deliver.

But I did honestly think there was a chance.  I thought that — for legislative compromise on this.  I'm less confident of that today than I was last week.  It's an election year.  The Senate is about to take two weeks off.  The closer we get to election, the less chance there is.

And I'm sad about it.

THE HEALTH CARE DEBATE - Losing Coverage

"Amid roiling health care debate, the share of uninsured Americans is growing" PBS NewsHour 11/7/2019

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SUMMARY:  Health care is a top 2020 political issue.  Democratic candidates are debating whether to build upon the Affordable Care Act, or 'Obamacare,' or replace it with Medicare for All.  Meanwhile, President Trump wants to dismantle the ACA entirely.  As millions of Americans enter the time of year when they choose their health plans, Amna Nawaz gets the latest from Margot Sanger-Katz of The New York Times.

HEALTH CARE BATTLES - State Eligibility Requirements

These so-called job requirements are based on the old lie that 'poor people are poor because they are just lazy.'

"Why federal judge turned down work requirements for Medicaid in two states" PBS NewsHour 3/29/2019

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SUMMARY:  This week saw President Trump resurface the political debate over health care, as he declared his intention to repeal the Affordable Care Act.  At the same time, a federal judge blocked work requirements the administration had tried to implement on Medicaid benefits in two states.  Amna Nawaz reports and talks to The Washington Post’s Catherine Rampell about health care policy and legal challenges.

AFFORDABLE CARE ACT - Court Attack Consequences

The Republicans immoral and unethical attack on ACA.

"Why invalidating the ACA could cause ‘enormous disruption’ to American health care" PBS NewsHour 12/17/2018

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SUMMARY:  The day before this year's deadline to sign up for health insurance under the Affordable Care Act, a judge in Texas ruled the law unconstitutional.  As the case makes its way through the appeals process, Amna Nawaz sits down with Julie Rovner of Kaiser Health News to discuss who's involved in the legal challenge and the "enormous disruption" that would result from invalidation of the law.

REPUBLICAN AGENDA - Still Trying to Kill 'Obamacare'

aka Republican unethically putting importance money before the health of American citizens.

"Funding cuts, premium increases and the future of Obamacare" PBS NewsHour 7/11/2018

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SUMMARY:  President Trump’s effort to eliminate the Affordable Care Act was stymied by the Senate last year, but he hasn't stopped trying to undermine it.  William Brangham asks New York Times health care correspondent Margot Sanger-Katz about recent funding reductions for enrollment navigators, whether coverage for preexisting conditions is in jeopardy, and the future of the ACA.

GOP TAX BILL - Old/Failed 'Trickle Down' Religion

"The surprising winners and losers of the latest GOP tax bill" PBS NewsHour 12/18/2017

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SUMMARY:  Who benefits most from the latest GOP tax plan?  Who won -- and who lost -- in the last-minute changes?  With the House poised to pass its tax bill on Tuesday, Lisa Desjardins joins Judy Woodruff to analyze its impact and some of the surprising details inside.

"Tax cuts alone won’t answer U.S. economic needs, Bloomberg says" PBS NewsHour 12/18/2017

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SUMMARY:  Michael Bloomberg, former mayor of New York City and billionaire investor and business owner, wrote a column this week calling the tax bill a “trillion-dollar blunder."  He tells Judy Woodruff why he thinks Congress and President Donald Trump put politics ahead of true tax reform.

"Sweeping GOP bill set to revamp U.S. tax code, slash corporate rate" PBS NewsHour 12/19/2017

aka "Coming of United States of America Inc."

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SUMMARY:  For Republican lawmakers, it's a day to celebrate.  Cheers went up as the GOP tax overhaul received House passage, signaling the end of a legislative sprint to get the bill wrapped up by Christmas.  Lisa Desjardins joins Judy Woodruff to discuss what ended up in the bill, a minor snag in the Senate, plus the prospects for passing a federal funding bill and avoiding a government shutdown.

The spin......

"U.S. needs to be a ‘little bit patient’ to see robust economic growth from the GOP tax plan, says Thune" PBS NewsHour 12/19/2017

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SUMMARY:  After a year in the majority marked by several legislative speed bumps and dead ends, Republicans are happy with the final tax bill that's poised to pass, according to Sen. John Thune (R-S.D.)  Judy Woodruff asks Thune about the long-term tax increase for the middle class, doubts that the tax cuts will spur the kind of growth predicted by the GOP plan and concerns about a ballooning deficit.

Killing the ACA by the back door.....

"The GOP tax bill deals a blow to the Affordable Care Act.  Here’s how" PBS NewsHour 12/20/2017

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SUMMARY:  The sweeping tax bill passed by Congress on Wednesday extends beyond what you file with the IRS.  It also affects American health care by repealing Obamacare's [ACA] so-called individual mandate.  John Yang learns more from Julie Rovner of Kaiser Health News about that and other health care matters on Congress’ agenda.

The uncharitable Republicans......

"Charities fear GOP tax overhaul will dry up donations.  Here’s how" PBS NewsHour 12/21/2017

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SUMMARY:  Charities are concerned that the GOP tax overhaul disincentives giving.  By doubling the standard deduction, fewer people may end up itemizing deductions, meaning fewer would take the charitable tax break.  Judy Woodruff learns more from Stacy Palmer of The Chronicle of Philanthropy about the effects and gets advice from people who want to give.

U.S. SENATE - Bipartisan Health Care?

IMHO:  Not likely.  Trump and Republicans are still hellbent in killing the ACA (aka Obamacare) and NOT giving American true health care coverage.  American lives are just not worth spending money on in their book. 😡

"Senators take a bipartisan step toward a health care fix" PBS NewsHour 10/17/2017

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SUMMARY:  Two leading senators reached a bipartisan deal Tuesday to stabilize health insurance markets under Obamacare.  Sen. Lamar Alexander (R-Tenn) and Sen. Patty Murray (D-Wash) said their two-year compromise would fund federal subsidies that President Trump ended last week.  Judy Woodruff sits down with Lisa Desjardins to discuss how this plan will give states more flexibility.

"Trump pullback from bipartisan health care fix gives Washington whiplash" PBS NewsHour 10/18/2017

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SUMMARY:  A bipartisan plan reached Tuesday to stabilize health care markets initially drew support from President Trump, but more recent statements -- in public remarks, from the White House and on Twitter -- have sent contradictory signals about Mr. Trump’s stance.  Lisa Desjardins reports on the changes the White House says it’s is hoping to see to support the deal.

REPUBLICAN AGENDA - Update on Trumpcare 2.1

"The sticking points keeping the GOP health care bill in limbo" PBS NewsHour 7/17/2017

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SUMMARY:  The vote on the Senate Republican health care bill has been delayed, but the behind-the-scenes battle continues.  What key questions could help decide the bill's fate?  Dr. Ezekiel Emanuel of the University of Pennsylvania and Avik Roy of the Foundation for Research on Equal Opportunity join Judy Woodruff to debate different aspects of the proposed legislation.

"McConnell aims for full Obamacare repeal after replacement bill withers" PBS NewsHour 7/18/2017

COMMENT:  Lets see, the Republicans, since before the election of President Obama had the opportunity to come up with their version of a health car plan.....and did NOT.  Now we are to trust they can come up with a health care plan AFTER taking health care away from 10s of thousands of Americans.  Really?! 🤔 Snake oil salesman comes to mind.

Also, it's DOA.

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SUMMARY:  With the latest push by Senate Republicans to repeal and replace the Affordable Care Act coming to an anticlimactic end, party leaders have shifted their focus to simply focus on “repeal.”  Sen. Mitch McConnell proposed delaying the effective date of repeal for two years, while Democrats flexed their opposition.  Lisa Desjardins joins Judy Woodruff to discuss the latest.

"Where Bernie Sanders sees bipartisan middle ground on health care" PBS NewsHour 7/18/2017

IMHO:  Sorry Bernie, but Republicans are too addicted to anti-ACA (aka anti-Obama) agenda to even recognize a compromise.  They are just like an opioid junkie and cannot stop.

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SUMMARY:  Will Democrats have a seat at the table now that the Republican push on health care has collapsed?  Sen. Bernie Sanders (I-Vt), joins Judy Woodruff to discuss what went wrong and the possible path ahead on health care reform.

HEALTH CARE - Virginia

"What Virginia's poorest citizens want from health care reform" PBS NewsHour 7/11/2017

and they are NOT going to get from Trumpcare.

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SUMMARY:  As Republicans on Capitol Hill try to repeal and replace the Affordable Care Act, we visit patients and health care providers at a free clinic in rural southwest Virginia -- a region that strongly supported President Trump, in a state that did not expand Medicaid under the Affordable Care Act -- to listen to the extreme health care challenges they face and what they think should be done.

"Deep in coal country, West Virginia patients speak out about GOP health bill" PBS NewsHour 7/11/2017

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SUMMARY:  As Republicans on Capitol Hill try to repeal and replace the Affordable Care Act, we visit patients and health care providers at a health center in Mingo County, West Virginia -- a region that strongly supported President Trump, in a state that has been ravaged by the opioid epidemic -- to listen to the health care challenges they face and how the expansion of Medicaid has benefited them.

FACTCHECK - Trumpcare 2.0 Premiums

"Senate Bill: Do Premiums Go Up or Down?" by Lori Robertson, FactCheck.org 6/30/2017

Democratic Sen. Chuck Schumer tweeted that premiums would be 300 percent higher under the Senate Republican health care bill for a 64-year-old earning $56,800 in 2026, compared with current law.  Republican Sen. John Barrasso said the bill “lowers the rates for insurance 30 percent a couple years from now.” Both cited the Congressional Budget Office.  Who's right?  They both are.

On premiums, there's something for both parties in the nonpartisan CBO's analysis of the GOP's Better Care Reconciliation Act.

That bill — just like the Affordable Care Act, and the House Republicans' bill — would affect premiums on the individual market in different ways, depending on individual circumstances.  Let's go through the details.

It's all about the individual market.  We've said this time and time again: These claims about premiums concern a relatively small segment of the insurance market where those without employer plans or coverage through a program like Medicaid buy their own insurance.  About 7 percent of Americans buy individual, or nongroup, market plans, while 49 percent get coverage through employers.  But politicians often leave out that important detail, perhaps giving the impression that all premiums would be significantly affected.

It's compared with current law — the Affordable Care Act.  The price of insurance isn't something that typically goes down.  The figures that Schumer, Barrasso (who made his comment at a press conference on June 27) and the CBO use are compared with current law.  So, a 30 percent decrease in a few years may still be an increase from what premiums are right now.

What does happen in the next few years?  “The legislation would increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter, relative to projections under current law,” the report by the CBO and Joint Committee on Taxation says.  The report considers premiums for benchmark plans — currently the second-lowest cost silver plan — which are used to calculate the amount of tax credits.

In 2018, average benchmark premiums for single individuals “would be about 20 percent higher” than under current law, the CBO said, “mainly because the penalty for not having insurance would be eliminated, inducing fewer comparatively healthy people to sign up.” The following year, average premiums would be about 10 percent higher than under current law, but by 2020, the average premiums “would be about 30 percent lower than under current law.”

Why the drop?  The Senate bill would use a less expensive benchmark plan starting in 2020.  That year, benchmark plans would pay a smaller percentage of benefits than under current law.  Plus, CBO said, funding in the bill to directly reduce premiums would do exactly that.

The current benchmark plans have an actuarial value of 70 percent, which means they pay, on average, 70 percent of the cost of benefits that are covered.  The Senate plan would lower the actuarial value to 58 percent.  So those benchmark plans pay out a lower percentage of covered benefit costs, on average, but that means the premiums are lower.  It also means, CBO said, that the deductibles for those benchmark plans would be higher than the deductibles for benchmark plans under current law.

In about a decade — in 2026 — average benchmark plan premiums in “most of the country” would be about 20 percent below what we'd see under current law, CBO said.  It notes that the averages for 2020 and 2026 include a wide range of impacts in different parts of the country, partly because of waivers some states would get to change required benefits or other aspects of the individual market.

Why would some 64-year-olds see a big increase?  The Senate bill, as does the House GOP bill, allows insurers to charge older Americans five times as much as younger Americans for premiums (starting in 2019).  The ratio under the ACA, or current law, is 3:1.  This means premium costs for older individuals will be higher under the legislation than under current law.

For example, CBO estimates that a premium for a bronze-level plan for a 64-year-old in 2026 — not including any tax credits — would be $12,900 for the year under current law and $16,000 under the Senate bill.  The difference is greater for a silver plan — $15,300 under the ACA and $20,500 under the Senate bill.  A 21-year-old, however, would see lower premiums under the Senate plan ($3,200 for a bronze plan versus $4,300 under current law).

Schumer's tweet was about a 64-year-old earning $56,800.  That's 375 percent of the federal poverty level in 2026, making that person eligible for tax credits under the ACA but not under the Senate bill, which cuts off subsidies after income of 350 percent of the poverty level.  When it comes to how the bill could affect net premium costs, the change in subsidies adds another layer of complexity.

What about subsidies and out-of-pocket costs?  Many buying plans on the individual market don't pay the full premiums, because they get tax credits that reduce the cost.  The Affordable Care Act provides tax credits to those earning between 100 percent and 400 percent of the federal poverty level.  The Senate bill would make them available to those earning between 0 percent and 350 percent of the poverty level.  And it would adjust those credits based on age for those earning above 150 percent, so that younger individuals pay less toward their premiums.

That, coupled with the 5:1 pricing variation based on age, is bad news for a 64-year-old earning $56,800 in 2026, an income level above the tax-credit cut-off.  Schumer's tweet included a graphic that said: “According to CBO, Congress' Non-Partisan Budget Office: In 2026, if you're 64 years old with an income of $56,800, under current law, you pay a $6,800 premium for a silver plan.  Under the Senate GOP bill, you'll pay a $20,500 premium for that plan.  That's a premium increase of 300%.” That's an accurate summary of the CBO report (see Table 5).

A 40-year-old, single person earning that much or more wouldn't see much of a difference in premium costs.  And a 21-year-old earning $56,800 or more would pay about $1,000 less under the Senate bill for a yearly premium compared with current law, whether it's a bronze- or silver-level plan, according to CBO's projections.  If that 21-year-old earned only $26,500 (175 percent of the poverty level in 2026), the situation is reversed: That person would pay less under current law.

CBO doesn't provide estimates on family premiums.

And then there are out-of-pocket costs to consider.  One reason benchmark premiums are lower on average under the Senate bill is because those plans cover a lower percentage of benefit costs.  Some people — say, the young and healthy — would rather have the lower premium and a higher deductible or copay; others wouldn't.  CBO said: “Some people enrolled in nongroup insurance would experience substantial increases in what they would spend on health care even though benchmark premiums would decline, on average, in 2020 and later years.”

Also, in 2020, the Senate bill eliminates cost-sharing subsidies that lower out-of-pocket costs for those earning between 100 percent and 250 percent of the poverty level.

Determining the individual impact.  Changes to the individual market made by the ACA, and the proposed changes under the Senate Republican bill, would affect people differently, depending on a variety of circumstances — age, income and health spending, among them.  To get an idea of how the Senate bill could change premiums for you personally, use the nonpartisan Kaiser Family Foundation's interactive map.

CBO's Table 5 also gives scenarios for three different ages and four different income levels.  In general, be wary of politicians' claims about premiums going up or down.  They may be referring to specific situations, and even averages don't tell the whole story.  As the CBO report shows, there's great variation on how premiums would change under the Senate bill, depending on the individual person.

HEALTH CARE IN AMERICA - Affordable Care Act Marketplaces

"Did Obamacare help or hurt you?" by Jason Kane, Laura Santhanam, and Matt Ehrichs; PBS NewsHour Updated 3/27/2017

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Capitol Hill is still embroiled in a debate about the cost of health care, who should pay for it and how.  And Americans across the country have been having that debate — who gets covered, which physician they can see and how much they should pay — almost every day for years now, since Congress passed President Barack Obama’s signature health care law in 2010.

Last week, the House Republican plan to repeal and replace the Affordable Care Act failed to earn enough support for lawmakers to vote on the law, the American Health Care Act.

“Obamacare is the law of the land,” House Speaker Paul Ryan said after the latest reform effort failed.  “It’s going to remain the law of the land until it’s replaced.  We did not have quite the votes to replace this law.  And so, yes, we’re going to be living with Obamacare for the foreseeable future.”

More than half of U.S. adults approve of the Affordable Care Act, according to a national survey from Pew Research Center, but those opinions quickly split along political party lines.

The PBS NewsHour asked people if they were concerned or encouraged by possible, future changes to the Affordable Care Act.  More than 1,000 people responded from across the country — from Maine to Missouri and California.

These are a few of those stories.

JENNIFER CARTWRIGHT

AGE:  41
LOCATION:  Wichita Falls, Texas
OCCUPATION:  Car and house insurance agent

Jennifer Cartwright knew something was wrong when her 2-year-old son’s stomach swelled up like a balloon.  Doctors later removed a fast-growing, softball-sized cancerous tumor — a rhabdomyosarcoma.  The Affordable Care Act went into effect just as her son, Zach, entered a year of treatment, including radiation “that just fried his insides” below his lungs and above his knees.  He was left scarred and could only eat through a tube, but he survived.  Today, he loves to play video games, especially Mario Brothers and Lego Dimensions, and will celebrate his 10th birthday this June.

Annually, his medical bills for hospital visits and a dozen medications add up to as much as $100,000, which — in a good year — equals Cartwright’s entire full-time income selling car and house insurance.  But Zach’s parents haven’t worried about him hitting a lifetime cap on insurance coverage because Obamacare abolished that practice, Cartwright said.  To defray costs, she enrolled Zach into Medicaid, but she said Texas tightened access to Medicaid services and has rejected care Zach receives since November: “They just made everything harder.  Everything needs pre-authorization.”

A lifelong Republican, Cartwright sees both sides of the health care debate that has embroiled the nation.  She said she agrees the nation overspends on health care and must cut costs, “but where?” she asked.  State policymakers and insurers don’t want to make life harder for pediatric cancer patients and their parents, she said, but “they don’t realize how delicate a balance it is, and now it’s out of whack.”

“I’m in this catch-22.  I understand insurance.  I understand it’s a business.  It’s for-profit,” she said.  “But I also see it from the personal side.  Here I am in the middle of it all.”

TIMOTHY TRIBBETT

AGE:  50
LOCATION:  Greensboro, North Carolina
OCCUPATION:  Veterinarian

When Timothy Tribbett first became a veterinarian two decades ago, he said his health insurance was “super affordable” at $125 each month.  But now, that price has quadrupled, and Tribbett grows angry when he talks about how he must pay more than his mortgage payment to stay insured.

After the Affordable Care Act passed, Tribbett said the small veterinary practice where he and 17 other people work announced they would no longer cover employee health insurance, and none of them qualified for subsidies to ease the burden.  Tribbett, 50, said he blames Obamacare for driving all but one insurance company out of his community.  Most North Carolina residents who buy marketplace insurance have only one option this year, NPR reported.  Tribbett would rather see high-risk pools set up for the uninsured (“don’t take money out of my pocket”) and plans offered across state lines to encourage “some competition.” The latter is something not included in the current version of the American Health Care Act, but it’s been discussed as something that could be part of future phases of Republican health care reform.

“If you work for a small company, and you have to get it on your own, you are absolutely screwed,” he said.  “I can’t chance going without it right now, but if it keeps going up, I just can’t afford it.”

In the past, Tribbett has taken medication for OCD and chronic neck pain, but he avoids going to the doctor to get prescription refills because his deductible for each visit is too high, he said.

While his premiums climb, Tribbett said he’s also trying to save some of his $75,000 annual income for retirement.  He hopes to move back to his family’s 100-acre farm, nestled in the Blue Ridge Mountains near Roanoke, Virginia.  But at this rate, Tribbett thinks he’ll be 70 before he can afford to stop working.

“I’m not looking forward to working another 20 years,” he said.

Tribbett thinks the Republican health care plan moving through Congress is a “step in the right direction.”  He supports proposed tax credits “for middle class people like me that have to buy their own insurance without subsidies,” and while conservative groups have criticized parts of the House Speaker Paul Ryan’s plan, Tribbett said “hopefully, those concerns will be addressed.”

JULIA RAYE

AGE:  50
LOCATION:  Shreveport, Louisiana
OCCUPATION:  Currently unemployed auditor

Medicaid patient to GOP: ‘You’re signing my death sentence’
More than 11 million adults — like Julia Raye of Louisiana — gained health insurance through the Affordable Care Act’s expansion of the Medicaid program.  But under the Republican plan to replace the ACA, Raye, an unemployed diabetic who will be starting a new job in the coming weeks, may be barred from reentering a much more restrictive Medicaid program in the future if she once again falls on hard times.  Going without insurance and appropriate medications would be disastrous for her health, she says.  “If you don’t think that Medicaid is important, then you’re signing my death sentence,” Raye said to the congressional leaders deciding the fate of the ACA.  “If you’re comfortable with that, then go right ahead.”

MINA SCHULTZ

AGE:  31
LOCATION:  Fairmont, West Virginia
OCCUPATION:  Health insurance counselor for West Virginia Medicaid

Mina Schultz’s life was ready for launch.  She had just earned her master’s degree in French from the University of Missouri in 2011 and wanted to join the Peace Corps.  At age 25, she planned to go without insurance for a few months, but Schultz’s father took advantage of a then-new Obamacare provision that allowed him to add her to his insurance.  Then her right knee began to ache and swell.  She iced it for six weeks, and doctors suggested the avid runner give her hobby a break to let her condition improve, but her knee only got worse.  She went for an MRI scan, covered by insurance.

“I joked with the technicians, ‘Did you see anything good in there?’  They said, ‘Yeah, you’ll be glad you came in.’ I thought, 'Ok, I must have torn something'”

Schultz had osteosarcoma, a rare bone cancer normally found in children.  She still chokes up when she remembers the moment she learned she had cancer.  A year later, doctors replaced her knee (half of her right leg is titanium), and she entered an Affordable Care Act health exchange for insurance while in remission.  After purchasing an ACA plan, Schultz joined the effort to sign up more enrollees.  In October 2014, she found a job at a community health center near her mother’s home in Fairmont, West Virginia, enrolling hundreds of West Virginians in the health insurance marketplace and onto Medicaid.

In December, Schultz said new enrollees streamed into her office, but after President Donald Trump’s inauguration, they’d scoff at the prices for coverage.  She said they told her: "‘Trump is going to fix this.  I only need this for a few months and then this will go away and it’ll be cheaper.’"

“People want the health insurance, they just don’t want huge deductibles and huge premiums,” she said.

With Obamacare, Schultz said her family avoided bankruptcy and she “can afford care despite a preexisting condition.”  She said she’s terrified the exchanges may go away.  Insurance companies decide in May which marketplaces they will commit to in 2018 and how much they will charge, but Schultz worried insurers may balk over uncertainty about Obamacare’s fate, raising insurance prices even more.

“They already went up too much this year,” she said.  “I worry that people are going to drop out because they can’t afford it.”

KOURTNAYE STURGEON

AGE:  54
LOCATION:  Indianapolis, Indiana
OCCUPATION:  Marketing

When Kourtnaye Sturgeon cooks dinner, her thoughts drift to her older son, his hard-fought battle against his heroin addiction and how close he came to death.

The summer after her son Ryan graduated high school, Sturgeon learned about his drug use.  When she confronted him (“with love, not anger”), Sturgeon said, “he broke down.”

Her son went in and out of treatment, including detox, counseling and taking suboxone, but his addiction’s hold was strong.  He dropped out of college in summer 2010 and lost his job at a pasta restaurant.  He not only stole from her, Sturgeon said, but also shoplifted meat from grocery delis and resold it to buy drugs and further fuel his addiction.

Finally, Sturgeon added him to her insurance in January 2011 under Obamacare.  Her son ended up in a 90-day inpatient treatment with 60-day intensive outpatient care and counseling, all covered by Sturgeon’s insurance.  He has since entered recovery, and this July, now 25 years old, he looks forward to celebrating three years of sobriety, Sturgeon said.

“I know my son would not have survived his illness.  I feel very blessed, but I also carry a bit of guilt,” she said.  “I’ve met so many parents who have lost their children to overdose.”

Sturgeon said she knows he is in continuous recovery and that “with this chronic disease, relapse is likely,” she said.  “But he has learned so much along the way from the benefit of really high quality treatment to help carry him through the relapse back health recovery.”

The Trump administration unveiled its proposed budget earlier this month.  It’s unclear which agency will take the lead on a national strategy to combat opioids, a job the White House Office on National Drug Control Policy has held for three decades.  The Trump budget eliminates that office altogether.

Sturgeon’s son is not alone, Sturgeon said, and neither is she.  At a time when an estimated 20 million Americans live with substance addiction, Sturgeon said it is important to make treatment accessible to combat this “complex disease.”

There is more.

"How healthy are the Affordable Care Act marketplaces?" PBS NewsHour 3/27/2017

Excerpt

SUMMARY:  The Affordable Care Act withstood a Republican effort to "repeal and replace," but there are problems with the current law that lawmakers acknowledge need to be addressed.  We meet a few Americans who have concerns about Obamacare.  Then Mary Agnes Carey of Kaiser Health News joins Lisa Desjardins to discuss why affordability is an issue for some.

OPINION - Shields and Brooks 3/24/2017

"Shields and Brooks on Obamacare repeal failure, Gorsuch grilling" PBS NewsHour 3/24/2017

Excerpt

SUMMARY:  Syndicated columnist Mark Shields and New York Times columnist David Brooks join Judy Woodruff to discuss the week's news, including the GOP's abandonment of a bill to repeal and replace the Affordable Care Act, plus the House Intelligence Committee's Russia probe and the Supreme Court confirmations hearings for nominee Neil Gorsuch.

JUDY WOODRUFF (NewsHour):  But first to the analysis of Shields and Brooks.  That is syndicated columnist Mark Shields, and New York Times columnist David Brooks.

Gentlemen, I'm sorry there is no news to talk about today, but let's see what we can find. (sarcasm)

Mark, seriously, the move today in the Congress and by the president to pull this health care bill, what is there to say?  The Republicans wanted — they said for months that this is what was going to happen.

MARK SHIELDS, Syndicated Columnist:  The first thing, Judy, is, I think, a general statement.  The Republican Party is an opposition party.  It's a protest party.

We have a protest President.  We have a protest party.  It's not a governing party.  It showed itself unable to accept the responsibility and the accountability of governing.

This bill wasn't a bad bill.  This bill was just an abomination.  There was no public case that could be made for the bill.  There was no public argument that could be made for the bill, because nobody knew what was in it.  There was no public campaign for the bill, because no organizations — every organization that cares — that was involved in medical care, whether it was the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, they were all against the bill.

It was a terrible bill.  There was nothing organized.  The only organizing principle is, it was against Barack Obama.  And Paul Ryan, a very earnest policy wonk, showed himself to be an inept political leader.  He couldn't even lean on the safest seats in his own party's caucus.

Those are ones you say, these are people who are really not threatened for reelection.  I need you.  You have to vote.

He couldn't even do that.  And Donald Trump showed he has no understanding of the legislative process.  He dealt in adjectives.  It was wonderful, fantastic, glorious.  He had no idea what was in it.  The Art of the Deal just collapsed, and this is a man who gave away the store to the Freedom Caucus, and got nothing in return, didn't even get their votes.

I mean, on no count was this anything but a disaster politically, and public policy, and just for the country.

JUDY WOODRUFF:  How do you explain it, David?

DAVID BROOKS, The New York Times:  Well, all those things contributed; Trump's bad negotiation, lack of experience, the factionalism.

And people talk about divisions within the party, blah, blah, blah, but the core problem was philosophical and intellectual.  The problem was with the substance of the bill.  We live in a country that has widening inequality, where there's a lot of people very — being very insecure.

And the Republicans could have taken some of their approaches, like the tax credits, like the health savings accounts and a lot of things, and to deal with the country as it is, as, say, take those mechanisms, market mechanisms, to reduce costs, but to give people basic security and shore up the coverage that they have now.

But, instead of doing that, they gave a bill that was, like, out of 1984 (the book), which devastated the poor, $880 billion cut out of Medicaid, while enriching the rich, increasing the after-tax incomes of people making more than a million dollars by 14 percent.

So, this was like every stereotype of the Republican Party.  And so it just didn't fit the country.  And the core problem for the Republicans is they can't figure out what they want to govern.

Even if they were the best and most efficient legislators in the history of the world, if you don't know what you want to do, and you don't know how you're going to address this country's problems, you're going to wind up with bills which are superficial, intellectually incoherent and unpopular.

And the last Quinnipiac poll had this at 17 percent.  And so it was a failure of understanding, what we do we want to do?  That's what killed this bill.

REPUBLICAN AGENDA - Trumpcare, Crash and Burn

IMHO:  Where else could the poorly formulated plan go?  All the years that Republicans had to come up with a good heal care plan and they try at the last 'minute' to come up with one?!

This is especially true when their modus operandi is money is more important than anything else.  They are just not willing to help citizens to PAY for health care, actually GET health care.  Their message is, 'you are not worth paying for.'

"Republican repeal effort in ruins, 'we're going to be living with Obamacare' for foreseeable future" PBS NewsHour 3/24/2017

Excerpt

SUMMARY:  It was a hectic day on Capitol Hill as top Republicans tried win enough votes to pass an Obamacare replacement.  But House Speaker Paul Ryan, along with President Trump, decided to pull the repeal when it was clear it would not pass.  Judy Woodruff speaks with Lisa Desjardins from Capitol Hill and Robert Costa from The Washington Post about today's political upset.

"Where does Congress go next on health care?" PBS NewsHour 3/24/2017

Excerpt

SUMMARY:  Now that Republicans have withdrawn a health care bill to repeal and replace the Affordable Care Act, what comes next?  Judy Woodruff gets two perspectives on the aftermath and next steps from Rep. Tim Ryan, D-Ohio, and Lanhee Chen of The Hoover Institution.

"Assessing the impact of the failed GOP health care bill" PBS NewsHour 3/25/2017

Excerpt

SUMMARY:  Following the failure of President Donald Trump and Republican House Speaker Paul Ryan to usher in a long-promised bill to replace the Affordable Care Act, questions remain over how the defeat will influence the new President's agenda.  NewsHour Weekend Special Correspondent Jeff Greenfield joins Hari Sreenivasan to discuss the implications for the Trump administration.

OPINION - Health Care and Free Market Capitalism

IMHO:

My view on health care, especially the Affordable Care Act, is that it must be preserved.

It is a primary duty of any free democratic government to see that its citizens actually get health care.  And in our FreeMarket Captialistic economic system this means seeing that citizens can pay for health care.  After all, the political problem with heal care is cost.

Today's Republicans have a bankrupt, immoral and unethical stance on this issue:

• They are hooked on their doctrine of anti-government.  Believing that even if the American people need good health care, it should not be government supported.

• They are immoral/unethical because the behave as if money (the cost of anything) is much more important than the people's needs.  If it costs too much, they will not pay for it.

• Congress has better heath insurance than most citizens.

The problem with health care will not be solved until there is a solution on how to pay for it. And in our economy there are only a few ways to do this:

• Have the political will to pay what ever it costs under the present health care system.

• Go to a single-payer system, Medicare for All purposed by Bernie Sanders.  Why, Medicare is the most efficient (cost effective) deliverer of health care.  It ensures health care at lower cost (bigger bang for out buck) than private for-profit health insurance.

• Give all citizens the same health care insurance Congress has.

The reason for the high cost of heath care under ANY system is that it is provided through for for-profit health insurance, and these companies want to do whatever it takes to increase their bottom line.   This is why they came up with blocking customers with per-existing conditions.  Insurance companies (of all types) make more money if those paying for the insurance do NOT actually use it.  In health care, they want healthy people who will use health care insurance very little.

The bottom line is that Republicans DO NOT think your health is worth paying for, in other words, you are not worth the cost.

Think about that the next time you vote Republican or support ACA repeal.

Tecknomage,

USN Retired (22yrs), Vet Nam Vet

REPUBLICAN AGENDA - Affordable Care Act Repeal

aka 'Your Health is Too Expensive to Fund Act'

"Hospitals worry an ACA repeal could harm their financial health" PBS NewsHour 2/27/2017

Excerpt

SUMMARY:  Efforts by the Trump administration and congressional Republicans to dismantle the Affordable Care Act are underway, unnerving to some hospital executives who see uncertainty for their bottom line.  If large numbers of people lose their insurance under a replacement, hospital finances could be at risk.  Special correspondent Sarah Varney reports.

JUDY WOODRUFF (NewsHour):  Now what hospitals fear about the possible costs of repealing and replacing the health care law.

Efforts by President Trump and congressional Republicans to unravel the Affordable Care Act are unnerving many hospital executives.  They say they're worried about big changes to their bottom line, particularly after they overhauled how care is delivered in response to the health law's rewards and penalties.

While Republicans try to figure out their game plan, special correspondent Sarah Varney reports on how hospitals are bracing for the unknown.

This story was produced in collaboration with our partner Kaiser Health News.

SARAH VARNEY, special correspondent:  Driving to work amid the barren winter fields in Northern Illinois, Cathie Chapman is worried about the future.  She lost her job after a nearby rural hospital closed.

CATHIE CHAPMAN, Perry Memorial Hospital:  I was really lucky.  I found another great hospital to work in with a wonderful group of people who deliver high-quality care.  But not everyone was as lucky.

SARAH VARNEY:  And as Republicans work to dismantle the Affordable Care Act, she wonders if it might happen again.  Now she runs the pharmacy at Perry Memorial in Princeton, Illinois.  And she's watching the Republicans' repeal efforts warily.

CATHIE CHAPMAN:  I think everybody who works in health care now feels a little uneasy.  Even if you're a large, profitable hospital, we don't know what's coming around the corner, and how it will affect us.

SARAH VARNEY:  Rural hospitals have long struggled to stay open: They have far fewer patients and thin margins.  Dozens have closed across the country in recent years, mostly in states that didn't expand Medicaid.

But, in Illinois, which did extend Medicaid to nearly all poor adults, patients at Perry Memorial have gained coverage under the Affordable Care Act and many hospitals have found firmer footing.

But Annette Schnabel, the hospital's CEO, says if large numbers of people lose their insurance under the Republicans' replacement, the hospital's finances and its patients would be at risk, especially after the hospital has invested so much money and time in complying with the health law.

ANNETTE SCHNABEL, CEO, Perry Memorial Hospital:  We have spent the last six years gearing up towards everything that we were responsible for doing in the ACA.  And the idea of we might have to totally go a different direction or how will we do that, it's going to take a lot of work.  There's a lot of effort that is going into this.

TRUMP AGENDA - HHS Secretary Tom Price

"As HHS Secretary, Tom Price has significant powers to change health care" PBS NewsHour 2/10/2017

Excerpt

SUMMARY:  Tom Price, a Republican congressman from Georgia, was confirmed as the next secretary of health and human services overnight.  The longtime opponent of the Affordable Care Act sees a smaller role for the federal government in health care.  But his new boss, President Trump, has said he wouldn't touch Medicare or Medicaid.  Lisa Desjardins talks with Julie Rovner of Kaiser Health News.

LISA DESJARDINS (NewsHour):  He is, after his swearing-in today, the nation's 23rd Secretary of Health and Human Services.

The U.S. Senate confirmed Georgia Congressman Tom Price in the wee hours this morning on a party-line vote of 52-47.  Secretary Price is a longtime opponent of the Affordable Care Act.

To Democrats like Maria Cantwell of Washington State, that is the problem.

SEN. MARIA CANTWELL, D-District of Columbia:  My view is, this vote is the first vote in the repeal of the Affordable Care Act.

LISA DESJARDINS:  But to Republicans like Tom Cotton of Arkansas, that's Price's appeal.

SEN. TOM COTTON, R-Ark.:  You could say his chief qualification for the job of replacing Obamacare is, he had the good sense to oppose it in the first place.

LISA DESJARDINS:  Price is also a retired doctor, the first physician to lead HHS in nearly 25 years.  But in confirmation hearings, he faced tough questions over his relationship with health care companies, and his investment in some which were affected by his actions in Congress.

Now Price is responsible for a more than a trillion-dollar health agency budget, for a department that oversees food and drugs, biomedical research, public health threats, and, of course, a large portion of U.S. health care.  That includes Medicaid, which covers more than 74 million people, and Medicare, over 55 million.

His theme?  A smaller role for the federal government.  In Congress, Price backed a proposed cap on Medicare spending per person.  Price also supported giving states fixed amounts, in block grants, to cover low-income people on Medicaid.

But his new boss, Donald Trump, said on the campaign trail he wouldn't touch Medicare or Medicaid.

DONALD TRUMP, President of the United States:  Save Medicare, Medicaid, and Social Security without cuts.  Have to do it.

THE ACA - Offer Savings?

"Does this Obamacare experiment offer significant savings?" PBS NewsHour 2/6/2017

Excerpt

SUMMARY:  One of the goals of the Affordable Care Act was to develop organizations that offer doctors and hospitals a deal: In exchange for more efficient care for Medicare recipients, providers receive a share of the savings as a bonus.  Now that ACOs have become embedded in the health care system, are they really working?  Special correspondent Jackie Judd reports.

JOHN YANG (NewsHour):  In that interview with FOX News that aired yesterday, President Trump said it could take longer to repeal and replace Obamacare than he'd indicated previously.

Last month, the president said he'd offer a replacement plan as soon as his health and human services secretary is confirmed.  But Mr. Trump told Bill O'Reilly that it could take until next year.

BILL O'REILLY, Host, “The O'Reilly Factor”:  Can Americans in 2017 expect a new health care plan rolled out by the Trump administration, this year?

PRESIDENT DONALD TRUMP:  In the process, and maybe it will take until some time into next year, but we are certainly going to be in the process.  Very complicated.  Obamacare is a disaster.

You have to remember, Obamacare doesn't work, so we are putting in a wonderful plan.  It's statutorily takes a while to get.  We're going to be putting it in fairly soon.  I think that, yes, I would like to say by the end of the year, at least the rudiments, but we should have something within the year and the following year.

JOHN YANG:  Most of the focus on the Affordable Care Act has been on coverage.

But among the goals of the 2,000-page law is to develop something called Accountable Care Organizations.  They offer doctors and hospitals a deal.  In exchange for better and more efficient care for Medicare recipients, the providers get a share of the savings.

Special correspondent Jackie Judd reports.

JACKIE JUDD, special correspondent:  Creating health care for the future sometimes means going back to the past.

Nurse practitioner Dana Sheer makes old-fashioned house calls to high-risk patients, like Howard VanVleck, who suffers from a neurological disorder.  On this day, a cough alarmed his wife.

LISA VANVLECK, Wife of Howard:  When I called the doctor's office about it, they said, can you bring him in?  And I said, really not.

JACKIE JUDD:  This visit was low-tech and quick, but, if needed, VanVleck can get an in-home ultrasound, an EKG, even a chest X-ray.

DANA SHEER, Nurse Practitioner:  Our program is really aimed at trying to figure out ways that we can provide really good, cost-effective, quality care at a patient's home, at a place where they can actually thrive and do better.

JACKIE JUDD:  How many times during that year would he have been in the hospital if you or a colleague hadn't visited?

DANA SHEER:  Likely every time.

JACKIE JUDD:  Sheer is part of the Accountable Care Organization, or ACO, run by Partners HealthCare, which collaborates with several Massachusetts hospitals.

At Mass General, Jason Wasfy does the once unthinkable for a cardiologist.  He routinely e-mails or video-chats with patients.

DR. JASON WASFY, Massachusetts General Hospital:  There are cases, high cholesterol, for example, where I don't Actually need to actually physically examine the patient.

HEALTH CARE - Doctor's Orders

"Reassessing the value of care for chronic health conditions" PBS NewsHour 1/18/2017

Excerpt

SUMMARY:  Surgeon Atul Gawande says we need to reconsider healthcare's focus on generously rewarding physicians who practice heroic interventions, rather than those who practice incremental medicine for chronic conditions.  Gawande talks with William Brangham about the value of that kind of care, and the potential effects of a Republican repeal of the Affordable Care Act.

DR. ATUL GAWANDE, The New Yorker:  When you think about the future of health care and where we're going at this moment of debate, there's a transformation going on that involves a recognition that our focus in medicine has been on heroic interventions, like the kind that I do now as a surgeon.

But the biggest gains are coming right now from incremental medicine, from a commitment to the kind of steady, overtime management of complex problems like chronic illnesses that can add years to people's lives.  But that's work done by some of the people with the least resources in our health care system.

WILLIAM BRANGHAM (NewsHour):  So, who practices incremental medicine in our health care system today?

DR. ATUL GAWANDE:  Well, good examples, just look at the list of who the lowest-paid people are.

Pediatricians are at the bottom.  You would also look at internists.  You would look at psychiatrists.  You would look at family physicians, HIV specialists.  People who take care of chronic illnesses by seeing people carefully over time, those are the people who get the least money.

The people who have the most [pay] are people like orthopedic surgeons, interventional cardiologists.  And my point isn't that — you know, that we're — that there is something wrong with heroism.

My own son has a congenital heart condition, where his life was saved by a cardiac surgeon stepping in at 11 days of life to save his life.  But he is now 21 years old because of constant monitoring and working with him with a primary care physician and people who controlled his blood pressure, recognized problems before they arose, dealt with learning issues that were related to his condition.

And that's the only reason now that he's getting to live a long and healthy life.  That's what we're not rewarding.  They don't have the kind of resources and commitment that we are giving to people like me.  I have millions of dollars of equipment available to me when I go to work every day in an operating room.

The clinicians who keep my son going are lucky if they can have a nurse.

HEALTH CARE - The 'Super-Utilizers' Issue

"A way to save money when half of all health costs is spent on a fraction of patients" PBS NewsHour 1/17/2017

IMHO:  If the Republicans had their way, these people would just be thrown out.  'They cost too much' (a nice Christian attitude).

Excerpt

SUMMARY:  Health care “super-utilizers” make up just 5 percent of the U.S. population but they account for 50 percent of health care spending.  As health care costs continue to rise, providers are trying to figure out how to find these patients and get to the root of their problems.  But the looming repeal of the Affordable Care Act may disrupt those efforts.  Special correspondent Sarah Varney reports.

JUDY WOODRUFF (NewsHour):  How some lesser-known changes to health care might fare, given President-elect Trump's vow to repeal the Affordable Care Act.

One of those involve so-called “super utilizers” — high-cost patients who frequently turn to emergency rooms for problems better handled by primary care doctors and social workers.

Special correspondent Sarah Varney reports.

This story was produced in collaboration with our partner Kaiser Health News.

SARAH VARNEY, Special correspondent:  Protective gown.  Rubber gloves.  Face mask.  Dayna Gurley is getting dressed for work.  She's a social worker charged not with treating infectious diseases, but with figuring out why her clients all but live in Houston's hospitals.

DAYNA GURLEY, Social Worker:  What's been going on?

SARAH VARNEY:  This patient, who asked not to be identified, has chronic massive ulcers, AIDS, hears voices, and, at times, spends three weeks out of the month at multiple hospitals around Houston.

Gurley is part of a promising effort in the U.S. health care system:  Honing in on so-called “super-utilizers,” patients with complex problems who frequent emergency rooms and cost public and private insurers dearly.

Super-utilizers make up just 5 percent of the U.S. population, but they account for 50 percent of health care spending.  As health care costs continue to rise, providers are trying to find these patients and get to the root of their problems.

An effort to do just that started in New Jersey's poorest city, Camden.  Family physician Dr. Jeffrey Brenner was inspired by how police departments were using crime data to detect hot spots.  To find Camden's health care hot spots, Brenner dug into ambulance records and E.R. data to show how high-cost patients were shuttling between city hospitals.

DR. JEFFREY BRENNER, Camden Coalition of Healthcare Providers:  In America, we're medicalizing social problems, and we're criminalizing social problems, and we're wasting huge amounts of public resources.

SARAH VARNEY:  To steer super-utilizers away from expensive emergency care, Brenner's team, including social workers Latonya Oliver and Bill Nice, seek patients out in local neighborhoods.

BILL NICE:  There's been a few patients that I have had like that…

SARAH VARNEY:  They work intensively with people like Peter Bowser.

Bowser was once homeless, and went to the E.R. 28 times in one year.

PETER BOWSER:  Because I was telling people when I was staying in the shelter, I said, ‘When I get my place,' I said, ‘I'm going to maintain it.'

SARAH VARNEY:  But after they helped get a permanent roof over his head, Bowser's trips to the E.R. all but stopped.

BILL NICE:  And I think you would prefer to spend your time here than the hospital any day of the week…

TRUMP NOT FILES - Tom Price vs 'Obamacare'

"Will Tom Price take a 'surgical approach' to revising Obamacare?" PBS NewsHour 11/29/2016

WARNING:  Price and the GOP will be using a meat cleaver for their 'surgical approach.'  You will be paying more or getting less.  Their plan (as always) puts money ahead of actually providing health care.  Their unmoral/unethical plan to just forget about those who NEED health care.

Excerpt

SUMMARY:  Rep. Tom Price (R-Ga) is an orthopedic surgeon and a vocal critic of the Affordable Care Act.  He's also President-elect Donald Trump's choice to head the Department of Health and Human Services.  Hari Sreenivasan speaks with Sabrina Corlette of Georgetown University, Robert Moffit of The Heritage Foundation and Sarah Kliff of Vox about Price's background and how he might shape health care policy.

HARI SREENIVASAN (NewsHour):  As President-elect Trump's pick to lead the Health and Human Services Department, Congressman Tom Price would oversee programs as wide-ranging as Medicare and Medicaid.  But, first, he'd help lead efforts to carry out one of Mr. Trump's signature campaign pledges:  Repeal and replace the Affordable Care Act, also known as Obamacare.

For more, we turn to Sarah Kliff.  She has written extensively on the topic for the Web site Vox.

What do we know about Congressman Price and the plans that he has already had in mind?

SARAH KLIFF, Vox:  So, he's a congressman who has spent a lot of time thinking about repeal and replace of Obamacare.  He's the author of a 242-page replacement plan for Obamacare.  He's the guy you would pick if you're quite serious about moving forward on Obamacare repeal.

HARI SREENIVASAN:  Republicans have tried to do repeal and replace before.  Even Speaker Ryan has a plan.  What do these plans have in common?

SARAH KLIFF:  So, they generally cover fewer people than Obamacare.  They would leave a few million people uninsured.  The exact number depends on the plan.  They're generally better for young, healthy people and worse for sick, older people.

HARI SREENIVASAN:  How so?

SARAH KLIFF:  They have a lot less protections for people with preexisting conditions.

They make it possible for insurance companies to charge more to those who are sick.  That would be a really big change from Obamacare, which outlaws those provisions.

HARI SREENIVASAN:  And then what does the pick say of Seema Verma, who is going to run Medicare and Medicaid, say about this new team that he's putting in place?  She's worked on Medicaid expansion as a consultant for different states?

SARAH KLIFF:  She's incredibly experienced in Medicaid policy.

It suggests to me that the Trump administration is thinking about making some big changes to Medicaid, possibly adding premiums into the program, which serves low-income Americans.