ILLEGAL IMMIGRATION NUMBERS GREATLY REDUCED THANKS TO TRUMP'S BORDER CONTROL POLICIES (WHERE'S THE MSM?)
ANOTHER TRUMP CAMPAIGN PROMISE FULFILLED.
WHY WON'T MSM REPORT ON THIS POSITIVE NEWS?
Sources: The Blaze, Fox News, Youtube
****** New illegal immigration numbers reveal Trump’s incredible impact on the border
One of President Donald Trump’s central (and most controversial) campaign promises was to shut down the flow of immigrants illegally crossing into the United States, especially from Mexico.
Newly released figures show Trump appears to be making good on his promise.
An analysis by the Daily Caller News Foundation found that from February through May in 2016, 188,000 people were caught attempting to illegally enter the United States from Mexico.
During the same period in 2017, only 76,000 were captured or deemed inadmissible, a decline of 59 percent.
In May alone, the number caught in 2017 was less than half (19,967) that recorded in 2016 (55,442), a truly remarkable turnaround considering Trump’s much-talked-about border wall has still yet to be financed by Congress.
“They’ve done more than any administration in the history of the world,” Texas Attorney General Ken Paxton told the Daily Caller.
“So, I’m pretty happy that they’ve done so much in such a short period of time so it would really be difficult for me to criticize them on that issue because there’s no comparison with any other administration as far as how quickly and effectively they’ve approached the problem on many different fronts,” Paxton also said.
In May, Ronald Vitiello, the chief of the U.S. Border Patrol, told a Senate Judiciary subcommittee the decline is due to Trump’s January executive orders mandating a shift in policy and resources on the border.
“As a result of the executive orders issued by the president, and the implementing policies issued by the secretary, as well as earlier policy changes and the significant investments we have made in border-enforcement personnel, technology, and infrastructure, we are seeing a historic shift in illegal crossings along the southwest border,” Vitiello said, according to the Washington Examiner.
Some portion of the GOP front-runner's plans are already in Obama's health care reforms.
Critics of Republican front-runner Donald Trump have said his plans to "Make America Great Again" are scant on details, but on Wednesday night he got specific about what he would do to reform health care.
The proposals go further than promising to save people from "dying in the streets" – a phrase he has repeated often in the debates.
On his website, he detailed his seven-point plan, which he says will broaden access, increase affordability, and improve quality. Like other Republicans, candidate Trump has consistently vowed to "repeal Obamacare," President Barack Obama's signature health care law, but in his proposal he acknowledged that such a move would require an act of Congress.
"On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare," says the proposal. Members of Congress have tried to repeal the law more than 50 times, but this January for the first time they managed to send a bill to Obama's desk, which he promptly vetoed. Though the move was expected, Republicans were sending a message to voters that if they put a Republican in the White House – and maintain their majority in Congress – then Obama' s health care law would no longer stand.
Obamacare has several provisions written in the roughly 1,000-page law that aim to increase access to health coverage and improve the quality of care. Trump specifically said that Congress should repeal the "individual mandate," the portion of the law that requires all Americans to get health insurance or pay a tax penalty. This point represents a shift from his apparent position in a CNN town hall in February, in which Trump said he liked the mandate.
"No person should be required to buy insurance unless he or she wants to," he said on his website. He proposed allowing people to deduct health insurance premiums from their taxes, and to sign up for tax-free Health Savings Accounts, which are meant to accumulate to cover medical expenses, and have high deductibles.
Obamacare, low- and middle-income people receive tax subsidies to help them pay for coverage. Consumers have complained that some of the plans come with high deductibles, which are aimed to encourage people to seek out care only when they need it, and to shop for medical care to find the best deals. High-deductible plans are endorsed by economists, but in the real world they have played out differently than anticipated: rather than shop for cheaper care, many patients forego it altogether.
Echoing the importance of consumer choice in reducing the cost of care, Trump said that under his plan, doctors, clinics and hospitals would make it easier for consumers to compare prices of different procedures or exams. He did not specify, however, where and how the prices would be listed.
Trump also proposed allowing states to sell insurance across state lines. Though touted by other Republican candidates – including Sens. Ted Cruz of Texas and Marco Rubio of Florida – the provision is already in the Affordable Care Act, but the Obama administration has not implemented it and has not announced when it would do so.
One of the most contested parts of Obamacare has been a provision that obligates states to expand Medicaid, the government's program for low-income Americans. Even the Supreme Court ruled that states could choose whether they wanted to implement the program, and so far the District of Columbia and 31 states have done so – the rest say they are concerned about costs.
Hillary Clinton and Bernie Sanders are in a pitched battle for the Democratic nomination, fighting for the hearts and minds of left-leaning voters across the US.
But where do they stand on the issues? While the candidates often agree on substance if not style, here's a look at five areas where they differ - not just from each other, but from their presidential predecessors, as well.
~ Taxes
They will go up - but for whom?
Bernie Sanders promises he will reduce income inequality through changes to US through tax policy. He has called for a 10% tax surcharge on billionaires, raising the top three tax brackets and creating a new top rate, boosting capital gains and estate taxes, extending Social Security taxes, going after income made abroad by US corporations, and creating a new 0.2% tax on all earners to fund a paid family leave programme.
Hillary Clinton's tax plan is basically Sanders-lite. She wants a 4% surtax on income over $5 million, an increase in capital gains taxes, the closing of "tax loopholes" for the wealthy, taxing hedge fund managers' "carried interest" income at higher rates and increasing the estate tax rate.
Bill Clinton also raised taxes on the wealthy - and caught considerable criticism from conservatives for doing so. He instituted two new high-level tax brackets, raised corporate taxes, and increased income subject to Medicare and Social Security levies. After Republicans took control of Congress two years into his administration, he signed legislation lowering the capital gains taxes. He also increased a tax credit for poorer workers.
John F Kennedy was the original Democratic tax-cutter. He reduced the top rate in the US from 95% to 65% and the corporate tax rate from 52% to 47%. Today's conservatives love to quote his claim that a high tax rate "siphons out of the private economy too large a share of personal and business purchasing power".
~ Higher education
Pitching college education that's free or just affordable
Bernie Sanders has set the bar when it comes to higher education policy in the modern Democratic Party, with his call for free college for all Americans funded by taxing Wall Street financial transactions. He points to the runaway costs of higher education as one of the driving forces behind growing income inequality in the US.
Hillary Clinton supports a plan to make two-year community college free, but her higher education policies are more modest. She has called for lowering student loan interest rates, providing $17.5 billion to improve the quality of higher education and encouraging colleges to set affordable tuition rates that don't require student loans.
Barack Obama signed legislation streamlining the student loan system, including provisions that allow the government to directly loan money to students rather than rely on for-profit middle-men. He has also proposed making the first two years of college free, with a programme modelled on a Tennessee system devised by the state's Republican governor.
Lyndon Baines Johnson is the godfather of the modern Democratic Party's education policies. As president he spearheaded passage of the Higher Education Act of 1965, which increased federal funding for universities and provided low-interest student loans and grants for needy students. It was landmark legislation in its day - but now seems relatively modest.
~ Healthcare
Mend it or end it - and start over from scratch.
Barack Obama supported and signed legislation increasing government regulation of the health insurance industry and creating private insurance markets for individuals not covered by employer-provided insurance. The programme was based, in part, on Republican proposals from the 1990s and the system instituted in Massachusetts by then-Governor Mitt Romney.
For Bernie Sanders, however, that particular half-loaf is far from enough. He wants to institute a single-payer government-run health insurance system fashioned on Medicare. He has also called for allowing the government to negotiate with pharmaceutical companies in order to lower prices and permitting Americans to import medication from Canada, where it is less expensive.
Hillary Clinton has said Mr Sanders is advancing an unrealistic proposal that threatens hard-won healthcare reforms made during Mr Obama's tenure. Instead she wants to expand existing law to improve coverage for prescription drugs and allow the government to negotiate with pharmaceutical manufacturers for better prices.
The former first lady does know a thing or two about how hard it is to get healthcare bills through Congress. In 1993 she was the driving force behind Bill Clinton's proposed legislation, which created a federal minimum-benefits healthcare package with limits on out-of-pocket expenses, all provided by regional healthcare alliances. That effort went down in flames before it even came to a vote in Congress.
~ Gun control
The one place where Clinton comes at Sanders from the left.
Hillary Clinton is the first prominent Democratic presidential candidate to openly run on a gun-control platform since Al Gore's losing campaign in 2000. She supports holding gun manufacturers liable for deaths caused by their products, expanding background checks and prohibiting those on no-fly list from purchasing firearms. She has also supported reinstating the ban on semi-automatic "assault" rifles.
Bernie Sanders, a senator from the rural state of Vermont, has a more moderate position on guns - although he has moved to the left over the course of the campaign. He supports expanded background checks on gun purchases and an assault weapons ban, but opposes holding gun manufacturers liable for deaths. He voted against a gun purchase waiting period multiple times in the early 1990s and for allowing guns in national parks.
Barack Obama shied away from campaigning on gun control in his two presidential campaigns, but the murder of schoolchildren in Newtown, Connecticut, in December 2012 convinced him to act. He has since called for an assault weapons ban and expanded background checks. He has taken unilateral executive action to increase enforcement of laws against gun trafficking and broadening the scope of federal regulation of firearm transactions.
Franklin Delano Roosevelt made the first serious effort at gun control by a Democratic president to date and his call in 1934 to create a national firearm registry and institute a federal tax on all gun purchases. No major Democratic officeholder would even consider broaching such a proposal today. It wouldn't just be dead on arrival in Congress, for many politicians it would be political suicide.
~ Foreign policy
Remember the Iraq War? Bernie Sanders does.
Hillary Clinton, as secretary of state, was one of the more hawkish members of Mr Obama's cabinet. It's no surprise then that as a presidential candidate she is well to the right of Mr Sanders and even Mr Obama. She has called for greater US involvement in the Syrian civil war, including enforcing a no-fly zone, and supports a continued US military presence in Afghanistan.
Bernie Sanders generally agrees with Barack Obama's foreign policies - limited involvement in Syria and an emphasis on working with US allies. He contrasts himself with Mrs Clinton by noting the past US military action that she supported and he opposed - in Libya and Iraq. He supports a full US withdrawal from Afghanistan and no US training of rebels in the Syrian civil war.
John F Kennedy's foreign policy as president, compared to the current crop of Democratic politicians, seems downright bellicose. He was an interventionist at heart, authorising the Bay of Pigs invasion of Cuba, taking a hard line against Soviet expansion in the Western hemisphere and initiating US involvement in Vietnam.
Faced with mounting evidence that get-tough policies in schools are leading to arrest records, low academic achievement and high dropout rates that especially affect minority students, cities and school districts around the country are rethinking their approach to minor offenses.
Perhaps nowhere has the shift been more pronounced than in Broward County’s public schools. Two years ago, the school district achieved an ignominious Florida record: More students were arrested on school campuses here than in any other state district, the vast majority for misdemeanors like possessing marijuana or spraying graffiti.
The Florida district, the sixth largest in the nation, was far from an outlier. In the past two decades, schools around the country have seen suspensions, expulsions and arrests for minor nonviolent offenses climb together with the number of police officers stationed at schools. The policy, called zero tolerance, first grew out of the war on drugs in the 1990s and became more aggressive in the wake of school shootings like the one at Columbine High School in Colorado.
But in November, Broward veered in a different direction, joining other large school districts, including Los Angeles, Baltimore, Chicago and Denver, in backing away from the get-tough approach.
Rather than push children out of school, districts like Broward are now doing the opposite: choosing to keep lawbreaking students in school, away from trouble on the streets, and offering them counseling and other assistance aimed at changing behavior.
These alternative efforts are increasingly supported, sometimes even led, by state juvenile justice directors, judges and police officers.
In Broward, which had more than 1,000 arrests in the 2011 school year, the school district entered into a wide-ranging agreement last month with local law enforcement, the juvenile justice department and civil rights groups like the N.A.A.C.P. to overhaul its disciplinary policies and de-emphasize punishment.
Some states, prodded by parents and student groups, are similarly moving to change the laws; in 2009, Florida amended its laws to allow school administrators greater discretion in disciplining students.
“A knee-jerk reaction for minor offenses, suspending and expelling students, this is not the business we should be in,” said Robert W. Runcie, the Broward County Schools superintendent, who took the job in late 2011. “We are not accepting that we need to have hundreds of students getting arrested and getting records that impact their lifelong chances to get a job, go into the military, get financial aid.”
Nationwide, more than 70 percent of students involved in arrests or referrals to court are black or Hispanic, according to federal data.
“What you see is the beginning of a national trend here,” said Michael Thompson, the director of the Council of State Governments Justice Center. “Everybody recognizes right now that if we want to really find ways to close the achievement gap, we are really going to need to look at the huge number of kids being removed from school campuses who are not receiving any classroom time.”
Pressure to change has come from the Obama administration, too. Beginning in 2009, the Department of Justice and the Department of Education aggressively began to encourage schools to think twice before arresting and pushing children out of school. In some cases, as in Meridian, Miss., the federal government has sued to force change in schools.
Some view the shift as politically driven and worry that the pendulum may swing too far in the other direction. Ken Trump, a school security consultant, said that while existing policies are at times misused by school staffs and officers, the policies mostly work well, offering schools the right amount of discretion.
“It’s a political movement by civil rights organizations that have targeted school police,” Mr. Trump said. “If you politicize this on either side, it’s not going to help on the front lines.”
Supporters, though, emphasize the flexibility in these new policies and stress that they do not apply to students who commit felonies or pose a danger.
“We are not taking these tools out of the toolbox,” said Russell Skiba, a school psychology professor at Indiana University who promotes disciplinary changes. “We are saying these should be tools of last resort.”
In Broward County, the shift has shown immediate results, although it is too early to predict overall success. School-based arrests have dropped by 41 percent, and suspensions, which in 2011 added up to 87,000 out of 258,000 students, are down 66 percent from the same period in 2012, school data shows.
Under the new agreement, students caught for the first time committing any of 11 nonviolent misdemeanors are no longer arrested and sent to court. Rather, they attend counseling and perform community service.
Nor do students face suspension for minor infractions. Instead, they also attend a program called Promise for three days or more. Repeat offenders get several chances to change their behavior before more punitive measures kick in.
One recent afternoon, an 18-year-old senior sat in the cafeteria at the Pine Ridge Alternative Center, where students are sent in lieu of a suspension, and spoke with a family therapy graduate student on a counseling team. The girl had been caught with a small amount of marijuana in her car on her high school campus, a misdemeanor that would have led to a suspension or arrest in the past. It was the first time she had gotten in trouble at school.
“I was freaking out,” she said. Her first fear was that she would be barred from prom. Here, though, she saw the larger picture and came to view the incident as “her second chance.”
She learned about bullying and drugs and alcohol. “It was a slap in the face,” she said. “I don’t even want to smoke anymore.”
Other students here learn to manage their anger, if that is their issue. Parents are involved in the process. And counselors have helped identify problems at home including abusive situations, something that administrators said underscores how invaluable the counseling component has been for the Promise program, said Belinda Hope, the principal at Pine Ridge.
Mr. Runcie and others said the more punitive measures tended to make a bad situation worse. Suspended and expelled children would be home alone or on the street, falling behind academically. Those arrested could be stigmatized by criminal records.
“The data showed an increase in the harshness of the disciplinary practices in schools — what was once a trip to the principal’s office is now a trip to the jail cell,” said Judith Browne Dianis, co-director of the Advancement Project, a civil-rights group involved in the effort.
Juvenile judges were among the first to express alarm over the jump in the number of students appearing in court on misdemeanors, an increase they said is tied to the proliferation of school police officers.
“We started to see the officers as a disciplinary tool,” said Judge Elijah H. Williams of Broward County Circuit Court, a juvenile judge who said he was “no flaming liberal” but saw the need for change.
“Somebody writes graffiti in a stall, O.K., you’re under Arrest.
A person gets caught with a Marijuana cigarette, you’re under Arrest.”
Everybody is talking about how Obamacare will look on January 1, 2014.
But how will things look on January 1, 2015?
We put that question to eight smart people who follow health policy.
They represent different political perspectives and come by their expertise in different ways.
There's an economist, three trained physicians, plus a longtime consumer advocate and organizer. Two of them worked for Republican presidents, one served a Democrat.
One frequently criticizes Obamacare from the right, another from the left.
But their predictions have more in common than you might suspect:
1) ****HAROLD POLLACK:
In 2014, the most interesting political and policy stories will shift from Washington to the fifty states. States face a mammoth implementation challenge. They also provide the terrain in which we will see whether bipartisan health policy is actually possible. In some parts of the country, we’ll see some fascinating negotiations as Republican governors and the Obama administration each seek a dignified path to make this thing work.
I hope that we see something else, too: An end to the politics of impunity toward the poor and the uninsured.
It’s sobering to think that the same inequalities that make universal coverage a moral imperative pose the chief political obstacles to universal coverage itself. Those with the most to gain from the Affordable Care Act’s Medicaid expansion are economically marginal, disorganized, alienated from the levers of politics, distrusted or disliked by many other Americans. This reality produces a striking sense of impunity among governors and legislators who deny Medicaid coverage to five million people, even as the federal government stands ready to foot virtually the entire bill.
As Medicaid expansion becomes real, Republican politicians who embrace it will begin to profit. Hospitals, cities and counties, and other interest groups in non-expansion states will ask hard questions about why their states chose a different path. Poor people themselves, in campaigns such as texasleftmeout.org, will increase the pressure, too.
It’s important that these recalcitrant officials pay some price—not just to smooth the way for expanded coverage, but to debunk a particularly toxic assumption in American life. Too many politicians assume that poor people just don’t matter, politically. On many issues from the sequester to unemployment insurance, the practical consequences of this assumption are only too obvious.
This assumption is being put to the test. In 2014, I’m betting that some governors will be surprised.
2) ***GAIL WILENSKY:
As expected, 2014 was a tumultuous year for the Affordable Care Act. It started in January with many people who thought they had enrolled not actually being insured--either because the information hadn't been accurately transmitted back to their insurance companies or because they hadn't paid their premiums by January 10. After a lot of pressure from the Administration to cover people retroactively if necessary, people newly insured began receiving services.
Access to health services was less problematic than many had feared because of the smaller-than-predicted numbers enrolling in private insurance. Only 4.5 million got coverage, even after the March surge in sign-ups. And there were the many "red" states that hadn't expanded their Medicaid coverage. Some states reported challenges getting primary care services provided to the newly insured--California having the most significant problems.
Some of the smaller regional insurance companies participating in 2014 decided not to participate again in 2015. Some larger companies that had only selectively participated in 2014 increased their participation only modestly for 2015, still concerned about the significant adverse selection that had occurred in 2014 and their difficulty to price properly.
The biggest uproar occurred when many smaller/mid-sized employers received notices that their existing policies didn't meet ACA standards and weren't being renewed. As expected, the Administration provided a variety of accommodations to these employers.
The best news is that the majority of states that had not previously expanded Medicaid announced intentions to do so for 2015. The bad news is that the newly elected Congress is even less likely to pass any legislative "fixes" than the previous Congress.
(Gail Wilensky has served as director of Medicare and Medicaid and she has chaired the Medicare Payment Advisory Commission. She is now an economist and senior fellow at Project HOPE.)
3) ***ANTHONY WRIGHT:
By the end of 2014, more than 2 million Californians will be enrolled in new coverage options under the Affordable Care Act. A million will have coverage through our exchange, Covered California, following its second open enrollment period. More will be getting coverage through our Medicaid program. Already 700,000 newly covered people have insurance through an early expansion of Medicaid; by February it will be more than 1 million.
Washington-based media will continue to hyperventilate about Obamacare, mistakenly using every website glitch or early enrollment figure as a binary barometer of the law’s success or failure. But even in a state like California—where the website (mostly) works, premiums came in below expectations, and enrollments are on target—officials aren't putting up a “Mission Accomplished” banner yet. Just as rollout problems were never indications of the ACA’s demise, progress to date is not proof the job is finished.
As elections are about the future, not the past, I predict Obamacare itself won't be a major factor in future contests. The debate will be “What’s Next?”
In states that have been more hostile to the law, at least some officials will change their minds about the Medicaid expansion, allowing it go forward.
In states like California that have embraced the law, officials and supporters of reform will focus on improving the law. Among the questions they will address:
1. How can we ensure a safety-net that survives and thrives—to provide primary and preventative care to the remaining uninsured, including undocumented immigrants that were excluded from the ACA?
2. How can we further regulate the insurance market—beyond basic steps like banning pre-existing condition exclusions—so that insurers compete not on avoiding sick people, but on cost, quality, customer service and prevention? How else can we make the health industry more accountable for improved quality and reduced cost of care? California is likely to debate (through bills, the budget, and the ballot box) more oversight of networks, transparency of health spending, rate regulation, investments in prevention and public health, and more.
While we will concentrate on the unfinished work of implementing the law in 2014, the work to fulfill the full promise of the law will be just beginning.
(Anthony Wright is director of Health Access California, a consumer advocacy organization.)
4) ***SEAN PARNELL:
Although it’s unlikely that 2014 will be as bad for the ACA as the initial rollout was, the law still faces significant challenges in the New Year.
The biggest hurdle will be enrollment, particularly among the young and healthy. Deductibles are high, premium subsidies generally aren’t available except to the poorest, the tax for being uninsured is low, and the young have always been overrepresented among the uninsured. This will continue to be the case in 2014 and beyond.
Late in 2014, insurers will announce premiums for 2015. They will be higher, inflicting a political price on Democrats. Expect more creative interpretations and regulatory flexibility out of the Obama administration in order to smooth over more unintended consequences of the ACA.
There will be more Americans who pay directly for more of their health care. The ACA is projected by the Congressional Budget Office to leave 30 million people uninsured, and tens of millions more will get high-deductible plans through exchanges or their employers. These self-pay patients will demand price transparency and discounts for paying in full at the time of treatment, and innovative entrepreneurs will step up to cater to them while ignoring the traditional third-party payment system.
At the end of 2014, I expect to see many advocates of the ACA look back and conclude that while it’s too early to call the law a failure, the meager results fall far short of what was hoped for.
(Sean Parnell is author of The Self-Pay Patient and a writer at www.theselfpaypatient.com)
5) ***DAVID BLUMENTAL:
The most recent CBO projections for ACA coverage, from May 2013, suggested there would be 7 million new privately insured Americans and 9 million new enrollees in Medicaid/CHIP by the end of 2014.
Through December 30, 1.9 million Americans had enrolled in private coverage through the federal and state marketplaces. As of December 20, 627,000 had enrolled in Medicaid/Chip. Let’s assume that by January 1 the numbers stand at about 2.0 million for private insurance (30 percent of the CBO 2014 target) and 1 million for Medicaid (11 percent).
The real deadline, however, for the first ACA open enrollment period is March 31, 2014, when penalties kick in. It would be reasonable to expect enrollment during February-March, 2014 to equal the 2013 numbers, bringing the total for private enrollees to about 4.0 million or 60 percent of CBO projections
Medicaid/CHIP numbers are harder to predict because enrollment can proceed continuously over the year. Assuming 1.5 million Americans enroll in Medicaid/CHIP during 2014, participation in public plans would come to 2.5 million or about 28 percent of projected.
Including the 3 million young people under 26 who have gained coverage under their parents’ plans in 2013, these projections would mean that a minimum of 10 million Americans would have become newly insured under provisions of the Affordable Care Act by the end of 2014.
As for costs, the ACA is given some credit (deserved or not) for keeping growth in overall health care costs below historical rates. However, times of rising personal wealth have always been times of rising health care spending. If the economy experiences strong GDP growth in 2014, growth in health spending is also likely to increase beyond the 2012 level of 0.8 percent per capita. A reasonable prediction: both GDP and health care will grow in the 2-3 percent range.
As a percent of GDP, health care expenses would remain unchanged at the 18 percent level.
This would have been viewed as a big accomplishment only a few years ago, but that was then.
(David Blumenthal, who has been a professor of medicine at Harvard and the National Coordinator for Health Information Technology, is now president of the Commonwealth Fund.)
6) ***TEVI TROY:
One year from now, the Affordable Care Act will be hobbled but still there. The hangover from the botched rollout will continue to haunt the program, but the website will be in better shape, and an increasing number of people will be getting subsidized insurance via the exchanges. At the same time, sticker shock will continue, especially among those without access to subsidized rates, and take-up rates will continually be lower than the administration predicted.
This will lead to a situation where Democrats are touting the number of covered individuals and calling the ACA a success, while Republicans will highlight the increased costs, lower than expected numbers of covered individuals, and the roll out problems to determine that the plan is a failure. The answer to the question of whether the law is a success or a failure will come from the employer-based market. If employer-based plans continue without significant disruptions, the ACA will weather the storm; but if individuals in the employer-based market lose their insurance or see major changes in their plans, the ACA’s political troubles will worsen.
In addition, one year from now, Republicans will be pleased with their election gains in the House and Senate, but will also realize that, even with their political victory, they cannot repeal the ACA while a lame duck President Obama remains in office.
This will set up the 2016 election as yet another do-or-die test for the ACA.
(Tevi Troy is a former Deputy Secretary of HHS and the author of What Jefferson Read, Ike Watched, and Obama Tweeted: 200 Years of Popular Culture in the White House.)
7) ***JOHN Z. AYANIAN:
The most notable change will be 12 million newly insured Americans. In May, 2013 the Congressional Budget Office (CBO) projected 9 million low-income adults would gain coverage in states opting to expand Medicaid during 2014, and another 7 million Americans would obtain private insurance through new federal and state health insurance exchanges. However, because of incomplete ACA awareness among eligible adults and early technical problems with the exchanges, I expect overall enrollment gains in 2014 will be 12 million instead of 16 million Americans.
A second major change over the next year will be much better functioning insurance exchanges. Major problems faced by HealthCare.gov and many new state exchanges will be essentially resolved through effective technical solutions.
The ACA’s future hinges on the U.S. Senate elections in 2014. If Democrats retain control of the Senate, ACA implementation will continue largely as planned. In contrast, if Republicans control both the Senate and House in 2015, Republicans and moderate Democrats in Congress will agree to change several features of the ACA. Essential benefit requirements for insurers will be loosened, financial penalties for uninsured individuals will be lightened, insurance subsidies will be reduced or eliminated for some currently eligible households (those at 300-400% of the federal poverty level), and the medical device tax will be eliminated. Because President Obama will veto a full ACA repeal, its two core components—Medicaid expansion in 25 or more states and subsidized private coverage for most currently eligible households—will be preserved until the 2016 Presidential election.
(John Z. Ayanian is a professor of internal medicine and director of the Institute for Healthcare Policy and Innovation at the University of Michigan.)
8) ***DON MCANNE:
There is no doubt that, in 2014, we will see enough individuals enrolled in Medicaid, in the exchange plans, and some new enrollment in employer-sponsored plans (to avoid the penalty, though small this year), that the Affordable Care Act will be considered a success. But success is not measured by enrollment in insurance plans but rather by the ability to obtain access to affordable health care.
Not only will tens of millions remain uninsured, those insured that need health care will face financial barriers of high deductibles and other cost sharing, and many will face lack of choice due to narrow provider networks. Unavoidable care provided out of network could result in catastrophic expenses. We will continue to hear stories of people facing excess costs and network problems that will prevent them from accessing care of their choosing.
Already, from both the left and the right, there is much discussion of single payer (improved Medicare for all) as an inevitability once it is realized how poorly functioning will be our fragmented, dysfunctional system of financing health care. We will not see the threshold for action in changing to single payer reached this year, but within a few years, demand for change will occur.
The feeble recommendations from the right would only make things worse, partly by diminishing what little protection we do have, so there isn’t much left other than single payer. Once enough people understand that all of us can have free choice of care that is affordable through equitable public funding, they will demand single payer.
(Don McCanne is a senior health policy fellow with Physicians for a National Health Plan.)
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God Bless
Laurel @BLACK POLITICAL BUZZ
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