Saturday, June 24, 2017

The American Health Care Act, the Better Care Reconciliation Act, and Vera

Trigger/Content Warning (TW/CW): the following blog post contains mentions of rape and incest. Reader discretion is advised.

It's not very often that I am at a loss for words. But between these two (United States of America) Congressional bills that are continually being worked on between the Senate and the House of Representatives, I am going to give my fellow Americans a piece of my twisted mind. With whatever words I can find.

First, allow me to break down the difference between the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA).

American Health Care Act

The American Health Care Act is a bill passed by the House of Representatives as an alternative to the existing law of the hand, the Affordable Care Act (ACA), better known in tabloids globally as "Obamacare." Instead of going through the entire list of things the AHCA does for everyone (even though I should), I'm going to show a few items. Emphasis, highlighted in yellow and italicized script, is of my doing to show how the bills would affect (effect?) me personally.
From Title 1, Energy & Commerce; Subtitle B, Medicaid Program Enhancement: (Sec. 112) Beginning in 2020, the bill eliminates: (1) the enhanced FMAP for Medicaid services furnished to adult enrollees made newly eligible for Medicaid by PPACA; and (2) the expansion of Medicaid, under PPACA, to cover such enrollees. However, a state Medicaid program may continue to provide coverage, with the enhanced FMAP, to such enrollees who were enrolled prior to 2020 and do not subsequently have any break in eligibility exceeding one month. The bill also eliminates, beginning in 2018, the state option to extend Medicaid coverage to non-elderly adults with incomes above 133% of the official poverty line.
That last sentence, in how it affects me, is that in the event I return to Medicaid, based on my income, I would be disqualified. In fact, currently Ohio Medicaid pays my monthly premium to Medicare. If this provision becomes law, Ohio will stop the program I'm enrolled in for Medicaid to pay my Medicare monthly premium, therefore I will be solely responsible for that. Having approximately 10% of your monthly Social Security Disability Insurance (SSDI) allowance taken out off the bat for health insurance is not exactly part of a complete breakfast.

That should actually help you with your financial fuckery, Vera.

You would think, Dear Reader. However, potentially losing that 10% means that a few of my creditors won't get paid like they're supposed to.

You probably should have thought about that before you bought (and either sold or threw out) all those clothes, shoes, furniture, bedding, storage bins, backpacks, and those damn Trapper Keepers, over a span of almost three years.

*mocks Dear Reader's last sentence* So I learn in real time. Bite me.
(Sec. 117) The bill allows a state Medicaid program to impose a work requirement as a condition of eligibility. However, a program may not apply such a requirement to: (1) a pregnant woman, (2) the sole parent or caretaker of either a child younger than age 6 or a child with disabilities, (3) an individual younger than age 19, or (4) an individual younger than age 20 who is married or head of a household and either attends secondary school or participates in employment-related education. The bill increases by 5% the FMAP for certain administrative expenditures that are attributable to implementing a work requirement.
Let's say: you have income right at the 133% of the federal poverty line. You are now eligible for Medicaid. In certain states where this option becomes utilized, YOU STILL HAVE TO WORK FOR IT, even if you are disabled.

That, in of itself, becomes a Catch 22 (both sides of an argument have negative outcomes). On one side, if you are disabled, in order to prove your Medicaid eligibility, you have to show that you have some employment upon you to as a condition to receive and maintain Medicaid. On the other side, showing the government that you are working as a condition of eligibility for Medicaid will be seen as a detriment to you receiving any disability (SSI/SSDI) compensation when your case is reviewed by Social Security.

Um, fuck this noise much?
From Subtitle C, Per Capita Allotment for Medical Assistance: (Sec. 121) Under current law, state Medicaid programs are guaranteed federal matching funds for qualifying expenditures. The bill establishes limits on federal funding for state Medicaid programs beginning in FY2020. Specifically, the bill establishes targeted spending caps for each state, using a formula based on the state's FY2016 medical assistance expenditures in each enrollee category: (1) the elderly, (2) the blind and disabled, (3) children, (4) adults made newly eligible for Medicaid by PPACA, and (5) all other enrollees. With respect to a state that exceeds its targeted spending cap in a given fiscal year, the bill provides for reduced federal funding in the following fiscal year. In addition, the bill: (1) requires additional reporting and auditing of state data on medical assistance expenditures, and (2) temporarily increases the FMAP with respect to certain data reporting expenditures.
Let's say an ice cream sundae costs $2.50 in 2015. You only have $1.80 (and I'm just playing with random numbers to prove a point) to pay for an ice cream sundae. So you end up requesting the additional 70¢ to cover the costs, and you get that scrumptious sundae. Lovely. Now, fast forward to 2019, to where that same ice cream sundae is now $3.20, and you only have $2.00. The request to cover the difference is still at 70¢. What's worse, there is a massive dog fight over who gets that 70¢. And when someone finally does get that assistance, where are they going to come up with that remaining 50¢ just to get that ice cream sundae? They will have to work for it, by any means necessary.

At this point, the question becomes, do I really want that ice cream sundae, or do I settle for the customary shit sandwich?
From Title II, Committee of Ways and Means; Subtitle A, Repeal and Replace of Health-Related Tax Policy:(Sec. 203) This section modifies the small employer tax credit for employee health insurance expenses to: (1) prohibit the credit from being used for health plans that include coverage for abortions (other than any abortion necessary to save the life of the mother or any abortion with respect to a pregnancy that is the result of an act of rape or incest) for taxable years beginning after December 31, 2017; and (2) repeal the credit for taxable years beginning after December 31, 2019.
(Sec. 204) This section repeals the penalties for individuals who are not covered by a health plan that provides at least minimum essential coverage (commonly referred to as the individual mandate). The repeal is effective for months beginning after December 31, 2015.
(Sec. 205) This section repeals the penalties for certain large employers who do not offer full-time employees and their dependents minimum essential health coverage under an employer-sponsored health plan (commonly referred to as the employer mandate). The repeal is effective for months beginning after December 31, 2015.
(Sec. 206) This section delays the implementation of the excise tax on high cost employer-sponsored health coverage (commonly referred to as the Cadillac tax) until 2026. (Under current law, the tax goes into effect in 2020.)
I don't understand why politicians are so infatuated with unborn humans, considering they currently don't pay taxes or contribute to American society other than by leeching off of their host.

Um, that's because once they do become born, they *will* have the chance to pay taxes and contribute to American society, pending unforeseen medical issues. Follow the money, Vera.


Better Care Reconciliation Act

The Better Care Reconciliation Act is a bill, currently in draft at the time of this blog posting, from the Senate as an alternative to the Affordable Care Act, or "Obamacare." Let's see how BCRA is any better than AHCA (if that is possible), again with emphasis in yellow highlight and italicized text for how the draft would affect me personally:
From Title I; Sec 102, Restrictions for the Premium Tax Credit; Subsection a, Eligibility for Credit; Paragraph 1, In General: Section 36B(c)(1) of the Internal Revenue Code of 1986 is amended ... by striking ‘‘equals or exceeds 100 percent but does not exceed 400 percent’’ in sub-paragraph (A) and inserting ‘‘does not exceed 350 percent’’...
Okay, looks like something I can dig, possibly.

Upon further reading, however, a lot of the draft language refers amending Section 36B(c) portion of the Internal Revenue Code of 1986. Let's take a look at that, shall we?
From Title 26 of the United States Code;§ (Section Number) 36B; Subsection c, Definition and rules relating to applicable taxpayers, coverage months, and qualified health plan; Paragraph 1, Applicable Taxpayer:(A)In general, The term “applicable taxpayer” means, with respect to any taxable year, a taxpayer whose household income for the taxable year equals or exceeds 100 percent but does not exceed 400 percent of an amount equal to the poverty line for a family of the size involved.
I don't need to be a law geek to see that there is going to be a ton of back and forth between the draft language and this current law. And this is a got damn Saturday morning; what the fuck am I doing reading this mind melting shit during Shabbat?

*stomach growls* Yeah, it would help if I ate something, huh?
From Title I; Sec 102, Restrictions for the Premium Tax Credit; Subsection d, Eligibility for Credit; Paragraph 1, In General: Section 36B(c)(3)(A) of the Internal Revenue Code of 1986 is amended by inserting before the period at the end the following: ‘‘or a plan that includes coverage for abortions (other than any abortion necessary to save the life of the mother or any abortion with respect to a pregnancy that is the result of an act of rape or incest)’’.
I think it's safe to say that a good majority of the congressfolks just do not like abortion. Well, if they don't like it, then they should not have one for themselves, right? Leave that decision to a pregnant individual and their doctor. Seems logical enough.

And speaking of rape and/or incest, based on how some police departments and law firms define "rape" and "abortion," and on how some medical facilities define "to save the life of the mother," good luck in getting that abortion if you happen to live in an area where a literal parasite, feeding off of what its carrier provides it for approximately nine months, paying no taxes or contributing to society, has more of a value than someone already viable for themselves, paying taxes, and being a decent individual.

Why do you compare unborn babies to parasites?

Heh, I learn it that from watching [H]ouse, M.D. way back in the day.
From Title I; Sec 126, Medicaid Expansion; Subsection a, In General; Paragraph 1, Subparagraph B: by adding at the end the following new subsection: ‘‘...Expansion Enrollees. ‘‘(1) In General, In this title, the term ‘expansion enrollee’ means an individual ‘‘(A) who is under 65 years of age; ‘‘(B) who is not pregnant; ‘‘(C) who is not entitled to, or enrolled for, benefits under part A of title XVIII, or enrolled for benefits under part B of title XVIII; ‘‘(D) who is not described in any of sub-clauses (I) through (VII) of subsection (a)(10)(A)(i); and ‘‘(E) whose income (as determined under subsection (e)(14)) does not exceed 133 percent of the poverty line (as defined in section 2110(c)(5)) applicable to a family of the size involved. ...
Title XVIII (18) refers to the Social Security Act's Health Insurance for the Aged and the Disabled. So, if you're like me; a 36-year old childless pain in the ass, but also happen to make poverty level wages and don't qualify for Medicare Parts A and B, or any other snafu "sub-clauses," you are so shit out of luck trying to get on your state Medicaid.

It looks like, from skimming over both the House bill and the Senate draft, I would be okay. Then I stumbled upon this article that broke it down in simple terms by journalist professionals:

As a 36-year old childless pain in the ass, the article points out what to expect based on groups of Medicaid recipients:
  • As someone younger than age 65, older folks (approximately ages 59-64) would have to pay premiums five times the cost of what younger folks currently do. Medicaid would end either in 2020 or 2021
  • As someone with pre-existing conditions, states can request to allow health insurers to charge folks like me more because I have a certain pre-existing condition, or in the worst case scenario, health insurers in my state could just drop me all together
  • As a disabled someone, Medicaid services would go bye-bye with either plan
  • As someone who utilizes mental health services, states can also request to stop covering "essential health benefits," which includes mental health. Or, in the worst case scenario, Medicaid would not be required at all to provide and cover mental health services
How come Congress can't just eliminate Medicaid all together? That's what it looks like they're doing.

Because Medicaid is part of the Congressional Budget that is listed under "mandatory spending," meaning it cannot be removed from the budget, what better way to kill the beast than to starve it from within? And that's exactly what Congress hopes to achieve.

So, what would people do without Medicaid or its services?

One word, Dear Reader: die.

Just like you said: follow the money. Folks on Medicaid are seen as "entitled" by the media and by politicians alike. We rely on funds in order to survive; funds that could very well easily go into some corporate shill's pocket. In order to get that money, they need to make adjustments to the game of human population chess by eliminating their threat: the consumer. What better way to do that is to force the consumer to spend all of their money, earned or unearned, on medical expenses to the point where they can't have an ice cream sundae, but instead have to live off of a shit sandwich until they choke and die. The only folks who actually benefit from these Medicaid changes are the top tier wealthiest of Americans. Why should these folks "who pulled up the straps of their boots and made an honest living" have to pay for folks "who sit at home, pop babies out like a machine, drive around in their scooters or fancy cars, and not do a damn thing"? That's the philosophy that is being sold in the ACA alternative bills that were initially bought up by so many supporters and/or voters of President Donald Trump back in 2016.

Except this time, those same group of voters/supporters are *expected* to be led to the proverbial slaughterhouse, along with the rest of the folks on Medicaid, to be processed for cannibalistic consumption by America's wealthiest elite.

Okay. What can we do to stop these proposed bills?

The only thing I can think of, and this is something I haven't done since 1990 (again, bite me), is to contact your House Representative and both of your Senators, and tell them to vote "NO" on these two bills. This link for the House and this link for the Senate will help you get started to find the people to contact so you can make your voice heard.

I never thought I would see Vera get so political.

I'm not supporting a candidate, you assdodo. I'm supporting the veto of an issue.

Now, I'm going to eat some ice cream before contacting my Senators and my House Representative.


  1. You haven't contacted your Senator or House of Reps person since 1990?

    1. Either since 1990 or 1991. I did it as part of a 5th grade assignment. I have no immediate memory about what I wrote to Sen. George Voinovich, z"l, at the time. Nor do I have immediate memory on what he wrote in response to me. At least he did write back!

      Meanwhile, since the AHCA was passed in the House, I decided to contact both Senators over BCRA. I was able to write a letter to Sen. Sherrod Brown (who is a Democrat). The features to write a letter to Sen. Rob Portman (who is a Republican) were actually disabled online.

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