Senate Republicans Alter Health Care Bill To Avoid So-Called ‘Death Spiral’ Monday, Jun 26 2017 

Senate Republicans have updated their plan to repeal and replace the Affordable Care Act, attempting to patch a hole that threatened to destabilize the individual insurance market.

The original Senate bill, unveiled last week, required insurance companies to offer coverage to everyone, including people with pre-existing medical conditions. But there was no requirement that individuals purchase insurance. Critics said that created a perverse incentive for healthy people to go without insurance, only buying coverage after they got sick. Without enough healthy customers making regular premium payments, insurance companies would be forced to raise prices, driving more customers away — a situation sometimes described as a “death spiral.”

The revised bill attempts to solve that problem by imposing a penalty on those who don’t maintain continuous insurance coverage: People who let their coverage lapse for at least 63 days in one year would be locked out of the insurance market for six months the following year.

The change comes as congressional forecasters are trying to predict how the Senate bill would affect insurance costs and coverage. The nonpartisan Congressional Budget Office is expected to release its analysis of the bill early this week.

It’s not clear whether the threat of a six-month waiting period would be enough to keep healthy customers in the insurance market. The Affordable Care Act already includes a limited enrollment window when people can sign up for coverage, along with a tax penalty for those who don’t. Even with those provisions, many insurance companies have struggled to attract a good mix of healthy and less healthy customers.

The bill passed by House Republicans relies on a different mechanism to encourage healthy people to buy coverage. Those who don’t would have to pay a premium when they finally did sign up.

Senate GOP Health Care Bill Discussion Draft 

Copyright 2017 NPR. To see more, visit

Remembering Wendell Ford: Governor, Senator and Kentucky Legend Sunday, Jun 25 2017 

By John Gregory | KET He billed himself as a country boy from Yellow Creek, but this insurance salesman turned politician rose to become an accomplished governor and one of the most powerful men in Washington, D.C. Wendell Hampton Ford represented politics of a different era, when campaigns could be waged with a firm handshake […]

How The Senate Health Care Bill Could Disrupt The Insurance Market Saturday, Jun 24 2017 

Senate Republicans have little margin for error as they prepare for a vote this coming week on a bill to repeal and replace the Affordable Care Act. Some lawmakers are already raising concern that the bill could aggravate the problem of healthy people going without insurance, driving up costs for everyone else.

“If you can get insurance after you get sick, you will,” Sen. Rand Paul, R-Ky., told NBC’s Today Show. “And without the individual mandate, that sort of adverse selection, the death spiral, the elevated premiums, all of that that’s going on gets worse under this bill.”

The Affordable Care Act, also known as Obamacare, tried to address that problem by requiring all Americans to have health insurance, or pay a penalty. But that so-called “individual mandate” is one of the least popular provisions of the law. Senate Republican leader Mitch McConnell of Kentucky and his colleagues are determined to get rid of it.

“We agreed on the need to free Americans from Obamacare’s mandate so Americans are no longer forced to buy insurance they don’t need or can’t afford,” McConnell said on the Senate floor Thursday.

But the Senate bill preserves another, more popular, piece of Obamacare: the requirement that insurance companies cover everyone, even those with pre-existing medical conditions. Imposing a coverage requirement on insurance companies without a corresponding mandate for customers runs the risk of creating a very shaky insurance market.

“What you don’t want to have is a situation where you’re saying we’re going to have everybody, regardless of their health problems, come in, and then have all the healthy people exit the market,” said health policy expert Linda Blumberg of the Urban Institute. “Because then the average cost of those who remain goes up really high.”

As premium costs rise, more healthy people drop out, which causes costs to rise even further. That’s the so-called “death spiral.”

The House version of the health care bill tries to discourage healthy people from fleeing the market by allowing insurance companies to charge a premium for those who don’t maintain continuous coverage. Senate staffers say they’re open to adding a similar provision to the Senate bill.

“I believe that the bill that the Senate will vote on, assuming they get to that point, will have some sort of mechanism to cause participation in it,” said former GOP Senate staffer Rodney Whitlock.

So why isn’t the continuous-coverage provision already in the bill? Whitlock offers three theories:

One possibility is that McConnell is worried the provision runs afoul of the procedural rules allowing Republicans to pass the bill with a simple majority vote. If so, he might be waiting until the last minute to introduce the continuous-coverage language, so Democrats have less time to raise the issue with the Senate parliamentarian.

Another theory is that Republicans are waiting for the insurance industry to demand the provision be inserted. That would allow the GOP leadership to show flexibility, while also adding credibility to the continuous-coverage mechanism.

Finally, Whitlock suggests, senators could be deliberately trying to create a rickety market, so states will be forced to take matters into their own hands.

“There are folks in the Republican conference who desperately want this to devolve to the states,” said Whitlock, who’s now vice president for health policy at ML Strategies, a lobbying and consulting firm. “So do I completely rule that out as a possibility of why you go that route? I don’t rule it out completely.”

The Urban Institute’s Blumberg warns that without a strong provision to keep healthy customers in the market, insurance companies will lean on states for permission to offer more bare-bones policies. That could leave some customers in the individual market with even fewer choices than they had before Obamacare.

“What will be available are policies that don’t cover a number of benefits that people are used to getting coverage for today,” Blumberg said. “They will have much higher deductibles than they are used to seeing. And as you get older, the coverage will be less and less affordable.”

AARP is already on record against the Senate bill, citing what it calls an “age tax” as well as cuts to Medicaid. The senior lobby is promising to hold all senators accountable for their votes.

Copyright 2017 NPR. To see more, visit

Rand Paul Doesn’t Support GOP Health Bill Thursday, Jun 22 2017 

Senate Majority Leader Mitch McConnell has unveiled the newest version of a bill to replace many provisions of the Affordable Care Act.

Negotiations over the much-anticipated bill were held in private, with even some Republicans like Sen. Rand Paul criticizing the secretive process “with little time to fully evaluate the proposal.”

Paul issued a statement Thursday saying he wasn’t ready to vote in favor of the new bill because it doesn’t fully repeal Obamacare.

“It does not keep our promises to the American people,” Paul said. “I will oppose it coming to the floor in its current form, but I remain open to negotiations.”

A vote on the measure is expected next week.

If no Democrats vote in favor of the bill, McConnell can only afford to lose two votes out of the 52 Republicans in the Senate. In case of a tie, Vice President Mike Pence would have the option to cast a tie-breaker.

The proposal would by 2024 phase out funding for states like Kentucky that elected to expand their Medicaid programs under Obamacare.

It would also end the requirement for people to buy health insurance, and employers of a certain size would no longer have to provide coverage for employees. It would eliminate taxes on the wealthy and insurance companies, but keep a provision that allows parents to keep their children on their insurance plans until age 26.

During a speech on the Senate Floor Thursday, McConnell said the plan was the product of dozens of meetings.

“It’s time to act,” McConnell said. “Because Obamacare is a direct attack on the middle class and American families deserve better than its failing status quo.”

He also chided Democrats for indicating they wouldn’t support the Republican-crafted plan.

“They can choose to keep standing by as their failing law continues to collapse and hurt more Americans, but I hope they will join us instead to bring more relief to families who have struggled under Obamacare for far too long,” McConnell said during his Senate remarks.

U.S. Rep. John Yarmuth, a Democrat from Louisville, criticized the proposal for its tax breaks and changes to Medicaid.

“Any senator who votes for this bill is clearly prioritizing a meaningless political victory over the health and livelihoods of the American people,” Yarmuth said in a statement.

McConnell blames the Affordable Care Act for rising health insurance premiums and says insurance companies pulling out of Obamacare markets show that the program is not working.

In Kentucky, five companies that sold insurance on Kentucky’s health exchange in 2016 pulled out of the program for 2017. The Kentucky Department of Insurance approved requests by the remaining companies to charge higher premiums.

The proposal, which is dubbed the “Better Care Reconciliation Act,” would change how states fund their Medicaid programs by shifting to block grants or per capita caps on spending.

The bill would also let states apply waivers to disregard some mandates of the Affordable Care Act, like the law’s ban on insurance companies charging higher premiums for people with pre-existing medical conditions.

After the bill was announced, videos showed protesters being forcibly removed from outside McConnell’s Capitol office.

“U.S. Capitol Police handles security in the Capitol complex,” said McConnell press secretary, Stephanie Penn, when asked for comment about the protests.

Senate Republicans Reveal Long-Awaited Affordable Care Act Repeal Bill Thursday, Jun 22 2017 

Updated at 2:32 p.m. ET

Senate Republicans unveiled their long-awaited health care overhaul proposal on Thursday. The Senate bill, called the “Better Care Reconciliation Act,” would repeal major parts of the Affordable Care Act, also known as Obamacare. The broad outlines of it look a lot like the House bill, the American Health Care Act, which was passed in May.

In a lot of ways, the Senate’s bill looks like the House bill: it rolls back the ACA’s Medicaid expansion — making for deep spending cuts to that program, compared to current law. The Senate bill also proposes eliminating many ACA taxes, and the employer penalties associated with the employer and individual mandates would be repealed retroactively, dating back to the start of 2016. And like the House bill, young adults up to the age of 26 could stay on their parents’ health care plans.

Larry Levitt, a health policy expert at the Kaiser Family Foundation, summed up his thoughts on the bill on Twitter on Thursday: “In broad strokes, the Senate bill is just like the House: Big tax cuts, big cut in federal heath spending, big increase in the uninsured.”

As with the House bill, the Senate proposal also allows insurance companies to charge older people five times more than younger people — under the ACA, that ratio is 3 to 1. That’s just one provision that could hit older Americans hard.

A small group of Republican senators has written the bill in secret in recent weeks, with many Americans and even some fellow Republicans eagerly awaiting details about what’s in the bill. After the bill was released on Thursday, protesters gathered outside Senate Majority Leader Mitch McConnell’s office. Video from NBC showed police removing some of those protesters from the hallway.

Big changes to Medicaid

Some of the biggest changes this bill makes are to Medicaid, the entitlement program that provides health care to low-income Americans. In that sense, it looks like the House bill, which the CBO said would cut Medicaid by $834 billion over a decade (relative to current law), with a loss of 14 million beneficiaries.

Both bills roll back a Medicaid expansion undertaken under the Affordable Care Act. That law extended the program to some low-income Americans above the poverty level. The Senate proposal would roll back that expansion, though it would do so more slowly than the House bill proposes.

As with the House, the Senate also proposes giving states either a per capita cap on Medicaid spending or a block grant of funds. That’s a fundamental change; currently the program is “open-ended,” meaning funding increases as need increases.

But there’s another change on top of that. Those caps would vary based on the rate of inflation, and the inflation rate the Senate would attach to those caps is one that is lower than the inflation rate the House attached.

That might sound like a minor wonky change, but it’s not, says one former Medicaid administrator.

“That’s a big deal. It’s a big shift,” said John Corlett, president of the Center for Community Solutions who also served as a Director of Ohio’s Medicaid program. “It means billions of dollars less in federal aid to states for their Medicaid programs.”

Tax cuts for richer Americans

The Senate bill is also much like the House bill in that it would repeal most of the taxes associated with Obamacare (it would bump out the implementation of the so-called “Cadillac Tax” on expensive, employer-sponsored health care plans, from 2025 to 2026).

Repealing those taxes, as the Tax Policy Center reported in May (regarding the AHCA), would overwhelmingly benefit higher-income Americans. The taxes in Obamacare were largely progressive, as Kyle Pomerleau of the right-leaning Tax Foundation told NPR.

To one health policy expert, those tax cuts, combined with the cuts to Medicaid, mean the bill isn’t a health care overhaul.

“It is a tax cut bill, and they had to find a way to finance it, and Medicaid beneficiaries are going to be the ones who hurt,” said Nicholas Bagley, a University of Michigan Law School professor who specializes in health law.

A different tax credit system

One other big change this bill could make is creating a new system for who gets premium tax credits, and how big those premiums are.

For example, it cuts the upper-income limit that determines who gets premium tax credits. Currently, that upper limit is at 400 percent of the poverty level. This bill would limit that to 350 percent.

It also would determine those credits based on age and income — that’s a change from the House bill, which based credits mostly around age.

There are a few other ways the Senate bill mirrors the House bill. It bans the use of any federal funds for any health care plan that covers abortion, except in the cases of rape, incest or where the pregnancy puts the mother’s life in danger.

As of 2020, the bill also eliminates cost-sharing subsidies that help low-income Americans pay for their insurance.

The Senate’s proposal allows states substantial freedom in determining their own health care programs — even more freedom than the House bill allows for. Under the Affordable Care Act, states can apply for “innovation waivers” exempting them from parts of the law and allowing them to determine their own health care systems, to an extent.

However, there are strict rules in place stating that states getting those waivers must provide coverage that is “at least as comprehensive” as they would be otherwise, as the Centers for Medicare and Medicaid Services explains.

The Senate proposal greatly widens that loophole, saying that states can get those waivers, provided their alternate plans simply don’t grow the deficit.


How Roger Ailes Helped Launch Mitch McConnell’s Senate Career Thursday, May 18 2017 

Long before Roger Ailes stepped down from his post at the helm of Fox News in the wake of sexual harassment allegations, he was a political operative working for Republican politicians like Mitch McConnell.

Ailes passed away on Thursday at the age of 77.

Back in 1984, he made a notorious advertisement featuring a gaggle of hound dogs that helped launch McConnell’s career in Washington.

“Nobody thought Mitch McConnell was going to beat Dee Huddleston,” said Al Cross, director of the University of Kentucky’s Institute for Rural Journalism and Community Issues.

Mitch McConnell was the judge-executive of Jefferson County and challenging two-term Democratic Sen. Dee Huddleston.

Back then, Kentucky was heavily Democratic — though the GOP was budding in the state; Kentucky voted for Republican President Ronald Reagan in 1980 and would again in 1984.

Still, Cross says the Republicans were in the “wilderness” farther down the ballot.

“He was 40 points behind with two months to go,” Cross said. “But then they put up this hound dog ad and it made people laugh.”

McConnell hired Ailes to jumpstart his campaign and the move paid off — Ailes convinced McConnell to run the now-legendary ads, which featured a team of bloodhounds searching for Huddleston because he missed senate votes to make paid speeches.

(Though Huddleston did make paid speeches, he had a 94 percent voting record according to a Newsweek article cited in the 2014 McConnell biography The Cynic.)

In his autobiography, McConnell called hiring Ailes “one of the smartest moves I made,” but said he initially though the ad campaign was “insane.”

In his 2016 autobiography, “The Long Game,” McConnell wrote:

“Ailes was particularly nervous about the scene he had to film at the U.S. Capitol. His plan was to unleash the pack of dogs, and turn them loose on the steps of the Capitol. ’We may get arrested for this one,’ Ailes told his small crew. ‘So we gotta do this in one shot.’ He placed a pile of hamburger meat at the top of the steps and some in [actor] Snarfy’s pant cuff so the dogs would stay close to him until they were unleashed.”

Partly assisted by the coattails of Reagan’s landslide victory in 1984, McConnell ended up winning the election by less than half of a percentage point.

Though, as McConnell points out in his book, he was the only Republican to defeat a Democratic incumbent that year.

Scott Jennings, a former McConnell strategist, said McConnell’s 1984 victory was a critical point for Republicans in Kentucky.

“That was the moment when the Republican Party started to become a viable alternative to Democrats in the state,” Jennings said. “Of course all these years later it is the dominant party.”

Though Democrats still outnumber Republicans in the number of voters registered in the state, the GOP has increasingly dominated the state’s ballot boxes with the help of an increasingly powerful McConnell.

Jennings said that Ailes’ ad for McConnell was successful because it made dry politics entertaining.

“If you asked most people if they want to watch political ads, ‘no’ would be the answer. But that’s an ad people wanted to watch and heck we’re still talking about it all these years later,” Jennings said. “I think Ailes’ legacy is in the production of content that people actually wanted to watch. And to make something that no one else had made yet.”

Ailes had a more limited role in McConnell’s 1990 campaign and in 1996 formed Fox News, which he oversaw until stepping down last year amid a string of sexual harassment accusations from current and former employees.

Kentucky Republican Reps Quiet On Trump’s Intel Share With Russia Tuesday, May 16 2017 

None of Kentucky’s Republican senators or congressmen responded to requests for comment on allegations that President Donald Trump gave classified information to the Russian ambassador and foreign minister last week.

Senate Majority Leader Mitch McConnell briefly addressed the issue during an interview on Bloomberg TV Tuesday morning.

“I think we can do with a little less drama from the White House on a lot of things so that we can focus on our agenda,” McConnell said.

McConnell echoed the statement during a news conference in the Capitol, refusing to expand on his reaction to the president’s actions.

The Washington Post reported Monday that Trump divulged classified information dealing with an Islamic State threat during an Oval Office meeting with Russian ambassador to the U.S. Sergey Kislyak and Russian foreign minister Sergey Lavrov.

Trump said that he shared the information intentionally and defended his decision on Twitter Tuesday morning, saying he had the “absolute right” to do so.

U.S. Rep. John Yarmuth, a Democrat, is the only member of Kentucky’s congressional delegation besides McConnell that has commented on the issue.

“If these reports are true, President Trump has become a threat to our national security. Unprecedented. Unacceptable. Un-American,” Yarmuth tweeted on Monday night.

Senate Democrats have called for the White House to release a transcript of Trump’s conversation with Kislyak and Lavrov. The issue is the latest in a string of controversial moves that the administration has had to respond to this month.

Last week, Trump abruptly fired FBI director James Comey, who was heading up the agency’s investigation into Russia’s interference with last year’s presidential election.

Kentucky’s congressional delegation was split along party lines — McConnell and the rest of Kentucky’s Republican delegation defended Trump’s move, while Yarmuth, the lone Democrat, condemned it.

McConnell has dismissed calls for an independent investigation into Russia’s election meddling, saying probes conducted by Congressional committees and the FBI are adequate.

Brownsboro remains VA’s ‘preferred site’ for new medical center in final environmental study Friday, Apr 28 2017 

The Department of Veterans Affairs has taken another step toward building Louisville’s replacement medical center on greenfield property at the intersection of Brownsboro Road and the Watterson Expressway, as its final Environmental Impact Statement (EIS) reiterated that this is its preferred site for the nearly $1 billion project. Just as the long-delayed draft EIS concluded […]

Kentucky’s Thapar, Trump Appeals Court Nominee, Will Get Hearing Wednesday Tuesday, Apr 25 2017 

A Kentuckian nominated by President Donald Trump to a federal appeals court will be questioned during a confirmation hearing on Wednesday.

The U.S. Senate Judiciary Committee is holding hearings on the confirmation of Judge Amul Thapar to the 6th Circuit Court of Appeals, which considers appeals from federal cases originating in Kentucky, Tennessee, Ohio and Michigan.

Thapar serves in the U.S. District Court of Eastern Kentucky and previously as a U.S. attorney for the Eastern District; both appointments were made by President George W. Bush.

Trump included Thapar on a shortlist of potential U.S. Supreme Court nominees released during the presidential campaign. He was one of four candidates interviewed for the position.

There are 20 vacancies in the federal appeals courts and 100 more in federal district courts. The 6th Circuit Court of Appeals has had a vacancy since 2013, when Judge Boyce Martin retired.

Courtesy Vanderbilt

Amul Thapar

President Barack Obama nominated Kentucky Supreme Court Justice Lisabeth Hughes to the seat in 2016, but the move was blocked by Majority Leader Mitch McConnell.

Carl Tobias, a law professor from the University of Richmond, said McConnell’s rejection of Obama’s nominee to the appeals court “has some of the same flavor” of his block of Merrick Garland, the president’s Supreme Court nominee.

“The Republicans were saying ‘well, it’s a presidential election year, we should let the people decide and just wait in the hopes that a Republican will be elected president,’” Tobias said. “They were prescient, and that’s what happened.”

After winning the election, Trump nominated Neil Gorsuch, a federal judge from Colorado.

Senate Democrats attempted to block Gorsuch’s confirmation, leading McConnell and Senate Republicans to deploy the “nuclear option” — lowering the number of votes required to stop debate on a judicial confirmation from 60 to a simple majority of 50.

It’s unclear whether Senate Democrats will attempt to slow down Thapar’s confirmation. Tobias said he expects “Democrats will ask some hard questions.”

The Civil and Human Rights Coalition sent a letter to the Senate Judiciary Committee expressing concerns about Thapar’s record ruling against “plaintiffs, prisoners, criminal defendants, or campaign finance restrictions.”

Paul Salamanca, a University of Kentucky law professor, published a letter of support for Thapar in the Lexington Herald-Leader, saying the judge would “take the law set forth by the framers of the Constitution or by Congress and apply it with fidelity.”

Thapar’s confirmation hearing will start Wednesday at 10 a.m.

News Commentary: The curious case of a hefty political contribution that coincided with the VA hospital site selection Friday, Apr 14 2017 

For years, the public has pondered why the Veterans Administration paid an investment group led by Louisville businessman Jonathan Blue millions too much for a proposed hospital site near two of the region’s 10 most congested hotspots. Now emerges another question: Was the VA’s site-selection process for sale, too? Here’s what we know: On Sept. 22, […]

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