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.

Rand Paul recounts harrowing baseball practice shooting where Majority Whip was wounded Wednesday, Jun 14 2017 

Kentucky Senator Rand Paul is uninjured after a shooting at a baseball field in Alexandria, Va., where Republican Congress members were practicing for a coming Congressional Baseball Game for Charity, which was scheduled for Thursday. Representative Steve Scalise was shot. Scalise is the House Majority Whip. Five people were taken to area hospitals, including the shooter. Witnesses reported […]

Sen. Rand Paul offering resolution to halt part of new $110 billion arms deal with Saudi Arabia Thursday, May 25 2017 

Sen. Rand Paul will soon offer a bipartisan floor resolution in the Senate objecting to a portion of the Trump administration’s new $110 billion military arms deal with Saudi Arabia, arguing such weapons will likely exacerbate the humanitarian crisis in Yemen and damage America’s national security. In a media conference call on Thursday, Paul and Democratic […]

Rand Paul Pans Sessions’ ‘Tough On Crime’ Prosecution Policy Friday, May 12 2017 

U.S. Sen. Rand Paul is criticizing Attorney General Jeff Sessions for directing federal prosecutors to charge defendants with the most serious crimes they can pursue.

The new guidelines are a departure from an Obama-era policy that eased prosecutions of people with non-violent drug offenses.

In 2013, then-Attorney General Eric Holder directed prosecutors to avoid charging people with crimes that carry mandatory minimum sentences, which require judges to impose lengthier prison terms.

In a statement, Paul said the reprisal of the “tough on crime” policy isn’t a good idea.

“Mandatory minimum sentences have unfairly and disproportionately incarcerated too many minorities for too long,” Paul said. “Attorney General Sessions’ new policy will accentuate that injustice. Instead, we should treat our nation’s drug epidemic as a health crisis and less as a ‘lock ‘em up and throw away the key’ problem.”

Paul has pushed for reforms to the criminal justice system, including reduction of mandatory minimum sentences on drug crimes, expungement of felony records and restoration of voting rights, though the proposals haven’t garnered enough support to get a floor vote.

However, Paul voted in favor of Sessions’ confirmation earlier this year. Sessions has repeatedly criticized the Obama administration for being “soft on crime” and accused the former president’s policies of leading to violent crimes.

Sessions’ policy amounts to a return to strategies conceived under former Attorney General John Ashcroft, who directed federal prosecutors to charge people with the most serious crimes possible.

Under the Obama-era policy, defendants who didn’t belong to large drug trafficking organizations qualified to be charged with crimes that didn’t carry long mandatory minimum sentences.

This week, Sessions issued a memo to Department of Justice staff ordering federal prosecutors to “charge and pursue the most serious, readily provable offense.”

“This policy affirms our responsibility to enforce the law, is moral and just, and produces consistency,” Sessions wrote. “This policy fully utilizes the tools Congress has given us.”

Prosecutors who wish to not pursue the most serious charges possible would have to get approval from a U.S. attorney or assistant attorney general.

Kerry Harvey, who was the U.S. attorney for the Western District of Kentucky until earlier this year, said implementation of the policy will depend on each U.S. attorney’s office.

“But on the face of it you would expect that the sentences, particularly in drug trafficking cases, would be longer,” Harvey said.

Rand Paul Calls Syria Airstrikes Unconstitutional Friday, Apr 7 2017 

Sen. Rand Paul has come out against President Donald Trump’s decision to attack Syria on Thursday, calling it unconstitutional.

“The president really doesn’t have the authority under the constitution to initiate war,” Paul said during an interview on Fox Business on Friday.

The U.S. military launched the surprise airstrike on a Syrian airfield Thursday evening. The move came in response to a chemical weapons attack on civilians the administration believes was launched by the country’s embattled leader, Bashar Assad, and killed dozens of people.

The U.S. has conducted airstrikes against the Islamic State in Syria since 2014, but Thursday’s is the first against the Syrian government.

Paul has long spoken out against the U.S. taking military action in Syria and the Middle East. On Friday, he warned that the attack could strain relations with Russia, a close ally of Syria’s.

“The ramifications could be extreme — they may not — but there is a great danger in bumping up against another nuclear power,” Paul said.

U.S. Rep. Thomas Massie, a Republican representing northern and eastern Kentucky, also voiced opposition to Trump’s attack, via Twitter.

“President Trump should have sought Congressional approval for so many reasons starting with ‘the #Constitution requires it,'” Massie tweeted.

Meanwhile, Kentucky’s other U.S. Senator, Senate Majority Leader Mitch McConnell, threw his support behind Trump’s actions.

“The strike was well-planned, well-executed, was certainly more than a pin-prick and sends a message not only to Assad that using chemical weapons again is something he cannot do with impunity,” McConnell said during a news conference on Friday.

McConnell notably opposed President Barack Obama’s failed request in 2013 for an authorization to use military force against the Syrian government.

On Friday, McConnell said he couldn’t see a resolution to the Syrian conflict that keeps Assad in power.

“I just can’t imagine after all the butchering of his own people that he’s been doing now for four, five years that there could be any successful conclusion to this chaos with him still there,” McConnell said.

U.S. Rep. John Yarmuth, the only Democratic member of Kentucky’s federal delegation, issued a statement in support of the strike against Syria, which he said was in response to “criminal and inhumane actions.”

But he also called on Trump to seek Congressional approval for future actions against the country.

“I hope that Speaker Ryan and Majority Leader McConnell will move quickly to seek the congressional approval of yesterday’s action, so that the constitutional prerogatives of Congress’s war-making authority are asserted,” Yarmuth said. “No escalation of military activity in Syria or the region can proceed without explicit congressional approval.”

This Is Why Men Pay For Maternity Coverage, Too Thursday, Apr 6 2017 

Congressional Republicans are signaling that they want to keep moving forward with a plan to repeal and replace the Affordable Care Act — despite reports Wednesday that the plan was all but dead.

And although there aren’t many details, it would likely include one of the key components of the GOP’s previous failed effort at repeal: a reduction in essential health benefits, or those services insurers are required to cover under Obamacare.

Maternity coverage is one. And it’s become a bit of a punchline for some Republicans, including Kentucky Gov. Matt Bevin.

“Truth to be told, as a 50-something-year-old man, I don’t need maternity health care coverage. I don’t,” Bevin said at campaign rally for President Donald Trump last month in Louisville. “I’m not expecting that I’ll be expecting, and the idea that I’d be expected to cover health care coverage on the outside chance that I might be [is] a little bit preposterous.”

If that’s preposterous, then so is the idea of insurance in general. Because to argue against pooled risk — or a group of people pooling funds to mitigate catastrophic costs, whatever they may be — is to argue against the concept of insurance itself.

Maternity Care is Costly

Before the Affordable Care Act, having a baby was in most cases an expensive add-on benefit to an insurance policy, costing some women as much as $1,600 more a month than a basic policy, according to a study from the National Women’s Law Center. Many had deductibles as high as $10,000. The ACA changed that.

And yes, having a baby is a women’s health issue. But not so much when it comes to health care costs. In 2010, nearly 4 million women went to the hospital for childbirth, making it the most common reason for a hospitalization.

Multiply all those visits by $9,600, the typical cost of a vaginal birth, or $15,800 for a C-section.

“We’re talking about maternity care, which is a very common service,” says Usha Ranji, associate director for women’s health policy at the Kaiser Family Foundation. “We’re not talking about a rare event.”

Ranji says spreading the cost of maternity care across the general population — regardless of who’s having babies — makes it more affordable for everyone.

“The nature of insurance is that we all are paying for services we likely will not use,” she says. “That’s the way the insurance market is designed.”

Pooling Risk

The idea is simple and familiar: pooled risk. That’s the underpinning of the entire insurance system, including for the employer market, Medicaid and Medicare. It’s also the concept behind car insurance, homeowners insurance, and so on. Although most people will never use their insurance policies to the fullest degree, they pool their money in case they have to.

Sarah Lueck is a senior policy analyst with the Center on Budget and Policy Priorities.

“[A basic ACA policy] covers a comprehensive set of benefits, many of which the person buying the plan isn’t necessarily going to use, but they may end up needing unexpectedly,” Lueck says. “And that helps spread the cost of that coverage among a larger group of people and makes it affordable for everybody.”

Which is why women can’t opt out of coverage for prostate surgery. And why young, healthy people can’t opt out of paying for insurance that includes heart disease coverage. And why maternity care is now included in all policies, regardless of sex.

It’s not a new idea. Employer-based insurance must include maternity benefits because of a federal law that says it’s discriminatory not to do so. Medicaid, the insurance program for low-income and disabled people, also covers having a baby. And in many states, pregnant women automatically qualify for Medicaid if they have a low enough income.

Although the American Health Care Act — also known as Trumpcare — failed to get a vote last month, Republicans are in the process of creating a compromise plan that seeks to appease legislators who want even more of a repeal of the ACA. Sen. Rand Paul tweeted over the weekend that he met with President Trump, and that “we are getting closer to an agreement.”

The new plan will likely kick the responsibility of individual market requirements to states. They could apply for a federal waiver to include things like maternity coverage. And with new leadership at the Department of Health and Human Services, that would probably go through.

Seema Verma, the new head of the Centers for Medicaid and Medicare Services, said in her confirmation hearing that women should be able to choose.

“Some women might want maternity coverage and some women might not want it, might not choose it, might not feel like they need that,” Verma said. “So I think it’s up to women to make the decision that works best for them and their families.”

Paul, who has led the latest charge to repeal ACA, also follows that line of thinking.

“Insurance companies should be able to sell a variety of plans with various types of benefits, rather than the currently mandated essential health benefits,” said Kelsey Cooper, state communications director for Paul. “For example, the pediatric dental coverage requirement is not something necessary for a family without children.”

In Louisville, Pence Pitches GOP Plan To Repeal And Replace Obamacare Saturday, Mar 11 2017 

Vice President Mike Pence stopped in Louisville Saturday to pitch the Republican plan to repeal and replace the Affordable Care Act.

“The Obamacare nightmare is about to end,” Pence said before a crowd of about 150 business owners.

The visit came as President Trump tries to rally support for the plan, especially among conservatives like Kentucky U.S. Sen. Rand Paul, who favors an outright repeal of Obamacare.

“Folks, let me be clear,” Pence said. “This is going to be a battle in Washington D.C. And for us to seize this opportunity to repeal and replace Obamacare once and for all we need every Republican in Congress and we’re counting on Kentucky.”

The current repeal and replace bill would do away with the law’s requirement that individuals have health insurance and large employers provide it.

The plan would also remove taxes that fund Obamacare and begin scaling back the Medicaid expansion in states like Kentucky that expanded the government healthcare program.

About 500,000 Kentuckians got health coverage under the Affordable Care Act, mostly through the Medicaid expansion, helping bring the state’s uninsured rate from more than 20 percent to about 7 percent.

Pence was joined by Gov. Matt Bevin who downplayed discord over the measure.

“Of course there’s disagreement as to what we should do with it,” said Bevin. “This is America. Americans have opinions.”

Sen. Rand Paul has been one of the most vocal critics of the repeal and replace plan, calling it “Obamacare lite.”

“The only thing that’s really united us over time is repeal,” Paul said on Fox News Friday. “And if ObamaCare lite is the replacement, conservatives aren’t going to accept it.”

Paul’s spokeswoman Kelsey Cooper issued a statement after Pence’s speech saying he “looks forward to continuing to work with the administration and Congress for a real repeal of Obamacare and replace it with conservative market-based solutions that will bring down prices and give families more choices.”

For Kentucky Voters, A Familiar Fight: Trump vs. Paul Friday, Mar 10 2017 

FRANKFORT, Ky. (AP) — Duard Rutledge voted for Donald Trump and Rand Paul for the same reason: They’re not afraid of a fight.

That’s why the 66-year-old retired Toyota worker wasn’t worried to see Kentucky’s junior senator getting in the way of the Republican plan to replace Obama’s health care law.

“When you get two thoroughbreds, they are high strung,” he said. “But if you get them headed the right way they can both win the race.”

Paul has been one of the most vocal Senate critics of the GOP plan to replace the federal Affordable Care Act, even before he knew what was in it. Last week, he hauled a copy machine outside of the room where House Republicans were writing the bill and asked for a copy, highlighting the secrecy surrounding the proposal. Since then, he has declared the plan dead, calling it “Obamacare lite.”

Trump has pushed back, but without the blunt-force approach that has defined his politics. He dispatched top aide Kellyanne Conway to appear via phone on a Louisville radio station to express disappointment with Paul’s comments. And while Trump has used his Twitter account to call Paul a “spoiled brat” in the past, he used his powerful social media presence this week to call Paul “my friend” and said he was sure he would “come along with the new and great health care program.”

Paul won another six-year term last year and White House pressure is unlikely to make him reverse course.

On Saturday, Vice President Mike Pence is scheduled to appear in Louisville, possibly to advocate publicly for the replacement plan. For Terry Wright, a retired union worker in Louisville who voted for Trump, that’s all he needs to hear.

“I trust him (Trump) more than I would trust anybody else,” he said, adding he did not vote for Paul in the U.S. Senate election.

Gage Skidmore/Creative Commons

Mike Pence

Pence is scheduled to appear with Republican Gov. Matt Bevin, who told reporters on Friday that he will tell Pence “we support their effort to fix this problem” while adding he is not a fan of the initial proposal.

“Sen. Paul … is not impressed with what has currently been offered. Truth be told, I’m not either. So I’m with him,” Bevin said.

After years of Democratic dominance, Kentucky voters are becoming accustomed to Republican rule and the infighting that can come with it. Whether it’s U.S. Sen. Mitch McConnell and Bevin — two fierce primary foes turned allies after Bevin won the 2015 governor’s race — or Trump and Paul’s vicious barbs during the GOP presidential primaries, many conservative voters see conflict as a healthy part of politics.

“Whenever we get into this kinder, gentler, ‘Well I’m not going to say that because it will make them mad,’ that’s how we get in trouble,” said Alan Halsey, a 31-year-old publisher of The Swift Creek Courier and owner of a general store who voted for Trump and Paul. “We need people that will stand. And butting heads is part of standing.”

The Trump-Paul spat is more complicated for Phyllis Vincent, a 70-year-old retired teacher in Frankfort who is running to be the chairwoman of her county Republican party. She wants to do away with Affordable Care Act, but she acknowledges it will be difficult to repeal it “root and branch” now that nearly half a million people in the state depend on it for health coverage.

“Part of me is a bit disappointed (Trump) is not pushing any harder than what he’s doing,” she said. But she also understands how many people have health care, and “we can’t just pull the rug out from under them overnight.”

The friction occurs against a backdrop of intense debate over the success or failure of the Affordable Care Act in Kentucky, where it has been touted as a success story by Democrats and some independent studies.

When the original roll-out of health care was plagued by technical problems, Kentucky’s state-run exchange, dubbed Kynect, ran smoothly. The exchange, combined with an expansion of the state’s Medicaid program, brought health care coverage to nearly 500,000 people, lowering the state’s uninsured rate from more than 20 percent to 7.5 percent.

But the program has cost taxpayers an extra $257 million in the state’s most recent spending plan, and the current governor has called the program a disaster and moved to overhaul it.

5 Key Takeaways From The GOP Health Overhaul Plan Thursday, Mar 9 2017 

Got questions about the GOP plan to overhaul federal health law? Join us on Twitter Thursday 12-1 p.m. ET for our #ACAchat. Kaiser’s Julie Rovner, NPR’s Alison Kodjak and health policy analysts of various political persuasions will be online discussing how the Republican plan could work, who wins and who loses. See you there!

After literally years of promises, House Republicans have a bill they say will “repeal and replace” the Affordable Care Act.

Some conservative Republicans have derided the new proposal — the American Health Care Act — calling it “Obamacare Lite.” It keeps intact some of the more popular features of the ACA, such as allowing adult children to stay on their parents’ health plans to age 26 and, at least in theory, ensuring that people with pre-existing conditions will still have access to insurance.

In some cases the elements of the law that remain are due to political popularity. In others, it’s because the special budget rules Congress is using so Republicans can avoid a Senate filibuster do not allow them to repeal the entire law.

But there are some major changes in how people would choose and pay for health care and insurance. Here are some of the biggest.

Tax credits to help buy insurance

Both the GOP bill and the ACA provide tax credits to help some people pay their premiums if they don’t get insurance through work or government programs. And in both, the credits are refundable (meaning people who owe no taxes still get the money) and advanceable (so people don’t have to wait until they file their taxes to get them). But the GOP’s tax credits would work very differently from those already in place.

Under current law, the amount of the credit is tied to a person’s income (the less you earn the more you get) and the cost of insurance where you live.

The GOP tax credits would be tied largely to age, with older people getting twice as much ($4,000 per year) as younger people ($2,000). But the Republican plan would also let insurers charge those older adults five times as much as younger adults, so even a credit twice as big might not make up the difference in premiums.

The GOP credits also do not vary by location, so they would be worth more in places where health care and health insurance are less expensive.

The GOP credits do phase out gradually, starting with incomes above $75,000 for an individual and $150,000 for families.

Medicaid

The biggest changes the Republican bill would make are to the Medicaid program. Starting in 2020, it would roll back federal funding for the ACA’s expansion that allowed states to provide Medicaid coverage to all low-income individuals under 138 percent of the poverty level, rather than just the specific categories of poor people (children, pregnant women, elderly, disabled) who were previously eligible.

Thirty-one states opted to expand access to Medicaid. People who are covered under the expansion would continue to be funded by the federal government after that, but states would no longer be allowed to enroll anyone under those expanded criteria. And an enrollee who loses eligibility for the expansion program could not re-enroll.

But the bill would go further as well, making changes to the underlying Medicaid program that House Energy and Commerce Committee Chairman Greg Walden, R-Ore., described as “the biggest entitlement reform in the last 20 years.”

Currently, Medicaid costs are shared between states and the federal government, but the funding is open-ended, so the federal government pays its percentage of whatever states spend. Under the proposed bill, the amount of federal funding would be capped on a per-person basis, so funding would go up as more people qualify. But that per-capita amount might not grow as fast as Medicaid costs, which could leave states on the hook for an ever-increasing share of the costs of the program.

“Capping federal contributions to the Medicaid program will likely force states with already tight budgets to limit eligibility and cut benefits to at-risk Americans,” said the American Public Health Association in a statement.

Help for wealthier people

If you earn a lot of money, or even just enough to put aside something extra for health expenses, the GOP bill will provide a lot to like.

First, it would repeal almost all of the taxes that were increased by the ACA to pay for the expansion of health coverage. Those include higher Medicare taxes for high-income earners, a tax on investment income and various taxes on health care providers, including insurance companies, makers of medical devices and even tanning salons.

The bill would also provide new tax advantages for those who can afford to save, including allowing more money to be deposited into health savings accounts, and lower penalties for those who use those accounts to pay for nonmedical needs.

In addition, the plan would lower the threshold for deducting medical expenses on income taxes and allow people with job-based tax-preferred “flexible spending accounts” to put away more pretax money. It would also restore over-the-counter drugs as eligible for reimbursement from those accounts.

Mandates to buy or provide coverage

The GOP plan doesn’t actually repeal the requirements for individuals to have coverage or for employers to provide it. That’s because it can’t under budget rules. Instead, the bill would reduce the penalties in both cases to zero, rendering the requirements moot.

The individual requirement was used by the health law to force healthy people into buying coverage to help improve insurers’ risk pools since they could no longer bar customers with pre-existing conditions.

Instead, the Republican plan would provide a penalty for those who do not maintain “continuous coverage.” Those with a break in insurance coverage of more than 63 days could still purchase insurance without regard to pre-existing health conditions, but they would be required to pay premiums that are 30 percent higher for 12 months.

The employer “mandate,” which requires firms with 50 or more workers to offer coverage or pay a fine, has actually had relatively little impact on insurance coverage, analysts have concluded, and probably is not necessary to prevent employers from dropping coverage. In both the ACA and the GOP bill, however, workers whose employers offer coverage could not decline that coverage and get a tax credit instead.

How to pay for it

With all the taxes and fees stripped from the ACA, how will Republicans pay for their tax credits? The answer is not clear.

“We are still discussing details, but we are committed to repealing Obamacare and replacing it with fiscally responsible policies that restore the free market and protect taxpayers,” said the Republican fact sheet that accompanied the release of the bill.

Also still missing is an estimate from the Congressional Budget Office that will detail not only how much the proposal will cost, but also how many people would gain or lose health insurance. Republicans insist that estimate will be available before the full House votes on the bill.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Copyright 2017 Kaiser Health News. To see more, visit Kaiser Health News.

In Other News… Rand Paul on the hunt, Beshear responds to president’s address, Lawrence eyes 2018 Oscar nod Friday, Mar 3 2017 

Fool’s Errand: Your junior Kentucky Sen. Rand Paul went on a bit of a tear yesterday after learning House Republicans had a draft of repeal/replace Affordable Care Act legislation tucked away, says The Hill. Bloomberg released a report on Wednesday, saying the bill would be available for the House Energy and Commerce panel on Thursday, but […]

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