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McCain wants to ke.ep his health care plan "neutral" by paying for his health care plan from cuts in Medicare and Medicaid wasteful spending

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This story in the NYT describes how the flawed effort to pass the Republican healthcare bill or repeal the Affordable Care Act passed under president Obama failed after another effort. Many developments killed it. In the end the president lost interest, especially when he saw Republican Senator Rand Paul of Kentucky go on talk shows on the weekend before its collapse to complain about the bill. Senator Collins of Maine was exasperated by the way the bill was being rushed through Congress, and she voiced her strong opinions about this by talking to people back home in Maine and sharing her conversations with the media. The bill pushed by Senator McConnell, the Republican leader in the Senate, imposed annual caps on Medicaid spending. And did this without any discussion, shutting out committee debate, any public discussion, or formal drafting. Once this process was set in motion in this way the Republican Senators formed camps. Senator Grassley of Iowa and Jerry Moran of Kansas, normally conservative moved to the moderate side. Moran held a town hall meeting covered in the NYT, where older people voiced their concerns. Most of the patient advocacy groups, the hospital groups such as the American Hospital Association, and other medical groups also opposed it.  After Senator McCain of Arizona said he could not return following a surgery in Phoenix, Senators Lee and Moran announced their opposition. With this the bill's support crumbled including any effort to repeal the Affordable Care Act.  ...

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About 1% of doctors account for 14% of Medicare's payments in 2012, according to WSJ analysis of data released by the Centres for Medicare and Medicaid Services.

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This WSJ editorial says president Obama's second inaugural address missed the opportunity to bind old wounds with a reference to King on Martin Luther King day. The president chose to set forth a broader liberal agenda including climate change. The editorial points to the tone of the inaugural as setting the tone for the rest of the term and the possibility of return to the rancor that characterized the first term. "We the People" from the Consititution was mentioned several times in the sense of "collective action" that defined this text as government action. The programs of Medicare Medicaid and Social Security as "committments we make to each other." And the programs "do not make us a nation of takers; they free us to take the risks that make this country great," which are seen by the Journal as not appropriate for an Inaugural address that rises above the fray of politics.

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Of the $787 billion stimulus program only $46 billion has gone out so far, mostly to help with unemployment checks and for Medicaid, and only $33 million has gone out for transportation projects.

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Governor Cuomo's budget for New York in 2011, at $132.9 billion, is 2.7% less than the prior year. Cuts to medicaid and local school aid, each amount to $2.85 billion This helps close roughly half of the budget gap of $10 billion.

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Ezra Klein on the three questions on which the Supreme Court will decide after three days of hearings on March 26-28, 2012- the Anti-Injunction act, The Individual Mandate, and Medicaid Expansion. Related to the Individual Mandate question are Severability issues.

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Encourage homeownership by offsetting high property taxes. Makes auto loans $10,000 interest deductible. State and local taxes deduction $40,000 from $10,000 set in 2017. Makes it friendly to homeowners and encourage home ownership, building new homes. $10,000 property tax bills not common in 2017 when the SALT deduction was set, are now common after the price rise during covid years 2020-2024.  Help Parents by setting a ceiling on student loan debt, fund childcare, and fund future savings accounts for newborns. Makes Social Security benefits tax free for 88% of recipients. Sets a ceiling on student loan of $20,000 per year, borrowing limit $65,000 per student. Much of the bloated student loans are from universities raising tution as a tax on young people. This is a burden on the middle class. Child care credits are doubled to $2000, made permanent. Newborns get $1000 from government to which parents can contribute upto $5000. SNAP benefits changed the law to adults under 65 years from 55 years able bodied asked to work, with caregivers to children under 14 instead of under 18 years exempted. For Medicaid benefits one has to work 80 hours a month for able bodied persons under 65 years, appointments upto $35 for income $32,000 to $44,000. ...

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The Centers for Medicare and Medicaid Services ban Elizabeth Homes, CEO of Theranos, from running a blood testing laboratory for at least 2 years, and took away regulatory approval for its California lab. The questions about the irregularities in Theranos blood testing led to the voiding of all test results in 2014 and 2015 for its Edison device. The WSJ first raised questions about the effectiveness of blood testing by Theranos leading to investigations by federal agencies.

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Krugman quotes Ohio's Republican Governor, who said: "I am concerned about the fact that there seems to be a war on the poor. That if you are poor, you are shiftless and lazy." Kasich is taking his own independent position to support Medicaid expansion and aid the unemployed.

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U.S. president Trump's 2017 budget is an effort to reshape spending priorities by the Republican party. Apart from Medicare and Social Security all other entitlement programs from the days of Lyndon Johnson's Great Society are subject to cuts. Deep cuts to Medicaid and food stamps, including introducing work requirements. The philosophy behind it is that compassion will now be measured not by how large these programs are but by how much the government can get people "off these programs and back in charge of their lives,"  according to Budget Director Mulvaney.  The cuts are $616 billion to Medicaid and Children's Health programs, $193 billion in cuts to Food Stamps, $143 billion in student loans, $72 billion in disability programs. The overhaul of the Affordable Health Care Act is part of this change. The reallocation would put more money into infrastructure for $200 billion, and in tax cuts, $19 billion in a parental leave program and $29 billion for veterans programs, plus added spending on the military. William Hoagland of the Bipartisan Policy Center, a Republican who worked on budget issues says it will be politically difficult as the cuts to lower income groups come with tax cuts for small businesses and higher income individuals.  Beyond the policy priorities there is an area where both Republicans and Democrats are skeptical of the budget. This is how it impacts the U.S. debt. Under Congressional Budget Office estimates the U.S. debt as a percentage of GDP which rose to about 75% after the Great Recession starting in 2008, is projected to grow to about 85%. In sharp contrast the Trump administration estimates of the Office of Management and Budget are for it to drop to 65% based on rosier estimates of 2% inflation, 3% growth for the decade ahead. Experts say this is unlikely once the Fed raises interest rates and the unemployment rate currently at 4.4% leads to rising inflation, undercutting growth which has remained below 2% for a long period. These concerns are also voiced by Hilsenrath in the WSJ based on the experience of other countries such a Britain that cut corporate taxes without seeing an uptick in economic growth. ...

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Many important changes in the health care bill do not come till 2013 or 2014. Its only in 2014 that government will hand out tax credits to low and middle incoem Americans to offset the cost of buying insurance and expand Medicaid federal-state programs to help expand insurance for the poorer sections of society.

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Governor Cuomo's 2011 budget for New York includes year-to-year cuts of $2 billion in spending on healthcare and education. Overall the cuts would reduce year-to-year spending by 2%. For Medicaid and education Cuomo made a deal for a two year appropriation locking in fixed rates of growth, so that budget battles with teachers unions and other interests do not have to be repeated next year.

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The arguments of both sides in front of U.S. Supreme Court Justices on the Health Care Law's expansion of Medicaid. Justice Scalia said the law gives the states no choice. Justice Kennedy pointed to the situation of the states which have no way to opt out without stripping millions of Americans of medical care. Justice Roberts pointed to the states willingness to accept federal aid for years which brings us to the current situation. The attorney generals of 27 states have objected to the Health Care Law's provisions which they believe effectively requires the states suffering tight budget constraints to cover more of the poor than they they think they can, with the alternative being dropping out of Medicaid totally, not giving them much of a choice. As the three day hearing came to a close on March 28, 2012, the Supreme Court's conservative Justices expressed doubts whether the Obama Health Care Law could surivive if some key parts are struck down. With Justices Sotomayor, Ginsberg, Kagan, on one side, and Scalia, with other conservative Justices on the other side, the Court's final decision depends on Justices Kennedy and Roberts. ...

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After the coronavirus pandemic the whole picture of life in retirement and aging is expected, says this report in WSJ.  Retirement homes are not viewed as a good place and about 30% of these homes in the U.S. are expected to close with financial difficulties. Most people will now work longer and continue to live at home. Telemedicine and other technology will help make this possible. Experts say most people will age and stay at home and financial incentives will be given for this to happen.  Aging will also be seen differently because of the resilience of older people during the coronavirus. People will be seen as productive and living a full life well into their seventies and eighties. Community services will expand. Government services including under Medicaid will consider that it is less costly to stay at home than in long term care facilities and provide financial coverage for caregiver or homecare aides help at home. Many new services and technology assisted services are being planned with a focus on older people and living productive lives, as America and Europe other countries shift their focus to this group. After coronavirus people are also looking to spend their years in a productive way, to do things that really matter and add meaning to their lives.. How to spend the next 10-20 years in the most meaningful way. ...

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WSJ shows breakdown on federal spending hikes and cuts in the big DJT US Tax Bill. 2025 US Tax Bill renews the tax cuts put in place by Trump in his first term that expire in 2017. About $2.75 trillion in spending increases are not offset says WSJ. Briefly it has spending hikes for $2.18 trillion      DJT Tax Cuts from first term  $1.31 trillion       Increase Standard Deduction $820 billion         Deduction for businesses $797 billion         Child tax credit $1.41 trillion        Limits on Alternative Minimum Tax The goal is to promote business growth and help small business owners, parents with children, help ordinary Americans take more in take home pay during cost of living pressures for the average American. Savings come from $1.87 trillion repealing personal dependent exemption and $916 billion from capping state and local tax deductions. Added savings from repealing clean energy tax incentives and EV credits. Increasing work requirements for Medicaid saves $625 billion, tution aid cuts $346 billion, $300 billion from SNAP changes.   ...

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David Brooks says the Paul Ryan Budget proposal is a bold step forward that is badly needed in this debate on health care, even though it has some grave weaknesses which need to be corrected. It is a bold step forward because he says Democrats say they want no middle class tax increases, or are not willing to say what kinds of tax increases they support, and yet they believe the Medicare and Medicaid and Social Security programs are worth preserving. This is'nt based on reality. He cites the weaknesses, beginning with the one discussed in David Leonhardt's column in the New York Times on April 7, 2011. Too many Americans pay too little into Medicare taxes and expect to collect several hundred thousand dollars more in Medicare benefits. The example given in Leonhardt's column is from a study that shows 56 year olds with average earnings pay about $140,000 in dedicated Medicare taxes over a lifetime, and then go on to collect $430,000 in benefits. Middle class and affluent boomers can't get off paying their share like everybody else. Its just the right way for their children and the nation's children. Ryan's plan excludes older people reaching retirement in ten years. The other major weakness is that the cuts are too deep. Things like the Pell grants which Ryan proposes to cut back to 2008 levels need to be preserved, and more money has to go into science, education and research and early childhood education for the U.S. to be competitive with China and India. The Ryan proposal places cuts that would be required so that tax revenues need to be at 18% of GDP. The number where a larger consensus exists is for tax revenues at 20% of GDP (also supported by business and the Wall Street Journal's editorial columns). This would preserve programs that are most productive for the economic future of the U.S. Ryan's proposal lets the hope for reducing costs of medical care rest entirely on future retirees deciding how much medical care (tests, procedures etc) they consume through larger cost sharing. Yet a structure and framework is needed to manage these costs effectively, and some combination of incentives to retirees to control costs and an effective structural framework is needed. ...

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The House passes the $819 billion tax and spending bill. Every Republican in the House voted against the bill in the 244-188 vote. Most of the money to be spent of about $526 billion will be spent in 2009 and 2010, though some spending on student loan programs, clean water projects and housing assistance will carry over into future years. To help workers with the downturn $27 billion will go to continue unemployment insurance benefits till December 31, 2009. $9 billion will go to increase the current benefit from $300 to $325 per week. This is money that will be spent as workers lose jobs. The bill also lets former employees to get COBRA coverage, It funds 65% of individual's premiums for upto 12 months. And workers over 55 or with more than 10 years service will get to keep their COBRA coverage until they get a new job or get Medicare. A big departure is allowing those who are unemployed enroll in Medicaid, and Medicaid will temporarily expand to include millions of unemployed workers. See the link to Education spending for the $125 billion going into Education spending that will save the jobs of hundreds of thousands of teachers and create jobs for construction as schools are repaired and renovated....

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The U.S. Supercommittee in Congress fails to reach an agreement to come up with $1.2 trillion in savings to reduce the deficit by the Nov. 23, 2011 deadline. This shifts the focus to the sequester or triggering automatic cuts in Jan. 2013, as mandated in the Congressional deficit reduction deal of August 2, 2011. These automatic cuts would reduce defense spending by 10%, cut social programs without touching Medicaid and Social Security, by 7.8%, and reduce Medicare payments by 2%.

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This report in the WSJ by Peterson and Hackman shows how the American Health Care Act proposed by Speaker Paul Ryan provides less financial support and allows premiums to go higher for seniors approaching retirement in the 50-64 year age group. Premiums are allowed to go up 5 times that of premiums of young people in the Ryan House  plan compared to 3 times in the Affordable Care Act. Subsidies in the form of tax incentives provide $2000 to younger people going up by age not income to $4000 in the Ryan House plan. By contrast someone 60 years old making $20,000 a year can get Affordable Care Act credit of $9874, and making $40,000 a credit of $6752, according to analysis by Kaiser Family Foundation. The Ryan plan makes health care costs lower for young people in an effort to bring more young people who use less services into the system to support its overall financial condition. Another feature of the Ryan Plan is that it allows only for CPI index +1% even if health care costs are rising faster. Deep cuts to Medicaid affect lower income seniors on Medicare. As a result the AARP organization representing seniors has come out in opposition to the Ryan bill. The GOP plan wants to reduce premium costs yet in the process it makes vulnerable seniors with lower incomes pay more, which is likely to hurt Republicans who won by winning a large part of the senior vote. ...

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The Trump administration is preparing direct aid to Americans and American industries hurt by the coronavirus epidemic. Each check will be based on family size and income, according to a Treasury Department memo seen by WSJ. The direct payments in two rounds will be on April 6 and May 18. This is part of a $1 trillion stimulus program. $50 billion lending facility is being setup for the airlines. Another $150 billion goes to distressed sectors in the economy. $300 billion will go to a small business interruption loan program, which will go to temporarily cover payroll costs for employees. The idea is to put a safety net and support workers who will need help while they are not working. The measures include two weeks of paid emergency leave for a large number of people. Money also goes to additional Medicaid funding, more money for food stamps, and for unemployment insurance program. Congress has passed the bill and president Trump is expected to sign it into law. Other bills will follow in Congress. A third economic package will cover additional needs of agencies of government, with $11.5 billion for Department of Health and Human Services, and Departments of Defense, Veterans Affairs, Homeland Security. All this is being done in Congress and by the Trump administration at top speed. ...

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Robert Shiller of Yale University, calls for revenue sharing by the federal government with local governments. This should go beyond the $26 billion approved this month for aid to local governments, designed to assist with Medicaid and hiring teachers. It is difficult to create jobs quickly and disperse and use money wisely, without the help of local governments, military or nonprofit organizations- as these organizations have the necessary infrastructure that can be used to get things done quickly. He cites the Civilian Conservation Corps created by FDR, using the Army as the organizational framework.

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 Frustration has grown with the poor early management response from U.S. Health and Human Services Secretary Alex Azar, says WSJ.  The president responded at one point with a tweet that "he told me nothing until later." The WSJ looked into Mr. Azar's missteps in a report recently. The president is considering replacing Mr. Azar says WSJ. Ms. Verma the head of Medicaid and Medicare Services is being considered. She has worked closely with vice president Mike Pence throughout this crisis. Mr. Azar served as HHS general counsel and later deputy secretary under president George W. Bush. He then worked as lobbyist for Eli Lilly.  This WSJ report says Mr. Trump called Mr. Azar on his flight from India to Washington, and the next day replaced Mr. Azar as head of the White House coronavirus task force with Mr. Pence. The president says repeatedly that vice president Mike Pence, as head of the White House task force has worked night and day round the clock to guide the effort- including talking to 51 state governors, coordinating the entire effort, and providing the president with reliable advice. In the depths of this crisis never has so much depended on so few- on vice president Pence, a former governor of Indiana, Admiral Polowczyk, Dr. Birx, Dr. Fauci, and the governors of states worst affected by the coronavirus. ...

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Senator Mitch McConnell, the Republican Majority leader in the U.S. Senate has come up with a new health care bill that is aimed at winning over reluctant Republican Senators. Two taxes on high income people on 3.8% investment income and a payroll tax of 0.9% on incomes over $200,000 for individuals and $250,000 for couples are retained in this version of the bill, which adds $231 billion over a decade. Some of this is used to offset rising premiums in the new bill, and provide additional funds. The deep cuts to Medicaid are retained and Senator Collins of Maine says she is opposed to the new bill because this will hurt people in rural areas of Maine, and does nothing to change this. Senator Rand Paul of Kentucky is also opposed to the bill. Opposition comes from moderate Senators opposed to deep cuts to Medicaid in Republican health care alternatives to president Obama's Affordable Care Act, and from conservative Senators opposed for other reasons.  Senator Graham of South Carolina and Bill Cassidy of Louisiana introduced their own version just minutes before Mitch McConnell brought up his revised bill. All Democratic Senators are opposed to the Republican bill and call the deep cuts to Medicaid disastrous for lower income people.  ...