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Thread: The health care debate thread.

  1. #541
    For those who believe there was divine guidance/intervention on behalf of the colonies during the Revolutionary War, do you believe that God through John McCain might have also had a hand in preventing the removal of millions of people from health insurance?

  2. #542
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by UTEopia View Post
    For those who believe there was divine guidance/intervention on behalf of the colonies during the Revolutionary War, do you believe that God through John McCain might have also had a hand in preventing the removal of millions of people from health insurance?
    I know you were joking, but the idea that millions of people are going to be "removed from health insurance" is a canard that has been allowed to become far too well accepted. The people that would have been affected by the now-dead Republican bill are those in what is called the "expansion group." Those are the folks who are able bodied and whose income is at a certain level above the poverty limit. (130%, I think.) They did not have Medicaid before Obamacare, and it was expanded to them. The federal government is still paying 90% of the cost of that expansion for those individuals. It is what policy wonks call a "open-ended entitlement, meaning it will expand every time in a state wants to add individuals to its Medicaid roles. The Republican bill would have transitioned those people off of Medicaid between now and 2024. Somehow, the bill would have made funds available to them to purchase insurance on their own. That at least was the concept. There has been hysterical complaining from people on the left, stating that millions of people will die, insurance will be wrested from the hands of needy people, and so forth. There were flaws in the bill, but being cruel and heartless was not one of them.

    Sorry to rant. This has been bugging me for a while, and you happen to be in my line of fire!

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  3. #543
    Quote Originally Posted by LA Ute View Post
    I know you were joking, but the idea that millions of people are going to be "removed from health insurance" is a canard that has been allowed to become far too well accepted. The people that would have been affected by the now-dead Republican bill are those in what is called the "expansion group." Those are the folks who are able bodied and whose income is at a certain level above the poverty limit. (130%, I think.) They did not have Medicaid before Obamacare, and it was expanded to them. The federal government is still paying 90% of the cost of that expansion for those individuals. It is what policy wonks call a "open-ended entitlement, meaning it will expand every time in a state wants to add individuals to its Medicaid roles. The Republican bill would have transitioned those people off of Medicaid between now and 2024. Somehow, the bill would have made funds available to them to purchase insurance on their own. That at least was the concept. There has been hysterical complaining from people on the left, stating that millions of people will die, insurance will be wrested from the hands of needy people, and so forth. There were flaws in the bill, but being cruel and heartless was not one of them.

    Sorry to rant. This has been bugging me for a while, and you happen to be in my line of fire!
    It was tongue in cheek, but I think you might underestimate those impacted. I have two in my family, both self-employed, who can only afford insurance through the exchange. They both make less than 40k annually and receive about an 80- $140 per month subsidy. One is 25 and healthy and has a low premium, high deductible plan that costs about 300 per month after subsidy. The other is 62 and extremely unhealthy. He (well my wife and her brothers) pay about 1k a month after subsidy for a cadillac policy. He couldn't get insurance before because of pre-existing conditions. As for the medicaid expansion group, those people did not have any coverage before Obamacare and will not going forward. They are, for the most part, people who work and who have been left behind in the economy. I think we are a wealthy enough country to provide 90% of the cost for medicaid. Others do not. I understand the arguments, but those people are still going to need medical care and the only care they will receive is treatment at an ER. The hospitals do not provide that care free of charge. It is passed on to the rest of us with insurance or with Medicare. So if the difference is the government paying 90% or even 100% or those with insurance or self-paying getting those costs passed onto them through increased medical costs, I am good with the former. Frankly, I do believe that both the Senate and House bills are cruel and heartless and if they do what you suggest, they have done a piss-poor job of communicating that information. I do not believe that ultra-conservative republicans like Lee have any plan to provide subsidies to that group after 2024. This problem is not going away. Unfortunately, the number of people who work and who cannot pay for health insurance and healthcare is going to increase going forward and no amount of trickle down from tax savings to the top 1% is going to trickle down to that group. Of course, I just read excerpts of a Trump interview where he thinks recent college grads. can purchase great health insurance for $12 a month, so I guess we are in good hands.

  4. #544
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    Quote Originally Posted by LA Ute View Post
    I know you were joking, but the idea that millions of people are going to be "removed from health insurance" is a canard that has been allowed to become far too well accepted. The people that would have been affected by the now-dead Republican bill are those in what is called the "expansion group." Those are the folks who are able bodied and whose income is at a certain level above the poverty limit. (130%, I think.) They did not have Medicaid before Obamacare, and it was expanded to them. The federal government is still paying 90% of the cost of that expansion for those individuals. It is what policy wonks call a "open-ended entitlement, meaning it will expand every time in a state wants to add individuals to its Medicaid roles. The Republican bill would have transitioned those people off of Medicaid between now and 2024. Somehow, the bill would have made funds available to them to purchase insurance on their own. That at least was the concept. There has been hysterical complaining from people on the left, stating that millions of people will die, insurance will be wrested from the hands of needy people, and so forth. There were flaws in the bill, but being cruel and heartless was not one of them.

    Sorry to rant. This has been bugging me for a while, and you happen to be in my line of fire!
    This is the key component. There was no "Somehow". They weren't going to do anything like this. They were going to remove the Medicaid expansion funds from the States and not replace it with anything.

    This whole bill had nothing to do with healthcare reform and everything to do with funding tax cuts which is how they were able to run it through the reconciliation process.

  5. #545
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by U-Ute View Post
    This is the key component. There was no "Somehow". They weren't going to do anything like this. They were going to remove the Medicaid expansion funds from the States and not replace it with anything.

    This whole bill had nothing to do with healthcare reform and everything to do with funding tax cuts which is how they were able to run it through the reconciliation process.
    Here's a breakdown by one of my Democrat colleagues:

    http://healthcarecounselblog.com/art...alth-care-bill

    Excerpt:

    "Creates tax credits for the purchase of health insurance on exchanges or in the individual market, which vary based on income and age. These credits are available for those making up to 350% of the Federal Poverty Level (FPL."

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  6. #546
    Tax credits it's do not equal subsidies that will help those in that group purchase insurance.

    Quote Originally Posted by LA Ute View Post
    Here's a breakdown by one of my Democrat colleagues:

    http://healthcarecounselblog.com/art...alth-care-bill

    Excerpt:

    "Creates tax credits for the purchase of health insurance on exchanges or in the individual market, which vary based on income and age. These credits are available for those making up to 350% of the Federal Poverty Level (FPL."

  7. #547
    Quote Originally Posted by LA Ute View Post
    Here's a breakdown by one of my Democrat colleagues:

    http://healthcarecounselblog.com/art...alth-care-bill

    Excerpt:

    "Creates tax credits for the purchase of health insurance on exchanges or in the individual market, which vary based on income and age. These credits are available for those making up to 350% of the Federal Poverty Level (FPL."
    That's a dead link


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  8. #548
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by Diehard Ute View Post
    That's a dead link


    Sent from my iPhone using Tapatalk
    Works for me. Try again:

    http://healthcarecounselblog.com/art...alth-care-bill

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  9. #549
    Sam the Sheepdog LA Ute's Avatar
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    JUNE 23, 2017
    AFFORDABLE CARE ACT




    Washington’s Best Kept Secret Revealed: What’s in the Senate Health Care Bill


    By Sonja L. Nesbit and Hillary M. Stemple


    After weeks of closed-door meetings about the content of the Senate’s health care bill, Senate Republicans released a “discussion draft” of their legislation on Thursday. The bill, titled the “Better Care Reconciliation Act of 2017” or BCRA, is the Senate’s response to the bill passed by the House of Representatives in May. While the bill is likely to be amended before it moves to a vote before the Senate (with a vote possibly coming as early as next week), the discussion draft provides insight into the health care system changes that are likely to result if the bill (or something similar) ultimately becomes law.

    Among other things, the Senate bill:


    • Creates tax credits for the purchase of health insurance on exchanges or in the individual market, which vary based on income and age. These credits are available for those making up to 350% of the Federal Poverty Level (FPL);
    • Eliminates insurance mandates;
    • Expands upon the state innovation waivers in Section 1332 of the Affordable Care Act by giving states greater flexibility to seek waivers, including waivers for the requirement that all insurance plans cover “essential health benefits;”
    • Eliminates financing for the Medicaid expansion over a multi-year period and fundamentally alters the federal funding construct of the Medicaid program; and
    • Repeals a number of the taxes that were included in the Affordable Care Act (ACA), including the Cadillac tax, the tax on prescription medication, the medical device excise tax, and the health insurance tax.


    While the Congressional Budget Office and Joint Tax Committee have yet to release their assessments of the bill, it’s safe to say these changes, if implemented, will have a significant impact on the American health care system.

    The Future of the Individual Market

    One of the hallmarks of the ACA was the establishment of a federal and some state-based marketplaces (known as exchanges) where individuals without employer-based insurance or other types of coverage (e.g., Medicare or Medicaid) could purchase insurance. To help individuals afford health care insurance, the ACA established income- and geographically-based tax credits for individuals with income up to 400 percent of the federal poverty level (FPL).

    The BCRA would:


    • Limit eligibility for tax credits to those with incomes at or below 350% of FPL;
    • Adjust the tax credits so that they are based on both the age and income of the recipient; and
    • Cap the tax credits at a lower percent of overall medical costs than under current law.


    Many analysts believe that the practical effect of these reforms would be to increase the cost of insurance premiums and deductibles for individuals who use tax credits to purchase health care coverage through the exchanges.

    The BCRA also provides $85 billion to help low-income individuals afford their health insurance premiums and out-of-pocket medical expenses. The additional funding will help offset the cost of coverage; however, it is not clear that the additional funds will offset the full cost of what will be needed to ensure that low-income individuals can afford health coverage. The Congressional Budget Office and the Joint Tax Committee’s analysis of the BCRA, which is reportedly due as early as Monday, will provide their projections on the practical effects that the proposed tax credits and funding for premiums and out-of-pocket expenses will have in keeping health insurance affordable and/or affecting the number of people who could lose coverage.

    The Future of the Obamacare Mandates

    The ACA mandated, with limited exceptions, that all individuals purchase health insurance meeting certain standards. If an individual fails to purchase health care coverage, they are subject to a tax penalty. Larger companies also are required to provide affordable insurance to their employees or face penalties.

    The BCRA eliminates the penalties for the individual and employer mandates for health care coverage, essentially making the mandates meaningless. While many employers will likely continue to provide health care coverage to their employees, some employers will opt to provide less comprehensive (i.e., less costly) coverage. Additionally many younger and healthier individuals may choose to forgo purchasing insurance on the individual market.


    The Future of “Essential Health Benefits”


    To ensure all insurance plans provide a baseline level of coverage, the ACA requires that plans, offered on the marketplaces and individual markets cover certain “essential health benefits” (or EHBs): outpatient services, emergency services, hospitalization, mental health and substance abuse disorders and behavior health treatment, maternity and newborn care, prescription drugs, rehabilitative devices, laboratory services, preventive and wellness services, and pediatric services, including oral and vision care. The BCRA permits states to obtain waivers to waive EHB requirements. As a result, the types of mandated services covered by insurance plans will vary by state. Interestingly, the Senate bill also includes $2 billion to help facilitate the use of these waivers.

    In response to the ongoing opioid crisis, the BCRA provides $2 billion for grants to states for treatment for substance abuse and mental health disorders for those states who opt to provide these services.


    The Future of Medicaid


    One of the largest drivers in the decrease in the number of uninsured Americans under the ACA was the expansion of Medicaid to include individuals with income up to 138 percent FPL. While only 32 states opted to expand coverage through Medicaid, nearly 11 million individuals obtained insurance coverage through Medicaid expansion.

    Beginning in 2020, Medicaid expansion states would be prohibited from enrolling new enrollees in Medicaid expansion under the legislation. The BCRA will begin to phase-out payments for the Medicaid expansion population in states starting in 2021, with full repeal of payments occurring in 2024. Meanwhile, individuals in at least seven states (Arkansas, Illinois, Indiana, Michigan, New Hampshire, New Mexico, and Washington) will lose coverage in 2021, as these states tied Medicaid expansion to continued provision of federal assistance at the levels established under the ACA. Low-income individuals who obtained coverage through Medicaid expansion will be eligible to purchase insurance with tax credits through the exchanges, though for many, such insurance may be cost-prohibitive.

    In addition to eliminating the Medicaid expansion, the BCRA (similar to the American Health Care Act that the House passed in May) shifts Medicaid from an open-ended funding or entitlement system to a funding system based on per capita payments. Under the new system, states would receive federal funding on a capped, per enrollee basis, based on each state’s historical Medicaid spending. States also would have the option to receive the funding in a yearly block grant. The net effect of both options is to reduce the level of federal funding that is provided to states to support their Medicaid program.

    Beginning in 2025, the BCRA also changes the inflationary index tied to Medicaid funding from the current medical inflationary index to the general Consumer Price Index for all urban consumers (CPI-U). Because health care costs tend to increase faster than general inflationary costs, this change will dramatically slow the level of federal funding that is provided to states to support their Medicaid programs. The reduction in federal Medicaid funding may lead to states further cutting eligibility and benefits provided under the program for low-income adults and children, the elderly, and the disabled.

    The BCRA also permits states to establish work requirements for non-disabled adults over the age of 19 in exchange for Medicaid coverage.

    The Congressional Budget Office and Joint Tax Committee estimate of the bill will include a projection of savings in federal spending in the Medicaid program and outline how much states will lose in Medicaid funding.


    Other Changes


    In addition to the changes described above, the BCRA:


    • Eliminates federal funding for Planned Parenthood for one year and prohibits the use of certain tax credits for health insurance plans offered in the marketplace that provide abortion services;
    • Dedicates funding for state high-risk pools; and
    • Guarantees insurance cost sharing payments to insurance companies in the insurance exchanges through 2019.


    Conclusion


    While it remains unclear whether the Senate will have enough votes to pass their health care bill, if the legislation eventually becomes law, health providers will need to prepare for the coming changes. These changes will likely result in reductions to coverage levels, as well as less robust insurance plans that may cover fewer services at higher costs to patients.

    Some changes will be dependent upon the actions taken by the states. Providers will need to carefully monitor whether states have requested waivers for EHBs or other ACA requirements. Providers also will need to monitor whether states are implementing more robust state regulatory requirements in place of the federal requirements and determine how their patients may be affected. The Congressional Budget Office and Joint Tax Committee estimate of the cost and practical effects of the legislation will provide an additional window into the implications of the Senate’s proposals on the industry.


    http://healthcarecounselblog.com/art...alth-care-bill
    Last edited by LA Ute; 07-21-2017 at 05:42 PM.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  10. #550
    Quote Originally Posted by LA Ute View Post
    I know you were joking, but the idea that millions of people are going to be "removed from health insurance" is a canard that has been allowed to become far too well accepted. The people that would have been affected by the now-dead Republican bill are those in what is called the "expansion group." Those are the folks who are able bodied and whose income is at a certain level above the poverty limit. (130%, I think.) They did not have Medicaid before Obamacare, and it was expanded to them. The federal government is still paying 90% of the cost of that expansion for those individuals. It is what policy wonks call a "open-ended entitlement, meaning it will expand every time in a state wants to add individuals to its Medicaid roles. The Republican bill would have transitioned those people off of Medicaid between now and 2024. Somehow, the bill would have made funds available to them to purchase insurance on their own. That at least was the concept. There has been hysterical complaining from people on the left, stating that millions of people will die, insurance will be wrested from the hands of needy people, and so forth. There were flaws in the bill, but being cruel and heartless was not one of them.

    Sorry to rant. This has been bugging me for a while, and you happen to be in my line of fire!

    I wish you'd give more of your opinion on health care. Seems you're one of the genuine experts on this board, and pretty fair minded about things....helps us who aren't experts on the topic.
    “Children and dogs are as necessary to the welfare of the country as Wall Street and the railroads.” -- Harry S. Truman

    "You never soar so high as when you stoop down to help a child or an animal." -- Jewish Proverb

    "Three-time Pro Bowler Eric Weddle the most versatile, and maybe most intelligent, safety in the game." -- SI, 9/7/15, p. 107.

  11. #551
    Sam the Sheepdog LA Ute's Avatar
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    The health care debate thread.

    Quote Originally Posted by mUUser View Post
    I wish you'd give more of your opinion on health care. Seems you're one of the genuine experts on this board, and pretty fair minded about things....helps us who aren't experts on the topic.
    It's just that the health care system is messy and complex, and the debate about reforming it is all too often downright dishonest. (I am talking about the politicians and pundits who drive the narrative.) Drives me nuts.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  12. #552
    Amazon got some secret health stuff going on. With the Echo now in everyone's house this may work.
    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  13. #553
    Oh Mike. If only here had been some way that you could have gotten involved in the process.




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  14. #554
    Sam the Sheepdog LA Ute's Avatar
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    John McCain, the maverick.

    https://youtu.be/IE48mGZbsUo

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  15. #555
    “Children and dogs are as necessary to the welfare of the country as Wall Street and the railroads.” -- Harry S. Truman

    "You never soar so high as when you stoop down to help a child or an animal." -- Jewish Proverb

    "Three-time Pro Bowler Eric Weddle the most versatile, and maybe most intelligent, safety in the game." -- SI, 9/7/15, p. 107.

  16. #556
    Sam the Sheepdog LA Ute's Avatar
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    Dems suddenly scrambling to come up with ObamaCare fix

    http://www.foxnews.com/politics/2017...acare-fix.html

    Wait, I thought Obamacare must not be touched because it is such good legislation. This is the first time I have heard any Democrat, anywhere, call for significant changes in that law. I think Hillary Clinton vaguely acknowledge to during the campaign that some tweaks needed to be made here and there to improve the law. But that's about it.

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  17. #557
    Quote Originally Posted by LA Ute View Post
    Dems suddenly scrambling to come up with ObamaCare fix

    http://www.foxnews.com/politics/2017...acare-fix.html

    Wait, I thought Obamacare must not be touched because it is such good legislation. This is the first time I have heard any Democrat, anywhere, call for significant changes in that law. I think Hillary Clinton vaguely acknowledge to during the campaign that some tweaks needed to be made here and there to improve the law. But that's about it.
    So what are they changing?

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    "Be a philosopher. A man can compromise to gain a point. It has become apparent that a man can, within limits, follow his inclinations within the arms of the Church if he does so discreetly." - The Walking Drum

    "And here’s what life comes down to—not how many years you live, but how many of those years are filled with bullshit that doesn’t amount to anything to satisfy the requirements of some dickhead you’ll never get the pleasure of punching in the face." – Adam Carolla

  18. #558
    Sam the Sheepdog LA Ute's Avatar
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    Quote Originally Posted by Mormon Red Death View Post
    So what are they changing?

    Sent from my SM-G930T using Tapatalk
    The article didn't say much but, here's what it did say:

    This week, multiple factions of the House Democratic Caucus met behind closed doors to discuss potential proposals.

    Some would aim to codify cost-sharing reduction payments, lower the cost of prescription drugs, and strengthen consumer protections to ensure premium increases are stabilized, according to the aide.

    Another Democratic proposal reportedly would allow people ages 50-64 to buy into Medicare.

    Staffers from both the Congressional Progressive Caucus and the Congressional Black Caucus told Fox News they plan to introduce ideas as well. The CPC will focus on additional options for public health care access to address counties losing insurers; and the CBC will roll out a “mini omnibus bill” for health care, pulling together legislation from all 49 members of their caucus and focusing on “expanding community health centers.”

    "It is only with the heart that one can see rightly; what is essential is invisible to the eye."
    --Antoine de Saint-Exupery

    "Things fall apart; the centre cannot hold."
    --Yeats

    “True, we [lawyers] build no bridges. We raise no towers. We construct no engines. We paint no pictures - unless as amateurs for our own principal amusement. There is little of all that we do which the eye of man can see. But we smooth out difficulties; we relieve stress; we correct mistakes; we take up other men's burdens and by our efforts we make possible the peaceful life of men in a peaceful state.”

    --John W. Davis, founder of Davis Polk & Wardwell

  19. #559
    Quote Originally Posted by LA Ute View Post
    The article didn't say much but, here's what it did say:
    The buy in for Medicare would be interesting.

    The biggest reason we have public employees working 30-45 year careers is the need to have access to insurance.

    (Unless you're a federal employee who gets retirement and health care....or a Utah state legislator)


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