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Thursday, May 4, 2017

TRUMPCARE: WHAT IS IN IT.

How the new Trumpcare bill could affect health care consumers

  • By GILLIAN MOHNEY           May 4, 2017, 2:46 PM ET
             Eric Thayer/Getty Images
COMING UP    The moment House passed Obamacare replacement bill
After weeks of wrangling, protests and pressure from the White House, a new health care bill was passed by the House of Representatives today. The new bill has changed multiple times since Republicans originally introduced it in March.
Here are some key takeaways about the newest version of the American Health Care Act (AHCA), also referred to as Trumpcare.

Pre-existing conditions

Technically, people with pre-existing conditions may not be barred from obtaining insurance coverage under the AHCA. However, their coverage options could be seriously affected by this bill. States would be permitted to apply for waivers to exempt insurance companies from a community rating provision and allow them to charge far higher premiums for people with pre-existing conditions.[The process takes over six months] its [version to accomplish before you are "qualified" for meds or any other necessity] according to the state rules]
The community rating provision is a way of "setting premiums" [more expensive than Obama's version] and is [not really] designed to ensure risk is spread evenly across a larger pool. This means that people are charged the same rate regardless of factors like health status. [Note: very true here] Under the Affordable Care Act, insurance companies may charge different rates for identical plans only on the basis of [age, geographic location, the number of people covered and tobacco use], according to the Kaiser Family Foundation. [Really?]
Under the AHCA, people in certain states could face far higher premiums for pre-existing conditions. States that apply for this waiver would have to implement high-risk insurance pools to accommodate them. But health care experts are skeptical that these high-risk pools would [might not] have enough money to fully cover people in need.
Karen Pollitz, a senior fellow at the Kaiser Family Foundation, told ABC News that if there is no protection from higher costs for their specialized insurance plans, people with pre-existing conditions would likely be priced out of coverage. In the 1990s, she added, people with pre-existing conditions who recently lost their jobs were supposed to be protected by the Health Insurance Portability and Accountability Act and not be barred from obtaining insurance coverage. However, insurance companies charged far higher premiums for people with pre-existing conditions.
"To actually protect someone with pre-existing condition ... they need full protection. Otherwise, it's like giving someone half a bulletproof vest," Pollitz said.

High-risk pools

The newest version of the bill allocates $8 billion over five years for states that apply for the waiver, to help cover the costs of care for people with pre-existing conditions. Most likely, the states would use this money to help fund a high-risk insurance pool for residents with pre-existing conditions.
Pollitz said it's unclear why $8 billion was picked as an appropriate number to fund a high-risk insurance pool, especially since it's unknown how many states would apply for the waiver and how many people with pre-existing conditions would need help paying for care.
"Eight billion is not a number that bears any resemblance ... to what this would cost," she told ABC News.
Before the Affordable Care Act, 35 states had high-risk pools to cover residents who otherwise would not be insured because of pre-existing conditions. The Kaiser Family Foundation found that state high-risk pools often had significantly higher premiums and likely included just a small fraction of people who needed coverage.

Health care mandate

The Trumpcare bill does away with the mandate under the ACA that requires people have health insurance or pay a fine. Under the new bill, people who go 60 days without health coverage would be penalized if they rejoin a health plan; they would face a 30 percent penalty on their insurance policy for one year.
Christine Eibner, a senior economist and professor at the Pardee Rand Graduate School, told ABC News in an earlier interview that some people would likely not view insurance as a necessity and be more willing to bet that they could afford the 30 percent surcharge on health insurance down the line.
"It doesn't seem that punitive," she said. "You're still guaranteed that you can get health insurance ... For some people, that might be affordable, and you might end up with employer coverage in the interim."

Essential health benefits

Under the ACA, certain essential health benefits — including maternal care, prescription coverage and mental health care — must be a part of any insurance plan. Under the new Trumpcare bill, states could apply for a waiver to exempt insurance plans from including these benefits in their plans. To qualify, the states would need to prove they could either lower the cost of health care for people or increase the number of people covered by insurance.
Health experts say that if this provision is enacted, costs for people in need of specific essential health benefits will likely face higher premiums because insurance companies will assume that a person who signs up for a plan with maternal care or prescription benefits will be likely to use those benefits.
"If somebody needs maternity care, it will be much more expensive," Eibner said.
Pollitz said that insurance companies would likely offer cheaper plans but that under those plans, people would be left vulnerable to high medical costs.
"If you waive hospitalization or prescription drugs, then it starts to make the policy cheaper, for sure," she said. "But you're also back to part of the [bulletproof] vest again."

Tax credit changes

Under the new bill, qualifications for tax credits to help pay for health insurance would change significantly.
While the ACA offers a scale of credits that take into account family income, cost of insurance and age, the Trumpcare plan would offer flat tax credits per individual, focused on age. The House GOP bill would provide tax credits of $2,000 to $14,000 a year for individuals who don’t get insurance coverage from an employer or the government. The credits would be based on age instead of income and would be capped for higher earners.
People who are older, are lower-income or live in areas with high insurance premiums would likely receive smaller tax credits under the new bill than they do under the ACA. Those who are younger, have higher incomes or live in areas with lower insurance premiums would likely receive more government assistance than they currently do, according to the Kaiser Family Foundation.
A 64-year-old who makes $26,500 a year could see net out-of-pocket costs increase from $1,700 a year under the current law to $14,600 a year under the GOP plan, according to Congressional Budget Office estimates. A 40-year-old making the same amount would pay a few hundred dollars more after the tax credits, from $1,700 under Obamacare to $2,400 under the GOP bill.

Medicaid

The new bill calls for major changes to the way Medicaid is funded. First, the federal support of expanded Medicaid coverage, to those earning no more than 133 percent of the federal poverty level, would be rolled back. States that expanded Medicaid would no longer receive extra funds for new expansion beneficiaries after 2020, Kaiser Health News said.
People who receive Medicaid would be required to work unless they are disabled, pregnant or elderly.
Beginning in 2020, federal Medicaid financing would be changed to a per capita cap rather than a matching program, under which the federal government has supplied funds based on the number and needs of the enrollees.
Additionally, after 2020, state Medicaid plans would no longer be required to provide ACA-designated essential health benefits, including emergency services, pregnancy and newborn care, prescription drugs and pediatric services. Capping federal funds for Medicaid could have a huge impact on seniors and disabled children who depend on that coverage, according to Pollitz.
"There are 75 million people on Medicaid today. It's the second-largest source of coverage," she said. Employer coverage is the largest.
She pointed out that without federal funds to help with Medicaid coverage, states may have less money to help fund high-risk pools or other subsidies to help people afford health care. The changes would reduce $880 billion in federal spending on Medicaid over the next decade, pushing onto the states more of the financial burden for covering more than 74 million people in the program, according to the Kaiser Family Foundation
"It would be a big hit for states," Pollitz said. "It matters for the coverage and what states are going to be willing to spend in addition to this federal grant money. They're going to have their hands full."

Older adults vs. younger adults

Under the ACA, insurance companies may charge an older person no more than three times its premium for a younger person with an identical plan. The new bill would increase the maximum allowable ratio to 5 to 1, which could significantly increase older people's premiums for comparable plans. States would be able to set different maximum ratios.
Eibner said that older Americans not yet eligible for Medicare would be at risk for expensive premiums.
"They will face higher premiums than they currently do, and the younger people will face [lower?] premiums."
ABC News' Devin Dwyer and MaryAlice Parks contributed to this story.

Tuesday, April 11, 2017

Climate Change II On Flagler Street

Just got off a Florida page and found many people attempting to correct the Miami image and save both Miami proper , as far north as possible, and Miami Beach from the increasingly frequent flooding.

The complaint is that it is only Climate Change that is doing the damage. That would be nice. It is a much slower process. However, what is happening in Miami and in Miami Beach and other Floridian, soon to be inundated, areas is that the builders who are Northeran Snowbirds are positively sure that bigger and better building in the more popular areas are the things to create.

Make the areas look like New York City; or Austin, Texas; or cities in Los Angeles/Hollywood areas of mansions and pools. [H.m.m.m California seems to be sliding into the Pacific, just about the same way that Florida is sliding into the Atlantic.]

The difference between the two coast lines is that California has mountains and cliffs that are eroding due to massive, expensive showcase homes built on eroding cliff sides.  On the other coast, Florida has become the New York City of the south.

What architect in his right mind would build tall very expensive hotels and condominiums in a swamp? If even one of them, would go back and read about the Barefoot Mailman, who made the trek along the coast of  Florida in the early years of Mr. Flagler and his railroad; he, or even a she, would find that the poor main carrier was constantly facing swamps and gators;  lots of slimy soil. and difficult to walk on sand.

In the beginning, the houses on the coast were small homes, one story with pro per hurricane shutters.
Now, the builders for the small homes are touting sealed windows, electricity and air conditioning so that owners could weather out a hurricane while watching their television with chips and dips; at least until the roofs would be whipped away by the hurricane winds.

Architects of the area schools dreamed of patios made with lots of screens against mosquitoes and hurricane shutters that let in the air without letting in the rains and the wind.  and only small indoor spaces, for privacy with lots more open areas for the cool semi-tropical breezes.

Now, the shutters are gone, the screens get ripped away, and plywood is used to cover all windows: Tightly against the storms. Once an elderly person called the Hurricane Center in Coral Gables and asked why they did not tell homeowners to open a window or a door on the calm side of the house and shut the door on the wind side of the house.  

They also had to remember to tell the home owners to reverse the procedure when the hurricane turned the winds and calm around in opposite directions. That person was told that it was only an Old Wive's tale and useless in the hurricane areas of Miami. The buildings got to be tall apartment buildings, and finally taller condos. The soil could be corrected it was believed.

 And now, both Flager Street in Miami and the Fountainbleu Hotel and others in Miami Beach are flooded during such  hurricanes. But no one knows why.  Think!  The answers are there in Florida just as they are on the Pacific coast.

Sunday, November 2, 2014

an Art Gallery with comments

Going Home
No telling what I will end up with
when I start a paint.






Oops, I printed it upside down! My son's girl friend spotted it at the top of the picture and



informed him that I had bought it ready-made and faked it by putting my old signature seal on it.

But that was a long time ago. Last year when I turned 82, a neighbor gave me two blank (new) canvases, and somewhere, I had also acquired a third. I do not like unpainted canvases, so I decided I wanted to do another horse. A year or so earlier, I had painted a picture of two clay bowls, and I felt I might just succeed with a horse. I almost did it right but destroyed it by over-painting. Disgusted I let it sit for a few months. I tried again with the same canvas.  No use wasting a decent sunset; but this time it turned out to be a hobby horse, straight off a carnival carousel.

Since the hobby horse was painted over again, I do not consider it more than a practice effort, so my third success is the one below.  A bit different, but a horse.
My Favorte 1961 Watercolor

Ramtod-tailed Hors
In a Bamboo Grove
Portrait attempt.  Not good enough yet.
Rose's without rain drops
A Seascape on Cardboard
A pleasant  Accident

Chinese Brush. Not free enou
More Flowers

Friday, August 22, 2014

Who Am I Kidding?

Who am I kidding? No one but myself!

I can no more grow old gracefully than a palm tree can become an oak tree.
I have tried to do here a bio but I was having a problem with self.

I am no more a youngster, nor am I very old. I cannot even think I am going to be old, even when my neck looks like a Thanksgiving turkey.  and my hair is a beautiful shade of white, the color of snow on a cold clear day in winter,
Bah! Whoever invented old age, should be put in a the stocks at the center of town.

Sunday, June 29, 2014

Second and Third Grade

Second Grade was not very interesting. The teacher found that I was scratching my head too often and discovered that I had head lice. I thought it was from our laundry tub where we got a bath every Saturday. My mother got coal oil, whatever that was, and my head got soaked every night and washed every morning, and finally they disappeared. I had my hair combed with a fine tooth comb every day just to make sure.

The rest of the year was not that interesting. We walked through a long double meadow, split in the middle by a copse of tall trees. Once I got threatened by a heavy set boy, but I ran and he did not follow me.

Snow om the winter was no fun. It was knee deep in the meadow which made walking to school difficult, but not impossible. Summer made up for it all. The buttercups and for-get me-nots would bloom one after the other. I would pick some for my mother. One day I did find a dime, so when I got home I went next door to the country store, owned by Mr. Disascio (never knew how to spell his name) and his wife and son, Tony.
[Mrs. Disascio made the most delicious spaghetti, and waffle cookies filled with some sort of cream. His father ran the store and used produce from his own garden to sell during the fall. Those days were idylic.]

At the store, I bought some candy and a cone of ice cream and took the candy to my mother. She was pleased with the 'gift.'

Third Grade was not what I liked, but only after my teacher punished me by sending me to my twin brothers's first grade class.  I had found a small sparkly disk on a chain and had given it to the classmate who did wonderful elocution poems for us in class. Dorothy was her name. She knew Hiawatha and The Face on the Barroom Floor; all of both long poems.  Well, I told my mother about it, but she misconstrued what I told her and insisted that I get the bauble back. I did try . . . even visiting the girl at her house. But she refused to return it to me. My mother asked about it often, but I could not say I had gotten it back so she was unhappy about it.  I made one last effort. Dorothy was sitting behind me in class and I turned around and asked her one more time. When she again refused, I got out of my seat and fought with her.

The natural result was I had to be punished and the teacher knew exactly what would hurt the most. My mother found out about my visit to First Grade at lunch time, and later when Dad came home from work, I received a spanking for fighting in the school room.

From that time on, I never made another 100 in spelling and never got another 100 in any class I attended.
No one had asked me why I did it, but I never forgot. I guess even my penmanship went downhill a bit, even though I like to draw the slanted up and down bars and the round over and around tubes of lines meant to teach us the correct method for writing legibly.

I almost forgot . . . my twin brothers, being in first grade . . . got to have their First Communion that year and I happened to be a pink Angel to guide them on their way down to the altar.  The picture that was taken for that even portrayed me as a very grouchy angel. The ceremony must have occurred after my spanking, because I was not a very happy angel.

One thing about the school I was in that year (3rd grade): I learned in religion class that the church made a big effort to convert a lot of people during the Middle Ages. I don''t know why the subject came up but I do remember that it seemed to be a bad time for the church. [Later in college when I found out how they had done the conversions, I was so shocked that I could not talk about it for over two years.]

That summer, I was playing in the peach tree in our yard with the angel robe on and the robe caught on a branch. I fell out of the tree [not very far down thank heavens, so I broke no bones] but it did take my breath away for a moment.  It was also the last time I ever went into the tub outside with only panties on. I figured that I was too grown up to be bare chested any more, so wore T-shirts from that time on, when my bothers and I went for a summer dip into the old tub. I did not learn to swim until years later.

It was also around this time that I went to Chester Creek with my cousins and my aunt. We were having a lot of fun, but one of the more cheerful ones, turned over the inner tube float that I was using. I thought I was going to drown, but my other cousin pulled me up out of the water right away. It was not as frightening since my cousin was so quick to get me out of the deeper water. She turned to be my favorite cousin, Sophie.


A short note about my penmanship. When I grew up and someone invited me to a Calligraphy class, I cheated by printing a calligraphic script phrase on thin paper. So that I could just write over what I could see under my good page.  It always made a good impression then with the teacher. But that was after seven children and a lot of grief from the marriage I thought was a good one.  Oh well.

Monday, June 16, 2014

Skipping to First Grade

First grade was something that was a bit of a memory lost for me. Previous to going to school, I was put into a dance class (to make sure I could perform like Shirley Temple, I surmise) and at  home, my father read me the comics every night, thank heavens.

I say, thank heavens, because by October, I got sick. I had measles, mumps and whooping cough, one right after the other.  During that time, I was able to read a lot of my children's books, including the Night Before Christmas, my favorite.

My first day out of bed was Christmas morning. I got up and got dressed in a neat dark blue sailor dress with a red bow tie in front.  I had asked for a bicycle for Christmas and I got one. OMG.  It was there leaving against the banister of the newest apartment we had, that over a shoemaker shop. My heart dropped. It was the wrong bicycle.  Was Santa a fault or . . . ?

The bicycle was a light green boy's bicycle with fat balloon tires. I had wanted a bicycle, but, . . . I was a girl, not a boy. The poor bicycle never got ridden the whole time I had it and even after we moved across from my father's work, I never even considered it mine

First grade after I returned to school, I remember being on stage at school in a cute red satin Russian outfit. It had short skirt with a white feather hemline trim, and red vest with a white blouse, and a tiara of red satin like the skirt, trimmed in silvery ribbons and a lot of long colored ribbons hanging down from each side.

A doll visited our first grade. She had all sorts of clothes to wear, even pajamas. She had a toothbrush and a hair brush and her own soap and washcloth. She was beautiful. Her owner said that she herself, never used soap on her face, but she neglected to tell us that she used creams and ointments. It took me a long time before I figured out that the creams and ointments had more to to with the face of the doll's owner than the doll that used soap and water.

Regardless when spring time rolled around, and the whole school was having a morning recess in the school yard, there were several wagons outside the school yard.  One in particular was a Bread wagon, all green and gold with big wheels with yellow spokes and a red or brown rim.

For some reason, the horse pulling the wagon spooked from something on the road, and it frightened him so that he ran right over the curb, breaking one wheel on the wagon, and headed straight into the school yard.  I was way in the back leaning on the small metal bannister because I had just recently returned to school and was still not able to play with the children. I was taking it "easy."

All the children started screaming at once, and running to get away from the horse and wagon.  A man, from a different wagon ran into the yard from the street, grabbed the horse's harness and stopped him in his run towards the children. I could not understand why everyone was screaming and crying. I saw who the man was and he was perfectly capable of stopping the horse. It was my father in his milk  run, or he was checking up on whether I was doing well in school.

I never told anyone who the man was, nor did anyone ever ask me about him. I did think it was neat, but no one, not even my father at home, said a word about catching the horse.

Back in the school room, probably one another day, I was reading my reader.  I said, "Oh, Nuts!" A common cuss word for children. My seat mate was aghast. "You said a bad word."  My response was, "No, I did not. It is here in our book."  And I showed her the page next to the picture of a nut tree right next to the text. That was that. She never said another word.

In the class, we had only one black boy learning his ABC's. but most of the time he fell asleep. When my sister went to that school 16 years later, she was the only white girl in the class. The neighborhood had changed that drastically.  In the early years, though I had to walk home and the shortest route was through the black neighborhood. I only could do that one time, because the children there ganged up on me and I guess they threatened me, so I never went through the area again.

By summer time, we had moved across the street from Miller and Flounder's Dairy, where my father worked. It was a white house with two floors. My father put in an oil heater in the fireplace and a plywood, high step-over door in the archway to the porch.  He then rented the upstairs to an older couple who, although I would go upstairs and read the Sunday comics where my father stored them in an extra room on the second floor, I never met them.

Not even when we got the chicken coup from the neighbor behind us who was moving to the city. Mom would make the attic into a nursery for the new chicks and I would visit them all the time.
We would have Sunday dinner, a chicken that she would prepare in the morning, starting with cutting off its head, and we would eat him in the afternoon. We also had eggs every morning for breakfast.

Friday, May 23, 2014

First View of the World

           Many years later, I came about a dream sequence that happened regularly. However, it belongs here in this part since it seemed to have occurred the day I was born, a bit earlier than my first post.

          I would dreams of a person whose finger I was holding. It seemed to me that the whole body of that person had the same thickness as that single finger i held. I dreamt this particular dream for several years, during hte time I was married and living in Miami, Florida. It was comforting dream, and I never knew why it occurred so regularly.

          After a particularly difficult day, sometime during the seventh year of my marriage, I stopped to think more deeply about it.  I reasoned, that if I was holding only a finger of my comforter, it had to be just after the moment of my birth. I  was wrapped in a warm blanket and I was being cuddled, as all babies are when they are first born.  But it did not appear to be by my mother. It was someone else.  Who, i do not know. I never heard any details of my birth, only afterward, when one of my aunts, who my mother did not like very much, was helping her out during the time of her recovery.

           Neverthelsss, once I decided that it had been that very day and hour that i was born, I NEVER dreamt that drream again.  Apparently, I was having a particularly rough time during my marriage, but did not understand why it was so difficult.  My husband was never rude or contrary to me and it actually seemed that it was a strong marriage. Seven children were loved and appreciated. So, at that time I had no inkling of any difficulty.  Or maybe I did and refused to admit it to myself.

          As it was I later found out that a divorce would be better than staying in the marriage and with a little bit of help from a friend. i was able to do that.  Things actually got a bit worse, but with my dream in my corner (how if dream can affect one's feelings, i don't know, but it did seems to happan that way to me.) I actually survived and all the children are here near where I live and they are very content with their lives.  A good feeling that I got them all grown and happy in what they do finally. Hurray!