Impacts of Proposed FY 2018 Budget Cuts on State and Local Air Quality Agencies

 

A Report by the
National Association of Clean Air Agencies (NACAA)

May 22, 2017

Executive Summary

President Trump will release his FY 2018 federal budget on May 23, 2017, which calls for huge cuts in funding for the U.S. Environmental Protection Agency (EPA). According to a document obtained by the National Association of Clean Air Agencies (NACAA),1 the budget will include a 31-percent reduction in EPA’s overall funding (from $8.2 billion in FY 2017 to $5.7 billion in FY 2018), the elimination of many important environmental programs, and – the focus of this report – a 30-percent decrease in federal grants to state and local air pollution control agencies (from $227.8 million in FY 2017 to $159.5 million in FY 2018).

Based on advance information about what the proposed budget would include,2 NACAA surveyed its members to learn what a reduction of approximately 30-percent in federal grants would mean to state and local air quality programs. The results revealed a very disturbing picture: cuts of the magnitude proposed would likely have a devastating impact on the efforts of state and local air pollution control agencies to provide healthful air quality for the American public. Indeed, if cuts of this magnitude are sustained by Congress, we fear more people will die prematurely and get sick unnecessarily.

State and local air quality agencies have faced inadequate funding for years and have already taken many steps to address their budget shortfalls. Additional cuts of 30 percent would severely impede the ability of many agencies to continue essential programs and, in the most extreme cases, some smaller local agencies could conceivably have to close their doors entirely. If such cuts are enacted, many state and local air pollution control agencies will have trouble fully implementing the Clean Air Act’s health-based air quality standards and delivering the clean and healthful air quality that the public deserves.

Additionally, these agencies could be subject to harsh sanctions under the Clean Air Act, including the withholding of millions of dollars in federal highway funds, severe emissions “off-set” limits that could interfere with economic development, and the possibility of EPA imposing Federal Implementation Plans on states.

In their responses, agency after agency painted a similar picture of severe curtailments to their programs in the face of the steep cuts being proposed: loss of staff, cancellation of programs and a diminished capacity to obtain and maintain healthful air quality. Nearly every respondent reported that cuts of this magnitude would severely reduce the benefits the agencies can provide. These include not only to the general public, with respect to decreasing air pollution, maintaining clean air and generally protecting public health, but also to the regulated community, in terms of permitting, compliance assistance and other services.

The respondents provided a long and varied list of ways in which a 30-percent reduction would impact state and local air pollution control programs, affecting nearly every function they perform. State and local agencies identified many activities to be reduced and/or eliminated, including staffing levels, monitoring, inspections, enforcement, permit issuance, compliance assistance, data analysis, equipment maintenance and complaint response, among others.

The impacts of these reductions are far reaching. Numerous agencies reported that they would be operating at a bare minimum level and that the services they provide the public would be limited or even eliminated. Perhaps most importantly, efforts to obtain healthful air quality and maintain clean air would suffer as a result of these resource constraints on their programs.

Agencies also reported that their state or local governments, which already provide the lion’s share of funding for clean air programs, would not be able to make up for the reductions in federal grants through additional state or local appropriations, general funds, grants or other contributions. Additionally, several agencies noted that they could consider increasing fees to address the shortfall, but that gaining approval for additional fees is unlikely as well.

Finally, state and local air quality agencies reported that a 30-percent cut in grants could force them to turn some of their important Clean Air Act implementation work back to the federal government. As local communities, including many regulated entities, generally prefer working with their local and state agencies (as opposed to EPA), the return of responsibilities to the federal government would be a tremendous loss. Additionally, since the proposed budget calls for sharp cuts to EPA’s operating budget as well, the agency would not be in a good position to take on the tasks that the state and local agencies can no longer carry out.

 

State and Local Air Agencies – In Their Own Words:

“A cut in our federal grant of 30 percent would impose serious and adverse impacts on our individual state and collective ability to effectively run our air pollution control programs. There would very likely be many more people in our state getting sick and possibly dying as a result of these budget cuts.”

“[We are] insufficiently staffed to assure citizens are protected from asbestos. Asbestos is a carcinogen and was widely used in buildings for fireproofing, thermal and acoustical insulation, condensation control, and decoration. Our current staffing of 5 FTEs is only able to inspect 8% of the structures. This inability to verify compliance places the public directly at risk.”

“If you cut back on enforcement programs, such as inspections and compliance assistance, your regulated community tends to be out of compliance more of the time. This can result in increased emissions which affect the health of your citizens.”

“We have been forced to cut programs—sunset Stage 2 vapor recovery, returned delegation of asbestos NESHAP, air toxics, downsized monitoring to federal minimum allowed. Permits are slower, enforcement is down.”

“If there are further reductions in federal funding, there will be a corresponding reduction in services. It is unreasonable to ask States to further supplement their programs with additional State funds.”

“Because we are at the federal minimum for our air monitoring network and unable to fully meet our planning, inventory, and asbestos compliance requirements, a reduction of 31% would be devastating. We clearly would be unable to meet the federally- mandated responsibilities.”

“Our current level of service will be significantly reduced… The level of public health protection currently provided will definitely be reduced to reflect the impacts of the budget cuts.”

“Without question, a cut of 31 percent to the already-reduced funding levels would devastate our program. Under the requested funding reductions, we would be forced to cut our staffing by at least one-third… a reduction in staffing along the proposed lines would significantly delay the issuance of permits for new construction.”

“The state and local funding cuts combined with the proposed 30% federal funding cut will result in about a 72% reduction in [our] overall budget. This will significantly impact [our] ability to be here at all, and if we are still here, it will be at a 60-70% decreased staffing level leaving us with 7-10 FTEs to manage a 6 county area. At this level, we will not be able to meet the core requirements of the state contract and federal grants.

“Enforcement would be reduced to only the most serious cases – Violations may not be detected early because there will be less report reviews, inspections, stack tests, and complaint response.”

“A reduction of federal funds may result in an air quality monitoring network that does not meet federal requirements.”

“These cuts ignore reality; because we still have to meet all the existing federal requirements, even the ones the new administration doesn’t like. When we fail, due to a lack of resources, it will be local taxpayers who bear the burden of paying environmental groups’ legal fees.”

“We’d no longer do any air toxics work.”

 

Who is NACAA?

The National Association of Clean Air Agencies (NACAA) is a national, non- partisan, non-profit association of state and local air pollution control agencies in 45 states, the District of Columbia and four territories. The air quality professionals in its member agencies have vast experience dedicated to improving air quality in the United States.

State and local air pollution control agencies (e.g., NACAA members) have primary responsibility for implementing our nation’s air pollution control laws and regulations. The associations serve to encourage the exchange of information and experience among air pollution control officials; enhance communication and cooperation among federal, state and local regulatory agencies; and facilitate air pollution control activities that will result in clean, healthful air across the country.

NACAA’s headquarters office is located in Washington, DC. For further information, including contact information for state and local air quality agencies, visit NACAA’s web site at http://www.4cleanair.org or call (202) 624-7864.

1 http://www.4cleanair.org/sites/default/files/Documents/EPA_FY18_Budget.pdf
2 On March 21, 2017, information regarding the Administration’s proposed FY 2018 budget for the U.S. Environmental Protection Agency (EPA) was released. While it did not include all the details of the proposal, it indicated that state and local grants under Sections 103 and 105 of the Clean Air Act would be reduced by 31 percent. The memorandum is available here: http://www.4cleanair.org/sites/default/files/Documents/EP A_Memo_FY_2018_Budget_March_21_2017.p df

A copy of the complete NACAA report can be found at: http://www.4cleanair.org/sites/default/files/Documents/NACAAFundingReport-FY2018.pdf

Posted in Air Pollution, budget, Environment, EPA, Trump | Leave a comment

“Drain the Swamp?” — Please

President Trump signed an executive order in late January — echoing language first endorsed by Mr. Obama — ostensibly prohibiting lobbyists and lawyers hired as political appointees from working for two years on “particular” government matters that involved their former clients. In the case of former lobbyists, they could not work on the same regulatory issues they had been involved in.  He very publicly touted this as a headline initiative to “drain the swamp.”

Mr. Trump reserved the right to issue waivers to this ban.  Mr. Obama made any such waivers public. The exceptions were typically granted for people with special skills, or when the overlap between the new federal work and a prior job was minor.  Mr. Trump offers no such transparency.

Ethics watchdogs, as well as Democrats in Congress, have expressed concern at the number of former lobbyists taking high-ranking political jobs in the Trump administration. In many cases, they appear to be working on the exact topics they had previously handled on behalf of private-sector clients — including oil and gas companies and Wall Street banks — as recently as January.

The Office of Government Ethics, through its head Walter Shaub, issued requests to each federal agency asking each to identify the specifics of each waiver granted.  The White House, in a letter from OMB chief Mick Mulvaney, has stepped in to block the disclosure of this information.  A senior OGE executive said she had never heard of a move by any previous White House to block a request like Mr. Shaub’s.  She recalled how the Bush White House had intervened with a federal agency during her tenure to get information that she needed.

Mr. Shaub returned a scalding, 10-page response to the White House late Monday, unlike just about any correspondence in the history of the office.  “O.G.E. declines your request to suspend its ethics inquiry and reiterates its expectation that agencies will fully comply with its directive,” Mr. Shaub wrote in a letter he also sent to every federal agency ethics officer and certain members of Congress. “Public confidence in the integrity of government decision making demands no less.”

Here is a link to Mr. Shaub’s letter.  https://www.nytimes.com/interactive/2017/05/22/us/politics/document-OMB-Director-Mulvaney-Letter-to-Office-of.html

Posted in Ethics, Executive Order, Trump | 1 Comment

Trump’s Budget from Hell

This is a budget from hell.  Increases for defense and the wall that will ultimately raise the total expenditures, despite the ill-advised cuts.  So, Mr. Zeldin, are you going to say something now, or tow the party line?

Trump wants to cut billions from the departments that regulate drugs, stop infections, and research cancer
Business Insider, By Rebecca Robbins, May 22, 2017

U.S. President Donald Trump listens to a question during a joint news conference with Colombia’s President Juan Manuel Santos (not pictured) at the White House in Washington, U.S. Kevin Lamarque/Reuters The Trump administration’s proposed budget for 2018 would make sweeping cuts to Medicaid as well as to the agencies and programs that propel the nation’s engines of science and biomedical research. The administration released a “skinny budget” in March that included sharp proposed cuts to Read the full story

Posted in AHCA, budget, Congress, economy, GOP, Health Care, immigration/deportation, jobs, Medicaid, science, Trump, trumpcare, Uncategorized, Zeldin | Tagged , , , , | Leave a comment

Cruelty Wrapped in a Lie

Published by The Guardian

Trump’s budget: major slashes to social programs – but $1.6bn for the wall

Millions of people stand to lose Medicaid access, alongside cuts to welfare and food stamps, under a proposed budget that still has numerous hurdles to jump

The president’s proposed budget, to be released Tuesday, is a wish list to fund the Trump agenda.
The president’s proposed budget, to be released Tuesday, is a wish list to fund the Trump agenda. Photograph: Pool/Getty Images

Donald Trump will embrace hardline right-wing economics on Tuesday with a budget that proposes swingeing cuts to social safety net programmes while allocating $1.6bn to a border wall.

Millions of people would lose access to Medicaid, the government insurance programme for the poorest and many disabled Americans. Food stamps for people on low incomes would be cut over the next 10 years under the White House plan and the families of undocumented workers would be frozen out of key tax breaks.

“We are no longer going to measure compassion by the number of programmes or the number of people on those programmes,” budget director Mick Mulvaney told reporters. “We’re going to measure compassion and success by the number of people we help get off of those programmes to get back in charge of their own lives. We’re not going to measure our success by how much money we spend but by how many people we actually help.”

The Trump blueprint is unlikely to become law because it will face opposition from both moderate Republicans and Democrats worried about its social impact and from fiscal conservatives who fear it will increase the deficit.

Chuck Schumer, Democratic minority leader in the Senate, condemned the proposed cuts to Medicaid. “This would pull the rug out from so many Americans who need help: those suffering from opioid and heroin addiction, people in nursing homes and their families who care for them, the elderly, the disabled, and children,” he said on the Senate floor.
Medicaid helps not only the poor but increasingly the middle class, as well as 1.75m veterans, Schumer added. “Here’s what candidate Trump said when he campaigned: ‘I’m not going to cut social security like every other Republican and I’m not going to cut Medicare or Medicaid.’ He promised he would help take care of those suffering from opioid addiction. If it cuts Medicaid, he’s breaking that promise right in half.

Economic experts were also quick to dismiss Mulvaney’s claims that Trump’s tax plans and budget would boost economic growth to 3%, balancing the federal budget within a decade.

Although Trump is an unconventional president, the budget shares much with the conservative orthodoxy of Ronald Reagan and Margaret Thatcher. It is entitled “A New Foundation for American Greatness” and Mulvaney said if he had a subtitle it would be, “The taxpayer first budget”.

Budget director Mick Mulvaney.
Budget director Mick Mulvaney. ‘We need everybody to pull in the same direction.’ Photograph: Jim Lo Scalzo/EPA

Cuts to Medicaid over the next decade exceed even the more than the $800bn reductions contained in a health bill passed by the House of Representativesearlier this month.

The president also aims to slash welfare by $274bn over a decade, including $193bn on food stamps, driving millions of people off the programme. This would be several times bigger than cuts attempted by House Republicans in the past. The number of people claiming food stamps spiked to 47m people at the height of the 2007-08 recession and had not come down as expected, still totalling 44m people, Mulvaney said, despite near full employment in the US.

Some $72bn over 10 years would come from social security’s disability insurance programme, including $50bn in savings which would be achieved by helping recipients get off the programme and find a job.

He added: “There’s a dignity to work and there’s a necessity to work to help the country and succeed and we need everybody to pull in the same direction.”

The Child Tax Credit and the Earned Income Credit would be limited to those who are authorised to work in the US. They would be required to show proof of a social security number – a move that would have a negative impact on children who are US citizens but whose parents are undocumented.

“I could ask you for your money I think, in good faith and good conscience, and say, ‘Look, I need to take some of your money and give it to this family, who deserves the Child Tax Credit, but I can’t do it to give the Earned Income Tax Credit, which is designed to help folks who work, to give it somebody who’s in the country and working illegally. It’s just not fair. It’s not right when you look at it through the perspective of the people paying the taxes.”

Trump would also reduce federal employee pensions and farm subsidies while keeping campaign pledges to leave core Medicare and social security benefits for the elderly untouched.

He also promised a “groundbreaking” proposal to provide six weeks of paid family leave to new mothers and fathers, including adoptive parents, championed by Trump’s daughter, Ivanka, and costing $25bn over 10 years.

Mulvaney confirmed that the budget plan defunds Planned Parenthood, on the premise that the American Health Care Act will become law, and “winds down” the support for the Corporation for Public Broadcasting, which feeds the money to outlets such as the Public Broadcasting Service and National Public Radio.

The blueprint also shaves 31.4% off funding for the Environmental Protection Agency and 29.1% off that for the state department and other international programmes.

The cuts to domestic spending would be redirected to the US military, law enforcement and supporting veterans. It allocates $2.6bn to border security, including $1.6bn for the “bricks and mortar construction” of a wall on the Mexican border, with the remaining $1m allotted to “technology and infrastructure”.

But the plan – a wish list to fund the Trump agenda – faces numerous hurdles. The healthcare bill is likely to undergo significant changes in the Senate while a rewrite of the tax code only has a broad outline so far. It also makes assumptions about growth.

People protest the Trump administration’s bid to overturn the Affordable Care Act.
People protest the Trump administration’s bid to overturn the Affordable Care Act. Photograph: David Mcnew/AFP/Getty Images

Mulvaney said Trump’s package of spending cuts and tax breaks would boost the US’s economy’s growth rate to 3% over the next decade, a considerable increase from the 1.9% forecast under current policy by the Congressional Budget Office.

The director, due to testify to the House and Senate this week, said: “I think what Trumponomics is – and what this budget is a part of – is an effort to get to sustained 3% economic growth in this country again. I think it’s sad that the previous administration was willing to admit that we couldn’t get better than 1.9% growth over the next 10 years … That assumes a pessimism about America, about the economy, about its people, about its culture that we’re simply refusing to accept. We believe that we can get to 3% growth.”

But economists were skeptical of the claim. Gus Faucher, PNC Financial Services’ chief economist said US productivity growth had averaged 1.75% over the last 45 years and that the period between the late 1990s and early 2000s when growth topped 3% was the exception. “It’s asking a lot to expect the exception not the rule,” said Faucher.

Marc Goldwein, head of policy at non-partisan thinktank Committee for a Responsible Federal Budget said the budget’s numbers did not add up. He said Mulvaney’s promise of returning to the 3% growth rates were “unrealistic at best”.

“We are not bringing the ‘90s back,” he said. “Three percent was normal then because the baby boomers were in their prime and we had a tech boom.” Now baby boomers are aging out of the workforce and the tech boom’s impact has fizzled, Trump’s budget would likely add “decimal points not percentage points” to US growth, he said.

“This is like pretending you have won the lottery when all you have is a handful of scratch cards,” he said.

Posted in budget, Medicaid, Tax Reform, Trump | Leave a comment

Australians have “better health care than we do”!

Letter to the Editor of the East Hampton Star. May 18, 2017, by Peggy Backman
In a recent op-ed in an online newsletter, congressman Zeldin tries to answer what he calls lies about the work-in-progress Trumpcare. However, he fails to mention that many of the problems he sees in the current Affordable Care Act (or Obmamacare) are the result of compromises the Democrats had to make with the Republicans and their lobbyists. Now they talk about these imperfections as if they in the Republican-heavy Congress had nothing to do with their enactment.
To rebut criticisms of the Republican’s sorry offer of healthcare reform, we have Zeldin’s misleading simplistic answers in his op-ed piece: For example, Mr. Zeldin says not to worry and mentions pre-existing conditions being protected in New York State. ‘Tis true and lucky us. But what about our fellow countrymen and women, who are not so fortunate as to live in a progressive blue state like New York, where state laws for many years have given state residents protection for pre-existing conditions?
The vast majority of Americans are not protected by progressive state laws, such as those in New York. But under Obamacare they now have these protections for pre-existing conditions—thanks Obama et al. However, the complicated scheme the Republicans are proposing, diminishes such protections. Why take away these protections (just because they came into being under a Democratic administration)? That is small-minded and too stressful for the people affected. We need to think about all of our countrymen and women: what helps all citizens, helps us all. Leave Obamacare alone. Strengthen it, but don’t repeal it.
And how does Zeldin think we will pay for his insurance plan with all the tax-breaks-for-the-rich that are in the so-called new bill? Giving more money to the zillionaires only makes their bank accounts swell; that game has been tried before and failed to help the rest of us. I say let’s chuck this Republican Trumpcare Act-Of-Despair and provide the American people with a single payer insurance, i.e., Medicare-for-all. Even Mr. Trump admitted recently to Australia’s Prime Minister that, with their universal healthcare system, Australians have “better health care than we do”. Mr. Trump actually said that! And I must mention that the scam that is now being offered to the American public does not measure up at all to what other countries have. Is that our American exceptionalism? God help us.
Posted in AHCA, Trump, trumpcare, Uncategorized, Zeldin | Tagged , , , | 1 Comment

We are Angry

By Amy Turner.

Shame on Lee Zeldin!

We’re angry that Rep. Lee Zeldin voted for a healthcare bill that is condemned by local and national health practitioners and will hurt our families. Rep. Zeldin has continued to lie about the contents of the bill and its negative impact on us, his constituents, dismissing our objections and refusing to listen to the medical community.

American Medical Association

The bill passed by the House today will result in millions of Americans losing access to quality, affordable health insurance, and those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question.

American Academy of Family Physicians

The American Academy of Family Physicians is deeply disappointed with the U.S. House of Representatives passage of the American Health Care Act. This legislation will harm millions of their constituents. It will destabilize our health care system, cause 24 million Americans to lose their coverage, and allow for discrimination against patients based on their gender, age, and health status.

American Osteopathic Association

Our organizations, which represent over 560,000 physicians and medical students, are deeply disappointed that the U.S. House of Representatives today passed the American Health Care Act, an inherently flawed bill that would do great harm to our patients.

American College of Physicians

This vote makes coverage unaffordable for people with pre-existing conditions, allows insurers to opt-out of covering essential benefits like cancer screening, mental health, and maternity care, and cuts and caps the federal contribution to Medicaid while sunsetting Medicaid expansion. As a result, an estimated 24 million Americans will lose their coverage, and many more will be at risk of paying higher premiums and deductibles.

American Academy of Pediatrics

The rate of children’s health coverage in our country is at a historic high of 95 percent; the AHCA would not only halt this progress, it would tear it down.

American Congress of Obstetricians and Gynecologists

The American Congress of Obstetricians and Gynecologists, the nation’s largest professional organization for women’s health care physicians, denounces U.S. House passage of the American Health Care Act. This legislation turns back the clock on women’s health, and will threaten the health and well-being of America’s women.

American Psychological Association

The American Psychological Association and its affiliated APA Practice Organization have called on Congress to reject the amended American Health Care Act, noting that it would allow states to waive essential health benefits, such as mental and behavioral health care and substance use treatment, and charge unfair premiums for individuals with pre-existing conditions.

AARP

The bill will put an Age Tax on us as we age, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care. In addition, the bill now puts at risk the 25 million older adults with pre-existing conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them.

American Diabetes Association

The most alarming last minute changes to the bill will allow states to waive the requirement for essential health benefits and health status rating. Weakening these rules will give insurers the ability to charge people with pre-existing conditions, such as diabetes, higher prices. It will also allow insurers to deny people with diabetes coverage for the care and services they need to treat their disease.

American Lung Association

The American Health Care Act will harm patients with lung disease and lung cancer. The American Lung Association calls on the Senate to reject the American Health Care Act. Quality and affordable healthcare with key patient protections is necessary for the health and safety of the more than 32 million Americans living with lung disease.

American Heart Association

This bill…seriously erodes ACA protections, including for patients suffering from cardiovascular disease….Without a score from the Congressional Budget Office (CBO), it is unclear how many people will lose their health insurance coverage under this bill or be forced to pay more for the same or less adequate care. However, if the CBO analysis of the last proposal is any indication, coverage for millions of Americans will be in jeopardy.

Arthritis Foundation

AHCA does not provide adequate protection for people with pre-existing conditions and will result in loss of coverage for millions of Americans. It allows insurers to charge expensive and prohibitive premiums, and does not require insurers to cover some services, like prescription drugs. Ultimately, AHCA will require patients to pay more while getting less.

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Shame on Zeldin Rally

About 1 week ago, CD-1 citizens held a rally in front of Rep. Zeldin’s Patchogue offices.  “Shame on Zeldin” was the battle cry referring to LZ’s vote for Trumpcare (AHCA).  By my estimate 150 people attended. There were 4 speakers: 2 physicians, one hospital administrator and one nurse. In striking contrast to Zeldin, these were people with hands on and life long experience in health care delivery.  A transcript of their speeches follows below.

D Posnett MD:

AHCA can be summed up as follows:

  1. Preexisting Conditions. We have them and the AHCA will make it possible for insurance companies to refuse to cover people with preexisting conditions.
  2. AHCA weakens Medicare by reducing it’s solvency to 2025 from 2028
  3. The Affordable Care Act has the Medicare Part D “donut hole” on schedule to close in 2020. Repealing the Affordable Care Act could force Medicare participants to cover much of the prescription medication needs out of their own pockets.
  4. The AHCA is bad for women in ways too numerous to name. The Kaiser Family Foundation does an excellent job of spelling out the problem in Ten Ways That the House American Health Care Act Could Affect Women:

Mike Anthony (Hospital Administrator, North Brooklyn Health Network):

My knowledge was built on years of reading federal registers and overseeing the filing of financial documents. I wouldn’t presume to tell Lee Zeldin that he lied about his wartime JAG experience.
 
During the second part of my speech, I condensed 5 or 6 LI healthcare experts into a concern raised by a Stony Brook Health Economist, Professor Debra Dwyer. (GYNHA is the Greater New York hospital Association)
  • What About the effects of AHCA on Long Island’s Safety Net Hospitals?
  • Per America’s Essential Hospitals (a group that represents safety net hospitals), “Our hospitals could not sustain such reductions without scaling back services or eliminating jobs.”
  • Ken Raske from GYNHA: 27 hospitals in NYS are already designated “institutions under fiscal stress.”
  • By one estimate 250,000 might lose coverage, another estimate says 334,000 on LI
  • The ACA has resulted in 25,000 more health care workers on LI. What happens to those jobs after ACA is repealed?
  • Per Stony Brook Univ. Health economist Debra Dwyer:
    “We have some hospitals that are going to be hit pretty hard…Stony Brook University Hospital and Brookhaven Memorial Medical Center in particular because they serve Suffolk County’s more vulnerable population and made investments in response to incentives from the Affordable Care Act.”
  • Per Dr. Victor Politi, president and chief executive officer of the Nassau Health Care Corporation says that, “repeal of Obamacare could ultimately result in his hospital receiving less federal reimbursement for patient care – and they already operate annually on a deficit.”
  • Per Janine Logan, senior director of communications and population health  at the Nassau-Suffolk Hospital Council: “This is bad news for New York.
  • Congressman Zeldin is intellectually dishonest. He constantly attacks Obamacare’s high premiums, deductibles and co-pays, but Obamacare had three features that enhanced insurance market stability: (1) Risk Adjustment (redistribute funds to plans with higher risk employees); (2) Reinsurance (Provider payment to plans that enroll higher-cost individuals); (3) Risk Corridors (limits losses and gains beyond certain corridors.)
  • ACA architects understood that risk exposure would be difficult to measure. Even with mandated insurance and community rating, experts were uncertain about the possibility of negative impacts brought by adverse selection (sicker patients signing up faster than healthy persons). Thus, the 3-part risk smoothing. These features were expected to last a few years until markets adjusted to the new reality.

Jeanne Spier RN

As a nurse , mom, wife, daughter, consumer and family health care provider I have had decades to participate in and observe American Health Insurance. It’s a hot mess. While The Obamacare/ Affordable Care Act (and even Bush’s Medicare D ) were a very good start, the ACA was over-diluted in the legislative process, followed by what I can only describe as partisan hatred.

I am adamant we should be pushing our legislative representatives to a Single Payer/ Universal Health care plan. NOW.  It is a perfect time to do so. With every American enrolled, just like Medicare, you needn’t sign up, therefore there are no tax penalties, no lapse of coverage penalties, no worry about a pre-existing condition. Premiums, deductables, and copays are REPLACED with a “Medicare” tax deduction. No one makes money off your health. It goes with you, if you move out of state, change jobs, or lose your job, you still have insurance.

It’s cost effective to manage and administer, like our Social Security System. Pharmaceuticals are far cheaper when bartered through a national purchaser. Ask the VA. Ask those that buy meds from Canada on the internet. Ask every other industrialized country.

I hope to debunk some of the hysteria regarding the recalcitrant insurance companies. What they are doing now is no different than what they’ve been doing for decades.

  • WHAT IS Insurance?- A thing providing protection against a POSSIBLE eventuality. (Derived from Middle Eng and French-) A SENSE OF ASSURANCE: A GUARANTEE
  • Not one of us knows if we or our loved ones will contract a terrible disease, have a stroke, get cancer, go blind, get addicted, develop mental illness, need emergency surgery.  So insurance is our “assurance” that we can remain solvent and cared for. The current legislation is certainly a step backwards. As President Trump said, “It’s complicated.”
  • We need to realize that health insurance and pharmaceuticals are for profit industries. Shareholders reap a reward from profits on your cancer, your diabetes, your bad heart, your addiction treatment, your end of life care.
  • Before the ACA most of the lay public never realized how much of the money-iceberg was lying below the water line, (unless we were unlucky enough to need it to pay medical costs. You would be shocked. Before the ACA insurers could and did DROP YOU like a hot potato if you exceeded their “lifetime maximums.” Then followed Medicaid and personal bankruptcy.
  • In the early 1990’s,  during an emergency hospitalization, I got stuck paying a $5000 out of pocket bill to a surgeon’ group because they were “out of network”.  We have learned how limited our options are.
  • In the late 1990’s, Oxford’s “managed care” Medicare HMO, dropped their senior citizen’s coverage like hot potatoes. I had never seen so many older folks in a true panic. SO THIS ISN’T NEW.  And Oxford, Cigna, and Aetna are still here, aren’t they? So the only ones hurt were the consumers.
  • During the 10 years I worked for NYHQueens 2003-2013, the cost of insurance premiums SKYROCKETED- starting YEARS BEFORE OBAMACARE.  What do insurance companies think of you?  From a very reliable source:  A United Health Care executive was overheard telling a fellow employee, “Patients are not our customers. Shareholders are our customers.”
  • Personal bankruptcies are often initiated by overwhelming Health Care Costs, in some studies up to 50%.
  • Planned Parenthood: 88%-97% of their services do not include abortion. They are the only source of health care for millions of women.
  • Hundreds if not thousands of Zeldin’s constituents have been forced into MediCAID, the insurance for poor people. (Not MediCARE which works very well.)

Commercial insurance, commercial addiction facilities and commercial end-of-life facilities are troubling.

Repeal Obamacare’s individual and employer mandates. Fine. Replace it with a single payer program!

Viral Patek MD

Recounted stories of several patients that had been saved by ACA or suffered because of lack of health care insurance.

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