Categories
Government Health Insurance Healthcare

Dear Buddy Carter: Health Care Premium subsidies help people

Buddy Carter, why do you persist in sending lies in your Congressional newsletter? Isn’t the purpose of these newsletters to inform rather than misinform?

Your recent newsletter takes aim at Democrats during the shutdown. You claim that Democrats are keeping the government shutdown in order to provide subsidies for healthcare for undocumented migrants.

You wrote:

Democrats, including Schumer and Jon Ossoff, have now voted for the fourth time to shut down the government, demanding $1.5 trillion in new partisan spending, including nearly $200 billion in taxpayer-funded health care for illegal immigrants.

That partisan spending you’re talking about, is subsidies necessary to keep Affordable Care Act insurance policies affordable for primarily middle class US Citizens and lawfully present migrants. These subsidies were passed into law during the COVID epidemic but now they’re terminating at the end of 2025. This will drive up the cost of health insurance policies for US citizens and lawfully present migrants by an average of 114%. That’s well over double, which most US Citizens and lawfully present migrants can’t afford.

I keep repeating US citizens and lawfully present migrants, because the Affordable Care Act provides health insurance for US Citizens and lawfully present immigrants, only, as this fact check carefully notes.

Now, there is a law, called the Emergency Medical Treatment and Labor Act (EMTLA), signed into law by Ronald Reagan decades ago that does allocate a small amount of Medicaid funds to reimburse hospitals for treating anyone and everyone in an emergency life-saving scenario regardless of the person’s status. So, if an undocumented migrant shows up at the hospital with his hand cut off because he’s operating machinery no US citizen wants to operate, the ER has to save his life.

Now, I realize that you may prefer that this person die. I hope, though, as a country we’ve not fallen so far as to wish death on people in this country solely because of the promise of an American dream.

Regardless of the moral ambiguity of letting people die in the street, what the Democrats are pushing for has nothing to do with the EMTLA and everything to do with helping middle class folk, like your voters, afford the premiums for healthcare.

Of course, you think of me as a screaming radical leftist and therefore beneath your interest, even though you are my elected representative, which means you’re supposed to represent people like me. Still, because of your partisan approach to leading,  you may discount what I say. Well, that’s fine. So let’s look to someone else who you might find worth your time.

Let’s look to the insurance commissioner for the state of Georgia, who has joined with other insurance commissioner of every single state, in sending to Congress several letters, including the latest, pleading with Congressional members like yourself, to please continue the ACA subsidies.

For more than a year, NAIC has voiced its strong support for continuation of the enhanced premium tax credits for Marketplace coverage. The enhanced credits expire at the end of this year, but health insurance premiums for 2026 must be finalized much sooner. Health insurers have already filed their initial rates for 2026, and state regulators are poised to give them final approval in the coming weeks. We must complete this action soon in order to make plans available for the annual Open Enrollment Period that begins on November 1. Without an extension of the enhanced credits in September, insurers and marketplaces will begin to notify over 20 million consumers in all 50 states of major premium increases in
a matter of weeks.

Contrary to what Speaker of the House Johnson implies by continuing to cancel House sessions, there is an urgency to renew these subscriptions now, before it’s too late. As North Dakota’s—note, North Dakota…not a screaming leftist liberal state—insurance commissioner notes:

Democratic lawmakers say extending enhanced premium tax credits is urgent, with open enrollment weeks away. Republican lawmakers say there’s time to negotiate over a policy later, since the subsidies expire in December.

 

Who’s right?

 

“The window is rapidly closing,” says Jon Godfread, North Dakota’s insurance commissioner. He says the enhanced subsidies need to be extended before open enrollment starts Nov. 1. “Let’s do this now.”

 

If lawmakers miss that deadline, he says, “it’s going to be really, really challenging to go back [to consumers] and say, ‘OK, now we fixed it, please come back and shop at this market that you were priced out of.’ I just don’t believe consumers are going to do that.”

Again, this is about renewing the healthcare subsidies that impact on the people you represent: voters in the state of Georgia.  It is not, as you stated in your newsletter, about healthcare for undocumented immigrants. This is a lie, and you know this is a lie. It’s not as egregious as the lie Ryan Zinke told, with his claim that Democrats are somehow trying to kill the $50 billion dollar rural healthcare fund recently passed, but it’s still a lie.

And the sad thing for you is, if you don’t do something now, if Johnson doesn’t stop shutting down the House and actually work with the Democrats, people will know November 1 that you all lied.

Categories
Healthcare Legal, Laws, and Regs

RFK Jr COVID vaccination mess is only the beginning…your food is next

The country is trying to deal with the CDC breakdown this last week, with limited COVID vaccination access and important CDC personnel quitting because they refuse to lie or to issue recommendations they know are bogus and harmful.

This follows the tragic shooting at the CDC by a man who bought into the lies about the COVID vaccination. A police officer was killed in the shooting…an event the President still has not acknowledged.

Now, thanks to Secretary Kennedy (RFK Jr) many people who could get the new COVID  vaccinations can’t, because they’re only allowing the vaccinations for those over 65 or those who are at higher risk. Kids under 5 can get a vaccination if their pediatrician approves. In my own state of Georgia, which has a requirement that vaccines be recommended by the Advisory Committee on Immunizations (ACIP) and the CDC, you can’t get  the new COVID vaccination without a prescription at any pharmacy regardless of your age and health.

Normally ACIP would have met by now, but RFK Jr has fired all previous members, and now Senator Cassidy doesn’t want the meeting to happen at all because he’s concerned about what happens to vaccines once a group of quacks get their hands on them. Perhaps he should have considered this before voting to confirm RFK Jr to head the HHS.

The situation with COVID vaccinations, and vaccinations in general, is chaotic. But wait…there’s more.

The Dietary Guidelines for Americans

Every five years, the USDA and the HHS release a document, the Dietary Guidelines for Americans. The document is updated and revised from previous releases based on recommendations from a federal advisory committee made up of nutritional and medical experts.

The committee’s recommendations for the new guidelines, due to be published this year, were delivered to RFK Jr and then just…disappeared.

The Guideline recommendations are in limbo, and one member of the recommending committee, Christopher Gardner, believes it’s because the recommendations didn’t tackle ultra-processed foods. But there’s reasons for this and one reason is that not all ultra-processed foods have an affordable replacement. Telling schools they have to use tomato sauce that contains no HFCS and costs twice as much, as compared to tomato sauce that has a small amount of HFCS is a tough sell with schools with tight budgets. Especially when those budgets have been cut by the current administration.

And try telling people on a fixed income who live in neighborhoods that are food deserts that they should be eating only whole grains, fresh fruits and vegetables, and lean meats or fish. A goal for a lot of people is they just don’t want to go to bed hungry—a situation neither of the wealthy-born RFK Jr and Trump has ever had to face.

Another reason the guidelines don’t focus on ultra-processed foods is not all ultra-processed foods are bad. It really depends on what you mean by ‘ultra-processed’.

There is a classification of foods based on their processing: The NOVA Food Classification System. It lists foods as minimally processed (Group 1), processed culinary (Group 2), processed (Group 3), and ultra-processed (Group 4). The latter is differentiated by the others by combining multiple ingredients, including those from Group 2, and incorporating additives to enhance flavor or shelf life. It also typically uses enhanced food production techniques.

Think corn, corn oil, canned corn, and corn chips. It’s the chips that are the bad guys.

But, wait a sec…if corn oil is ‘OK’ what about corn syrup? Or the baddy of all, high fructose corn syrup (HFCS)?

Then this is where things start to get a bit trickier. It’s not just the ingredients, but how those ingredients are manufactured that can make the difference between  Group 2 processed (corn syrup) and Group 4 ultra-processed (HFCS)). The latter is considered ultra-processed because some of the glucose from corn starch used to create corn syrup is enzymatically converted to fructose.

So, it’s not just the ingredients but also the processing that’s being targeted.

Well, not quite.

The Kessler Petition

Early in August, a former FDA chief, David Kessler, petitioned the FDA to revote GRAS, or “generally recognized as safe” designation from certain refined, processed food products to force the makers to either successfully petition to continue using the product or remove it, entirely. Specifically, he targeted refined carbohydrates.

One of the ingredients Kessler wants to dump is corn syrup, yet corn syrup is considered a Group 2 processed food in the NOVA classification, not Group 4 ultra-processed. It’s corn from the minimally processed food group (Group 1) that is further refined using milling. It’s definitely something you can buy, and use, from the grocery store.

And this is where things get confusing, because Kessler is fine with people buying corn syrup in the store. So, on the one hand, I can use corn syrup when making bread at home; on the other, I can’t buy commercially made bread that uses corn syrup as an ingredient.

Kessler also targeted refined flours and starches using extrusion technology. The problem with removing GRAS on this food technique is it’s also used to incorporate vitamins and minerals into flour and starch products, such as vitamin enriched breads. One use of extrusion is being explored as a way of making rice more nutritional, since rice is such a main staple throughout the world. It’s also the primary technology behind plant-based milks, which have become a popular nutritional replacement for dairy milk. In fact, extrusion can make dairy milk healthier.

This demonstrates that the problem with going after ‘ultra-processed’ foods is we don’t really understand what this term encompasses, and by its very nature, it’s too vague to be useful. Because of this vagueness, we might get rid of ‘bad’ food, but we also could eliminate good food, too.

Though it’s been crippled by budget cuts and firings, the National Institutes of Health still maintains a medical library that carries a paper by Allen Levine and Job Ubbink. Published in the Obesity Science and Practice journal it touches on the complicated problems with defining ultra-processed foods based solely on the processes used.

Group 4 products are not necessarily unhealthy. Infant formula, an often‐quoted example… can sustain newborn babies in the first half year of their lives, when breast milk is unavailable and is considered safe and nutritious. The verdict on the health impact of meat analogs based on plant proteins is still out, as many are formulated with high salt and saturated fat contents but there is no reason they cannot be formulated with acceptable amounts of salt and saturated fats next to a high protein and fiber content and thus fit in a healthy diet in addition to being animal friendly and more sustainable than meat.

This confusion about ultra-processed and what it means and when is it good versus bad is why the Dietary Guidelines for Americans don’t incorporate restrictions against ultra-processing; preferring to focus more on clear food choices organizations and people can easily understand.

Kessler’s recommendations are a mashup of NOVA categorized processed and ultra-processed foods, some based on their use, others based on how they’re created, and even others based on whether the use is personal or commercial. Except that he’s incorporating a procedure (a petition to revoke GRAS designation) that would result in a catastrophic and sudden undermining of our food system with seeming little concern for the short or even long-term consequences.

And all indicators show he has a receptive audience in RFK Jr.

Ominous nutritional clouds on the horizon

I mention the Kessler petition because I believe that RFK Jr is going to use this petition to give credibility to his own ideological biases to redefine The Dietary Guidelines for Americans. And this will not be a good thing.

RFK Jr ignored the advisory committee’s recommendations and has claimed the new Guidelines will only be a few pages, four at most. The problem is, the Guidelines themselves are not intended for a general audience, they’re intended to provide the scientific basis for all of the recommendations. In other words: they’re not used by parents to determine what milk to buy for their kids, but for schools as justification for the type of milk they serve. It is the summaries contained within the guidelines that are released to the public. To remove all of this in order to just provide a simplified push for a few foods removes all transparency to any decision made in the guidelines.

Why is this harmful? After all, we’ve had years of ignoring the Guidelines and can continue doing so.

It’s harmful in how the Guidelines can impact on what foods are accessible. For instance, the Guidelines can be used to define what food can be purchased with SNAP funds, or that schools have to serve for meals. Eliminating ‘ultra-processed’ foods, especially when we don’t have a clear understanding of what this term even means will eliminate a whole lot of affordable food options for most folk. That school tomato sauce purchase is a good example.

And what about ‘good’ ultra-processed foods, like some forms of yogurts, enriched flour, or plant-based meats and milks? These can be nutritionally superior to minimally processed alternatives but the processes used for them would become taboo.

I suspect even something as essential as the peanut-based paste used to feed kids in starving countries would fail any ultra-processed test RFK Jr would provide.  And the sensible recommendations for listing beans, peas, and legumes as a protein source will die a quick death in favor of raw milk and beef fat.

The impact on the Dietary Guidelines could be bad, but worse would be for RFK Jr to actually act on Kelling’s petition. Combined with the Trump immigration effort’s impact on the food industry and the Congressional budget cuts for SNAP, we could be heading into times when price of eggs is the least of our concerns.

Will we survive?

Will we survive RFK Jr’s interventions on vaccinations and food? The short answer is yes. The longer answer is yes, but it won’t be easy and will be a battle every day until he’s gone. And the sadder answer is yes, but not all of us.

We can be reasonably sure that any food producer impacted by an RFK Jr version of dietary guideline or GRAS reversal would tie any such decision in court for years. It’s one thing to ask ice cream companies to remove artificial dyes from ice cream; it’s another to completely toss plant-based milks, baby formula, corn syrup, or foods with shelf stabilizers.

And it’s impossible to turn an entire populace back into primitive hunter/gatherers.

And therein is our tiny path to salvation: RFK Jr’s “my way or the highway” form of decision making will undermine whatever he attempts. He’s a fruitcake with fruitcake ideas and absolutely no guardrails to stop him. Trump isn’t stopping him, Congressional Republicans aren’t stopping him, and the talking heads are just chanting “Go Bobby Go!”

But it’s the obvious badness about his arbitrary decisions we can use, both as a target to fight and a rallying cry.

In the last few days, blue states like New Mexico, Illinois,  and others are looking at what they can do to ensure citizens have access to COVID vaccinations:

Pritzker’s health department in Illinois is currently exploring the possibility of purchasing Covid-19 vaccines in bulk straight from manufacturers in response to the mess in Washington, a senior Illinois health official confirms to me. Meanwhile, a coalition of mostly-blue states led by Massachusetts Governor Maura Healey is planning to coordinate on the purchase and distribution of pediatric vaccines, should the federal government restrict access to them, according to a source familiar with ongoing discussions. This will likely include big states like New York and Pennsylvania.

Unfortunately, though, the fact that only blue states are acting leaves significant numbers of people living in red states that will offered something like ivermectin, instead, and a whole lot of folk will end up dying.

Like I said RFK Jr can be survived…but not by everyone.

 

header image courtesy heaute.at via CC by 4.0 

 

 

Categories
Healthcare

About my healthcare exchange promise—I lied

I promised you wouldn’t write about the Healthcare Exchange…but I lied.

Today, I am officially enrolled in an affordable healthcare plan via the federal Healthcare Exchange.

Though the GOP has worked tirelessly to ensure I not get this far, I persevered and made it. Though I realize the GOP is still doing everything in its power to ensure I don’t have healthcare coverage come this January, at this moment, I am covered. I have what every Republican Congressional member has, but doesn’t want me to have: healthcare coverage.

I will be able to go to the doctor when I’m sick. I will be able to get the medical care I need in order to survive. And I won’t be filing for bankruptcy if I do get sick.

My statement to the GOP on Twitter was heartfelt but a little severe. I want to take this time to provide a more measured statement…

For years you tried to stop me getting healthcare coverage, but you have failed. You actually brought the government to the edge of financial disaster to keep like me from getting healthcare coverage, but you have failed. Even now, you’re scrambling to file lawsuits in attempt to prevent me from having healthcare coverage, but those are tomorrow’s battles. For today, you can’t take away my healthcare coverage, and you have failed.

 

Neener neener.

all complete notice

Now, I return to my previously made promise to not talk about the Healthcare Exchange.

Thank you.

Categories
Healthcare

Stage 2 on the Healthcare Marketplace

update

Yesterday, I was able to upload my identification. Now, some human somewhere will have to concur that it indeed verifies I am me.

In the meantime, USA Today has posted a story with tech details about the fixes being done on the system this weekend. It interviews the “top technology expert” behind the system, who managed to use the word “geekalicious”.

I was especially surprised when reading the following:

It is upgrading software that lets people create accounts to apply for insurance. One symptom of this has been malfunctioning pull-down menus that have worked only intermittently all week. And HealthCare.gov is moving one part of the site that processes applications from so-called virtual machine technology, which uses software to let a website securely share computer servers with other sites, to using servers dedicated exclusively to that process, he said.

earlier

I am not who I say I am. Or I can’t be verified to be who I say I am.

I’ve been able to go through the entire application process…except for verifying who I am. And evidently, they forgot to turn this part of the application on.

I’ve put in my correct name, address, social security number, and so on. I put in what I know the IRS has for me.

Nada. Zip.

So I took the option to upload a document. A simple scan of my driver’s license.

I tried once, and got a message that maximum file size is 10MB. My file size was a little larger than 1MB. OK. So I compressed the PDF down to about 67KB.

Nada. Zip. Same error message.

I snipped out just my drivers license, and created a JPEG of the image. File size? A svelte 34KB. I uploaded it…

Nada. Zip.

And, as usual for almost any activity associated with this system, I must now call in. Except I have no interest in calling in. I’m going to wait a week, in hopes that someone remembers to turn on the rest of the application. I’m disappointed, though, that I couldn’t even look at the plans, because I’m stuck in the never never land of “verification”.

This isn’t load problems, people. This is a crappy system that has all the symptoms of never having been tested. Other than a cursory run through.

I may like Obamacare, but the Marketplace sucks.

PS Oh, and I’ve never been able to use Chrome to access the Marketplace. Not once. I’ve had to use IE and Firefox.

Categories
Healthcare

Healthcare Exchange: 1 Shelley: 0

I joined the masses in attempting to access the new Healthcare Exchange yesterday. I thought I had an edge by creating an account with the system a few weeks back, but no such luck. Attempting to log in kept resulting in a blank page (which showed itself to be a “downstream error” when accessing the site using Firefox).

I noticed that the format of username that was acceptable a few weeks back no longer meets the criteria for new user names, so I don’t know if I have an account or not. And forget trying to use Chat to verify whether I need to create a new account, or can use my existing one (with its improper username format).

I expected glitches, but not such wide systematic failures, where people can’t even get access to the security questions to create an account. This breakdown isn’t the fault of Obamacare. This breakdown is, unfortunately, all too typical with large new systems developed with too many inputs from middle management and too little heed paid to experienced software developers. And way too little effective load testing.

Using Java doesn’t help. Java requires a very savvy tech architect, and well designed infrastructure. Even tiny fractures can cause big pile ups in a poorly designed Java system.

Regardless, I’m not going to bash the law just because of early system failures. I’m irritated at journalists and their pondering of “people giving up” because they can’t access the system. Hey boys and girls: people who want and need affordable healthcare coverage aren’t going to give up because of software glitches. Perhaps if the pundits would stop talking and start listening, they wouldn’t write or say such silly crap.

However, someone needs to be kicked in the ass behind the scenes of the Healthcare Marketplace.