Let us proceed with Health Care Reform through Regular Order to find our way forward out of the morass -please read Sen McCain's speech on 07 25 17

Good afternoon,

I wanted to share with you one of a series of memoranda I sent to a total of 27 Senators Democrats, Republicans and Independents since the drama opened in the Senate which turned into a chamber of the macabre and absurd populated by ideologically driven individuals who put their fortunes over country all but one. Hon Sen. John McCain, I have posted his memorable speech of Tuesday 07 25 17 in the Senate. His vote which ended the seven-year misguided campaign to repeal and? Replace? Repeal alone or Replace partly with a shell of a Bill on which he dramatically turned his thumb down, said no, firmly softly and finally put an end to the torturous struggles of the Legislative process that produced a pathetic shell of a lose- lose Bill. [Please watch Video of Sen. McCain's dramatic deed Coup de grace- an act of mercy. It happened early morning on Friday 07 28 17.]

The three Senators who distinguished themselves by extinguishing the final dying embers are Hon Sens. Susan Collins and Lisa Murkowski and our genuine dyed in the wool Hero John McCain. Their actions saved millions of our fellow Americans especially those who are poor, aged and disabled. I have written about the impact of the drastic cuts in Medicaid, SNAP and SCHIP on Page 6 of this memorandum.

As I reflected on their principled decisions and valiant acts of great personal integrity this analogy occurred to me- three brave warriors of Ancient Rome stepped into the breach and under the Heroic Leadership of Horatius Codes held of the powerful Etruscan Armies at a bridge while the Romans were cutting down the supports to prevent the Etruscans from storming the Capitol. The valiant compatriots of Horatius were Spurius Lartius and Titus Herminius.

People need to know Hon Sen. S. Collins was threatened by challenge to duel and Hon. Sen. Murkowski was threatened by the Secretary of the Interior who insinuated the State she and her colleague represents would suffer if she voted against the Senate bill. Threats were made to Senators from the North East who voted against the Senate Repeal and Replace Bill by an overwrought Texas Congressman Blake Farenthold- Farenthold’s comments, which could be read as both chauvinistic and threatening, are not the first time the Congress member has been connected with inappropriate behavior toward a female colleague. Farenthold was sued in 2014 for sexual harassment and gender discrimination by his former communications director Lauren Greene. (The lawsuit was settled out of court.) Carly Sitrin-Vox. Jul 24, 2017, 5:00pm EDT

[Had the “final Gasp in the form of a shell of a bill” been revived by the Senate and enacted- 16 million people would have lost coverage, premiums were expected to spike 20% and expenditures would continue to sky rockets because there were no provisions to contain costs of Drugs, Medical equipment and per capita per person per month costs, or incentives to year after year improve quality of experience of care, outcomes and reduce waste due to excessive testing, needless procedures, medications prescribed and prevent complications/adverse reactions to unnecessary test, meds and needless procedures, futile visits for Emergency care in Ambulances by reimbursing preventive care and efficient, safe and effective timely planned disease management provided in seamlessly and consistently by Integrated Care Teams in Patient focused Family centered medical centers /practices.]

I started my campaign in early spring of 2017 to educate, advocate, persuade and encourage our elected representatives

Velandy Manohar, MD

[email protected]

07 27 17

Please cut through the Gordian knot that is crushing the legal framework that protects the health of people and holds up 1/6 of the Economy

Health care Legislation [Campaign to Repeal and delay, Repeal and replace or What?]

May I share with you what I see…Senator

Note:

I watched the Press Conference at about 5:15 PM today [07 27 17]involving 4 of your Republican colleagues, Sens: McCain, Johnson, Graham and Cassidy. They declared the “Skinny Repeal Bill” is a fraud. Were you able to see this press conference. Let us Kill this Skinny Repeal Bill and get to regular Order, please.

Sadly when it counted only one of the Four stood up and acted on their conscience and public assessment of the Bill. It is inexplicable that Hon Sen. Bill Cassidy has not advocated for the Patient Freedom Act of 2017 that he and three others including Sens. Collins, Capito and Isakson have formulated which shows promise in terms of providing Coverage for millions of Americans who got coverage under PPACA of 2010 and has creative ideas for funding and managing the costs at the federal and State levels. I have written about this alternative in CT. Mirror and in my Linked in Posts.

My plea; Senators on both sides of the Aisle must act right now to adopt their alternative legislative package to the American Health Care Act, BCRA 1,2, 3...or What?

         It appears that neither the Republic Caucus or the Democratic caucus members can develop a consensus to find a way forward to enact a safe, effective and affordable Health care reform Bill that adds value to the all our fellow Americans with breaking the bank or casting aside millions of working poor, disabled, ill and aging individual across the Land.

May I share with you what I see:

         Assuming there are 48 members in the Democratic Caucus (46 Democrats plus two independents) who are voting as a Bloc, this caucus cannot offer and push through any Legislative initiative through the Senate, they will need at least twelve Republicans to bring to the floor Patient Freedom Act for Debate and vote. Another scenario would be to create a bipartisan coalition that can work on the PFA as written and introduce the reformulated PFA during the Votarama tonight as the final package as a legislative endgame.

           I believe based on my study of available data Patient Freedom Act of 2017 remedies the major flaws of the PPACA of 2010 and is a viable alternative legislative package to the highly flawed AHCA and BCRA (as stated by the Congressional Budget Office and opposed by scores of organizations including AARP, American Heart Association, the American Medical Association and others).

           In rural communities Health Care providing centers- hospitals and clinics and the staff who provide compassionate, efficient and value adding care are foundational constituents of the life and wellbeing, integrity and stability and sense fo security to the communities they serve in addition to Schools and Churches.

           These three organs that circulate life sustaining energies through the communities they serve namely Churches, schools and Health care centers and their staff form the warp and woof of rural communities - just as Individual liberty, religious freedom are the warp and woof of civilized society that we strive to sustain in the USA.

         So please help us dear Lord as we struggle and muddle through life to form a more perfect union. Things are very rough and tumble now, the circumstances are dire- we must heed Sen. McCain’s inspiring speech in the Senate

         “Our responsibilities are important, vitally important, to the continued success of our Republic. And our arcane rules and customs are deliberately intended to require broad cooperation to function well at all. The most revered members of this institution accepted the necessity of compromise to make incremental progress on solving America’s problems and to defend her from her adversaries.

  “That principled mindset, and the service of our predecessors who possessed it, come to mind when I hear the Senate referred to as the world’s greatest deliberative body. I’m not sure we can claim that distinction with a straight face today.”

Please let us [namely “We the people…”] reason together and make common cause and fulfill the promise of US Constitution: “… in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common Defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity,…”

Velandy Manohar, MD, Distinguished Life Fellow, Am. Psychiatric Association.

The rationale for formulating this response.

It is incumbent for the members of both the Republican and Democratic Caucus to act as one family to respond as urgently as possible to advance an alternative health care bill that has better chance of covering 23 million more of our fellow Americans than the current AHCA regardless of their emotional attachment and political allegiance to the Affordable Care Act.

President Donald Trump provided us with a reasonable rationale for rejecting the AHCA and formulating a new legislative package. Recently he asserted that the House-passed AHCA was “mean,” and has expressed concerns of the bill not going far enough to protect individuals in the marketplace. He unambiguously called for the Senate to add more money to the bill.

As commentator Andrew Sprung wrote in The New York Times, we are afraid that Senate moderates may act in a dangerously passive manner in a moment so critical in our history.

The alternative health care bill we are suggesting to be formulated– one based on the Patient Freedom Act of 2017 — may provide a deal between Democrats and Republicans as a Federalist compromise.

A plan to attain and hold a majority of votes:

If a quorum of three or more of the approximately dozen Republican senators who are demurring on supporting the AHCA can be recruited to block the passage of the AHCA and defy the head of their party, the PFA could be an acceptable alternative legislation to the AHCA. Since the PFA will retain several of the ACA’s popular provisions, this can be reason enough for Democrats who are emotionally committed to retaining the ACA to work with the sponsors of the PFA to ensure its passage and enactment.

The popular provisions of ACA expected to be retained in the PFA include:

1. Ban on lifetime and annual limits

2. Coverage of adult children until age 26

3. Prohibition against pre-existing condition exclusions

4. Prohibition against health status discrimination

5. The preventive services requirement

6. Section 1557, which prohibits discrimination based on race, national origin, sex, age or disability

7. Requirement for coverage of mental health and substance use disorder with limited cost-sharing as well as the extension of mental health parity rules to the health care market

8. Provision of Black Lung benefits for coal miners

9. The continuation of Section 1332 state innovation wavers

10. The continuations of the federal marketplace for states that desire to use it.

State options under the PFA are worthy of note because of the devolution of power as compared to the ACA. Also, Roth health savings accounts are at the center of the PFA’s favored option.  Any citizen or lawful alien residing in a state who is enrolled in a health care plan and not otherwise covered by a federal health program would be eligible.

The PFA (full text here) also requires providers to post their prices in a manner that will allow consumers to compare prices among providers. It also imposes specific limits on the number of providers may bill for emergency services.

We urge the Democratic Caucus to invite the four sponsors of the Patient Freedom Act to collaboratively work on the PFA as drafted to gain the support of a majority of senators. This can enable the bipartisan group to demand the PFA be debated on the floor of the Senate and a straight up and down vote be scheduled promptly.

We must repudiate the secretive process that is being pursued by the Senate leadership and prevent the AHCA from becoming the law of the land.

We must take the initiative away from the majority leader of the Senate to enact an affordable, sustainable, innovative and equitable Health Care law based on the Patient Freedom Act.

 

We would like to provide updates starting with full Text of the Draft Senate Republican Health Care Bill -BCRA of 2017

June 23, 2017

  I.

In the Senate 115th Congress- First session, HR 1628,the Better Care Reconciliation Act of 2017: https://www.cnn.com/2017/06/22/politics/republican-health-care-bill-text/index.html

 II.

A. APA is urging the Senate to reject the health care reform proposal unveiled today by Senate Republicans: https://alert.psychnews.org/2017/06/apa-to-senate-reject-health-care-reform.html

B. Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin, announced that they would oppose it without changes — more than enough to bring it down:

https://mobile.nytimes.com/comments/2017/06/22/us/politics/senate-health-care-bill.html

C.A growing rift among Senate Republicans over federal spending on Medicaid and the opioid epidemic is imperiling legislation to repeal the Affordable Care Act. https:

//www.nytimes.com/2017/06/20/us/politics/health-care-medicaid-opioid.html

D. Middle Class, Not Poor, Could Suffer if Trump Ends Health Payments: https://www.nytimes.com/2017/06/20/health/health-subsidy-cuts-could-hurt-the-middle-class-the-most.html

E. Abortion Adds Obstacle as Republicans Plan to Unveil Health Bill: https://www.nytimes.com/2017/06/21/us/politics/abortion-republicans-health-bill.html

F. Moderates in the Senate are concerned about the bill's slashing of Medicaid spending. Obamacare's Medicaid expansion, which extended the program to those making 100% to 138% of the federal poverty limit, would be phased out over three years starting in 2020:

https://www.businessinsider.com/chuck-schumer-senate-healthcare-bill-republicans-wolf-2017-6

G. As for Medicaid—the federal program that provides health services to roughly seventy-five million Americans, most of whom are poor or elderly or are children—the bill involves much bigger, and more harmful, changes. Finally, the legislation would deliver a hefty tax cut to some of the wealthiest households in the country. Please read the full report: https://www.newyorker.com/news/news-desk/what-the-senate-health-care-bill-means-for-america

 III.

A. The $800 billion reduction is confirmed to CNN by a senior administration official

What to do about Medicaid was a major flashpoint of the House GOP bill:

https://www.cnn.com/videos/politics/2017/05/22/trump-budget-cuts-800-billion-from-medicaid-christine-romans-nr.cnn

 I. Starting Friday, the money is likely to run out even quicker. That is when Supplemental Nutrition Assistance Program, or SNAP, benefits are set to fall for more than 47 million lower-income people -- 1 in 7 Americans -- most of whom live in households with children, seniors or people with disabilities. Barring congressional intervention, the maximum payment for a family of four will shrink from $668 a month to $632, or $432 over the course of a year.

https://www.cbsnews.com/news/millions-on-food-stamps-facing-benefits-cuts/

C. Medicaid/SCHIP Cuts and Hospital Emergency Department Use. "Cuts to public programs are likely to have ripple effects across the safety net for low-income Americans."

https://content.healthaffairs.org/content/25/1/237.full.html

 We are urging Republicans and Democrats to work together to formulate an alternative to "The Better Care Reconciliation Act of 2017". This is essential and urgent because these cuts in Medicaid, SNAP and SCHIP will rip us asunder the social safety net that has added value to the lives of millions of our fellow Americans. These cuts must not be allowed to stand because they're unwise and imprudent, penny wise and pound foolish and if we may say so unethical, cruel and harmful to all Americans because this Bill violates the foremost principle of medical ethics: Primum and Non-Nocere; Above All Do No Harm.

Velandy Manohar, MD

Distinguished Life Fellow, Am. Psychiatric Association