Excerpts from
"Verma, an Indiana health care consultant who is a protégé of Vice President Mike Pence, has had plenty of practice adapting the waiver's authority to boot people off the Medicaid rolls under the guise of promoting "personal responsibility."
As the Administrator of the Centers for Medicare & Medicaid Services, Seema Verma oversees a $1 trillion budget, representing 26% of the total federal budget, and administers health coverage programs for more than 130 million Americans. She was nominated by President Trump on November 29, 2016 – the seventh nomination by the President-elect – and confirmed by the U.S. Senate on March 13, 2017.
As part of a deal with the Obama administration to allow Medicaid expansion, Verma created a "Healthy Indiana" plan that required people to make seemingly modest monthly payments—from one dollar up to a hundred, depending on their income—into a personal account to ensure coverage. But if there are any slip-ups in payments, you either get punished with higher co-pays and skimpier coverage—or kicked out of the program altogether for six months. In practice, as WFYI public radio reported, the state and private insurers too often made repeated bureaucratic mistakes that left even steadfast payers without coverage. On top of that, as USA Today reported, more than half of the low-income people who qualified for the relatively top-tier version of the Indiana program were cited for failing to make a required monthly payment, forcing them into cheaper and riskier bare-bones programs, according to a state-funded survey. State officials claim that only a small portion of them were locked out altogether from receiving any health care coverage—regardless of the seriousness of their mental or physical health conditions. It is still being promoted as a national model for other states by Verma and the budgetary hit-squad at HHS. The dystopian future awaiting the most seriously mentally ill people under a Trump administration can, perhaps, be glimpsed by looking at what happened when Tennessee, facing a fiscal crisis, used HHS waivers to cut over 350,000 people from the Medicaid rolls starting in 2005 and drastically curtailed benefits for others. These included limiting virtually all recipients to a total of five medications. With 35,000 of the most seriously and chronically mentally ill recipients losing all coverage, homelessness, emergency room visits and jailings rose sharply in Tennessee. In fact, as many as half of the state's most seriously and persistently mentally ill people in some counties who were theoretically eligible for the state's "safety net" alternative to their lost Medicaid coverage couldn't manage the paperwork obstacles and were left to drift into oblivion. One family's obituary for their son who committed suicide explicitly blamed TennCare, as Medicaid is known, for denying him the services and medication he needed. "If you send paperwork to the severely mentally ill and require them to fill out all these forms, you're going to lose a lot of people right off the deck," says Gordon Bonnyman, the Tennessee Justice Center staff attorney who opposes such cuts and restrictions emerging now from the Trump administration. In addition, millions of people who won coverage under Obamacare could be in for a rude surprise when their new mental health benefits either disappear or become so limited as to be nearly worthless. A little-known bonus of the Affordable Care Act is that it also mandated ten "essential health benefits" including drug and mental health treatment for all those enrolled in individual and small company plans, along with the millions of beneficiaries of expanded Medicaid coverage, theoretically offered on a par with medical benefits, a requirement known as "parity." Here's another shock: Citizens of major Democratic, pro-Obamacare states such as California and New York can't necessarily count on their progressive governors to protect them from the same sort of harsh restrictions in the proposed Republican health care bill embraced by conservative GOP governors in the South and other red states. As Kaiser Health News reported, the deep cuts in the Obamacare subsidies that assist Americans to buy individual and small company insurance coverage in the marketplaces could make all the plans unaffordable. So to keep insurers in their states and bring average consumer costs down, even liberal governors may have
to ask for waivers allowing them to omit essential health benefits or charge far higher rates to the sickest and most disturbed people. The far skimpier coverage that could be potentially offered is a potential deathblow especially for the most troubled mentally ill people and addicts who turn to Medicaid for help. It's disturbing that despite over 59,000 overdose deaths annually, most due to opioids and heroin, nearly three million—often mentally ill—drug addicts who got coverage for the first time under Obamacare and Medicaid could face new barriers to care; others will surely be frightened away from enrolling in Medicaid by drug- testing requirements if states win permission to do so. All these potential restrictions will be worsened by the impact of Attorney General Jeff Sessions's determination to restore maximum prison sentences for even low-level drug offenders and Tom Price's unscientific, abstinence-oriented opposition to using medically-assisted opioid treatments such as Suboxone, rejecting his department's own research findings. When taken together with reduced access to treatment, the Trump administration's extreme law- and-order response to the opioid crisis, despite Trump appointing a
presidential commission to address the epidemic, could well lead to the deaths of thousands of more addicts each year. Even the well-meaning federal parity requirements for both small Obamacare and large corporate plans are still often more a promise than a reality, due to exorbitant out-of-pocket costs and shortages of in-network mental health providers, NAMI reported in November 2016. Yet many of those reforms, too, could be further undermined in the Republican stampede to repeal Obamacare and cut Medicaid spending that is finding a new outlet in arcane agency decision-making out of the public spotlight. "It will be disastrous," Cheryl Fish-Parcham, Director of Access Initiatives for Families USA, says of the potential passage of Trump's Obamacare repeal in Congress. The same ominous potential remains if Republicans get everything they want through new regulations and waivers. EVEN IF YOU RETAIN YOUR MENTAL HEALTH COVERAGE UNDER TRUMP, most people can't afford it: nearly half of all psychiatrists don't take private insurance or Medicare. As Bloomberg News recently reported, they're increasingly choosing to take cash-paying patients with easier-to-treat g even more of the severely mentally ill to navigate the fragmented and overbooked community clinics in a desperate waiting game for help. Meanwhile, Medicaid enrollment remains an obstacle course even for the low-income people who qualify, and, of course, it will be virtually impossible for otherwise eligible mentally ill people to join Medicaid after rigid spending limits are enacted. Hospital emergency rooms have already become the short-term treatment site of last resort. Too often the absence of any kind of care can lead to suicide, now the second-most common cause of death for Americans between ages fifteen and thirty-four, according to the Centers for Disease Control (CDC). Of the nation's 33,000 firearm deaths a year, over 60 percent are self-inflicted. The nation is still reeling from state mental health budget cuts of over $4 billion during the three years after the 2008 crash. In most states, budgets still remain below 2009 levels. So if the nation would just address the funding shortage, we're told, we would go a long way towards helping the 40 percent of the nation's ten million seriously mentally ill adults who
don't get any treatment in the course of a year. (Those with serious mental illness are defined by the federal government as being severely impaired during the past year by such conditions as schizophrenia, bipolar disorder and major depression.) The shortage of funds, stigma and lack of access to treatment have been singled out as the primary evils in the reform narrative offered by mental health organizations. But they generally don't pay much attention to the true quality of care or overmedication or pharmaceutical corruption of the mental health system—or of the mental health advocacy groups themselves. Of course, there's usually little public interest in addressing mental health issues at all until there's a senseless mass shooting that shocks the country. They've ranged from the thirty-two killed at Virginia Tech in 2007 and the twenty-six killed at the Sandy Hook school in Newtown, Connecticut, in December 2012, to so many others, including the largest mass shooting in American history as of this writing: the killing in June 2016 of forty-nine patrons at a gay nightclub by Omar Mateen, a troubled twenty- nine-year-old Muslim man. He was seemingly fueled by some combination of Islamic extremism, self-hatred over his bisexuality and an undiagnosed mental disturbance. As Mateen grew up, his anger flared up regularly at
of Islamic extremism, self-hatred over his bisexuality and an undiagnosed mental disturbance. As Mateen grew up, his anger flared up regularly at classmates, his first wife, coworkers and, finally, with a legally purchased assault weapon, it took aim at all the strangers that he massacred at the pulse nightclub in Orlando, Florida. Unfortunately, in the first half of 2016 alone, there were nearly 170 mass shootings involving four or more people shot or killed in each incident, although there's no consensus on what portion of such killers show signs of mental illness. Estimates range from 20 percent with serious, disabling mental illnesses to as much as 60 percent, according to The American Journal of Public Health. Still others have been identified by Pennsylvania psychologist Peter Langman, author of School Shooters and creator of the Schoolshooters.info archive, as "psychopathic shooters" lacking in empathy and as "traumatized shooters" raised in abusive homes. It's likely, in fact, that most mass killers have some form of mental illness, even if many don't meet the narrow legal definition of insanity: the inability to tell right from wrong at the time of the crime. By the time you read this, there will most likely be yet another horrific tragedy that stirs new calls for reform, new debates over whether mental illness or unimpeded access to guns is really at fault and concern from
progressives that people with mental illness are being unfairly stigmatized since they are far more likely to be victims than perpetrators of violence. After these shootings, right-wing and Republican Party leaders inevitably talk about mental health as the real issue to be addressed, rather than the truly insane lack of meaningful gun control. As usual in these and other public arguments on guns, liberals often decry right-wingers' references to mental illness as a ploy to avoid gun control, while conservatives denounce gun control as a phony ruse that will disarm regular citizens and won't stop criminals, crazy people and terrorists from getting guns. In truth, the country needs both dramatically improved and accessible mental health care along with far tougher gun control laws. Former Arkansas Governor Mike Huckabee, a frequent GOP candidate and Fox commentator, declared after the slaying of nine at Umpqua Community College in southern Oregon in October 2015, "Do we need to do a better job in mental health? You bet we do." When Huckabee was governor, though, Arkansas received a "D-" rating on a national scorecard issued by NAMI, which remains a valuable yardstick. When conservatives talk about mental health, for the most part they're talking about tracking down chronically crazy people and forcing them to have treatment or locking them up somewhere—without bothering to think about who will
locking them up somewhere—without bothering to think about who will pay for it all, let alone if it would be effective or helpful. (The hollowness of the right-wing's emphasis on mental illness's role in gun violence was underscored when the NRA successfully pushed—along with the ACLU and disability rights groups—for legislation that overturned in February 2017 an Obama administration regulation that closed yet another potential loophole: it required the Social Security Administration to report to the FBI background check system mentally impaired beneficiaries who were incompetent to manage their own finances.) There is, of course, a sharp debate over the extent that seriously mentally ill people engage in violence, but they're only a fraction of all those who commit violent crimes—and they're eleven times more likely to be victims of violence than the general population. At the same time, untreated, severely mentally ill people are disproportionately more likely to engage in violence than the average citizen, and that is largely accounted for by the substance abuse that afflicts as many as 50 percent of them.
Mental Health Inc: How Corruption, Lax Oversight and Failed Reforms Endanger ...
By Art Levine"Verma, an Indiana health care consultant who is a protégé of Vice President Mike Pence, has had plenty of practice adapting the waiver's authority to boot people off the Medicaid rolls under the guise of promoting "personal responsibility."
As the Administrator of the Centers for Medicare & Medicaid Services, Seema Verma oversees a $1 trillion budget, representing 26% of the total federal budget, and administers health coverage programs for more than 130 million Americans. She was nominated by President Trump on November 29, 2016 – the seventh nomination by the President-elect – and confirmed by the U.S. Senate on March 13, 2017.
As part of a deal with the Obama administration to allow Medicaid expansion, Verma created a "Healthy Indiana" plan that required people to make seemingly modest monthly payments—from one dollar up to a hundred, depending on their income—into a personal account to ensure coverage. But if there are any slip-ups in payments, you either get punished with higher co-pays and skimpier coverage—or kicked out of the program altogether for six months. In practice, as WFYI public radio reported, the state and private insurers too often made repeated bureaucratic mistakes that left even steadfast payers without coverage. On top of that, as USA Today reported, more than half of the low-income people who qualified for the relatively top-tier version of the Indiana program were cited for failing to make a required monthly payment, forcing them into cheaper and riskier bare-bones programs, according to a state-funded survey. State officials claim that only a small portion of them were locked out altogether from receiving any health care coverage—regardless of the seriousness of their mental or physical health conditions. It is still being promoted as a national model for other states by Verma and the budgetary hit-squad at HHS. The dystopian future awaiting the most seriously mentally ill people under a Trump administration can, perhaps, be glimpsed by looking at what happened when Tennessee, facing a fiscal crisis, used HHS waivers to cut over 350,000 people from the Medicaid rolls starting in 2005 and drastically curtailed benefits for others. These included limiting virtually all recipients to a total of five medications. With 35,000 of the most seriously and chronically mentally ill recipients losing all coverage, homelessness, emergency room visits and jailings rose sharply in Tennessee. In fact, as many as half of the state's most seriously and persistently mentally ill people in some counties who were theoretically eligible for the state's "safety net" alternative to their lost Medicaid coverage couldn't manage the paperwork obstacles and were left to drift into oblivion. One family's obituary for their son who committed suicide explicitly blamed TennCare, as Medicaid is known, for denying him the services and medication he needed. "If you send paperwork to the severely mentally ill and require them to fill out all these forms, you're going to lose a lot of people right off the deck," says Gordon Bonnyman, the Tennessee Justice Center staff attorney who opposes such cuts and restrictions emerging now from the Trump administration. In addition, millions of people who won coverage under Obamacare could be in for a rude surprise when their new mental health benefits either disappear or become so limited as to be nearly worthless. A little-known bonus of the Affordable Care Act is that it also mandated ten "essential health benefits" including drug and mental health treatment for all those enrolled in individual and small company plans, along with the millions of beneficiaries of expanded Medicaid coverage, theoretically offered on a par with medical benefits, a requirement known as "parity." Here's another shock: Citizens of major Democratic, pro-Obamacare states such as California and New York can't necessarily count on their progressive governors to protect them from the same sort of harsh restrictions in the proposed Republican health care bill embraced by conservative GOP governors in the South and other red states. As Kaiser Health News reported, the deep cuts in the Obamacare subsidies that assist Americans to buy individual and small company insurance coverage in the marketplaces could make all the plans unaffordable. So to keep insurers in their states and bring average consumer costs down, even liberal governors may have
to ask for waivers allowing them to omit essential health benefits or charge far higher rates to the sickest and most disturbed people. The far skimpier coverage that could be potentially offered is a potential deathblow especially for the most troubled mentally ill people and addicts who turn to Medicaid for help. It's disturbing that despite over 59,000 overdose deaths annually, most due to opioids and heroin, nearly three million—often mentally ill—drug addicts who got coverage for the first time under Obamacare and Medicaid could face new barriers to care; others will surely be frightened away from enrolling in Medicaid by drug- testing requirements if states win permission to do so. All these potential restrictions will be worsened by the impact of Attorney General Jeff Sessions's determination to restore maximum prison sentences for even low-level drug offenders and Tom Price's unscientific, abstinence-oriented opposition to using medically-assisted opioid treatments such as Suboxone, rejecting his department's own research findings. When taken together with reduced access to treatment, the Trump administration's extreme law- and-order response to the opioid crisis, despite Trump appointing a
presidential commission to address the epidemic, could well lead to the deaths of thousands of more addicts each year. Even the well-meaning federal parity requirements for both small Obamacare and large corporate plans are still often more a promise than a reality, due to exorbitant out-of-pocket costs and shortages of in-network mental health providers, NAMI reported in November 2016. Yet many of those reforms, too, could be further undermined in the Republican stampede to repeal Obamacare and cut Medicaid spending that is finding a new outlet in arcane agency decision-making out of the public spotlight. "It will be disastrous," Cheryl Fish-Parcham, Director of Access Initiatives for Families USA, says of the potential passage of Trump's Obamacare repeal in Congress. The same ominous potential remains if Republicans get everything they want through new regulations and waivers. EVEN IF YOU RETAIN YOUR MENTAL HEALTH COVERAGE UNDER TRUMP, most people can't afford it: nearly half of all psychiatrists don't take private insurance or Medicare. As Bloomberg News recently reported, they're increasingly choosing to take cash-paying patients with easier-to-treat g even more of the severely mentally ill to navigate the fragmented and overbooked community clinics in a desperate waiting game for help. Meanwhile, Medicaid enrollment remains an obstacle course even for the low-income people who qualify, and, of course, it will be virtually impossible for otherwise eligible mentally ill people to join Medicaid after rigid spending limits are enacted. Hospital emergency rooms have already become the short-term treatment site of last resort. Too often the absence of any kind of care can lead to suicide, now the second-most common cause of death for Americans between ages fifteen and thirty-four, according to the Centers for Disease Control (CDC). Of the nation's 33,000 firearm deaths a year, over 60 percent are self-inflicted. The nation is still reeling from state mental health budget cuts of over $4 billion during the three years after the 2008 crash. In most states, budgets still remain below 2009 levels. So if the nation would just address the funding shortage, we're told, we would go a long way towards helping the 40 percent of the nation's ten million seriously mentally ill adults who
don't get any treatment in the course of a year. (Those with serious mental illness are defined by the federal government as being severely impaired during the past year by such conditions as schizophrenia, bipolar disorder and major depression.) The shortage of funds, stigma and lack of access to treatment have been singled out as the primary evils in the reform narrative offered by mental health organizations. But they generally don't pay much attention to the true quality of care or overmedication or pharmaceutical corruption of the mental health system—or of the mental health advocacy groups themselves. Of course, there's usually little public interest in addressing mental health issues at all until there's a senseless mass shooting that shocks the country. They've ranged from the thirty-two killed at Virginia Tech in 2007 and the twenty-six killed at the Sandy Hook school in Newtown, Connecticut, in December 2012, to so many others, including the largest mass shooting in American history as of this writing: the killing in June 2016 of forty-nine patrons at a gay nightclub by Omar Mateen, a troubled twenty- nine-year-old Muslim man. He was seemingly fueled by some combination of Islamic extremism, self-hatred over his bisexuality and an undiagnosed mental disturbance. As Mateen grew up, his anger flared up regularly at
of Islamic extremism, self-hatred over his bisexuality and an undiagnosed mental disturbance. As Mateen grew up, his anger flared up regularly at classmates, his first wife, coworkers and, finally, with a legally purchased assault weapon, it took aim at all the strangers that he massacred at the pulse nightclub in Orlando, Florida. Unfortunately, in the first half of 2016 alone, there were nearly 170 mass shootings involving four or more people shot or killed in each incident, although there's no consensus on what portion of such killers show signs of mental illness. Estimates range from 20 percent with serious, disabling mental illnesses to as much as 60 percent, according to The American Journal of Public Health. Still others have been identified by Pennsylvania psychologist Peter Langman, author of School Shooters and creator of the Schoolshooters.info archive, as "psychopathic shooters" lacking in empathy and as "traumatized shooters" raised in abusive homes. It's likely, in fact, that most mass killers have some form of mental illness, even if many don't meet the narrow legal definition of insanity: the inability to tell right from wrong at the time of the crime. By the time you read this, there will most likely be yet another horrific tragedy that stirs new calls for reform, new debates over whether mental illness or unimpeded access to guns is really at fault and concern from
progressives that people with mental illness are being unfairly stigmatized since they are far more likely to be victims than perpetrators of violence. After these shootings, right-wing and Republican Party leaders inevitably talk about mental health as the real issue to be addressed, rather than the truly insane lack of meaningful gun control. As usual in these and other public arguments on guns, liberals often decry right-wingers' references to mental illness as a ploy to avoid gun control, while conservatives denounce gun control as a phony ruse that will disarm regular citizens and won't stop criminals, crazy people and terrorists from getting guns. In truth, the country needs both dramatically improved and accessible mental health care along with far tougher gun control laws. Former Arkansas Governor Mike Huckabee, a frequent GOP candidate and Fox commentator, declared after the slaying of nine at Umpqua Community College in southern Oregon in October 2015, "Do we need to do a better job in mental health? You bet we do." When Huckabee was governor, though, Arkansas received a "D-" rating on a national scorecard issued by NAMI, which remains a valuable yardstick. When conservatives talk about mental health, for the most part they're talking about tracking down chronically crazy people and forcing them to have treatment or locking them up somewhere—without bothering to think about who will
locking them up somewhere—without bothering to think about who will pay for it all, let alone if it would be effective or helpful. (The hollowness of the right-wing's emphasis on mental illness's role in gun violence was underscored when the NRA successfully pushed—along with the ACLU and disability rights groups—for legislation that overturned in February 2017 an Obama administration regulation that closed yet another potential loophole: it required the Social Security Administration to report to the FBI background check system mentally impaired beneficiaries who were incompetent to manage their own finances.) There is, of course, a sharp debate over the extent that seriously mentally ill people engage in violence, but they're only a fraction of all those who commit violent crimes—and they're eleven times more likely to be victims of violence than the general population. At the same time, untreated, severely mentally ill people are disproportionately more likely to engage in violence than the average citizen, and that is largely accounted for by the substance abuse that afflicts as many as 50 percent of them.
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