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Today’s Scorecard on the HELP Committee Hearings

By Carole R. Myers

September 7, 2017

Senator Lamar Alexander (R-Tennessee), working with Senator Patty Murray (D-Washington), scheduled four bipartisan hearings on stabilizing the Affordable Care Act (ACA) individual markets which are also known as exchanges. The first two of the hearings were held this week and two more are scheduled for next week.


Five Governors testified today before the Senate Health, Education, Labor, and Pension (HELP) committee, following the five state Insurance Commissioners who testified yesterday. At the end of the day, there was consensus on one potential fix, a growing consensus on another suggested remedy, and an impasse on a third option.


Consensus: The five Governors who testified advocated for the continuation of CSR (Cost Sharing Reduction) payments to insurance companies to cover the cost of out-of-pocket expenses, including co-pays and deductibles, for the lowest income individuals enrolled in the individual market plans. The only disagreement was whether the HELP committee should push for a one year assurance of funding or a multi-year plan.


Growing consensus: State flexibility was promoted across-the-board. Specifically, section 1332 waivers pertaining to certain ACA provisions were promoted. There was a coalescing around several specific procedural changes (e.g., shortened approval process, “me too” applications, allowing Governors and Insurance Commissioners to apply for waiver instead of state legislators, etc.). Views were mixed on whether waivers would apply to only procedural issues, leaving ACA consumer protection some coverage provisions intact, or if protections and coverages could be modified under the waivers.


Discord: Governor Haslam (R-Tennessee) led the charge in requesting federal money for establishing reinsurance plans as a means to reduce premium costs. He and the other Governors indicated there is insufficient time for the states to get reinsurance plans up and running for 2018. Senator Alexander pushed back, indicating he could not pass a bill that included funding for a federal reinsurance plan.


Stay tuned for next week when healthcare stakeholders testify and state flexibility is discussed.  You can listen to the hearings live or on-demand (  Hearings will be held next week on September 12 and 14 at 10 am EDT.


Carole R. Myers, PhD, RN

September 7, 2017 9:00 p.m.

Carole R. Myers

A Refreshing Start on What Truly Made America Great

By Carole R. Myers

September 6, 2017


Photcredit:Library of Congress

I just listened to the opening comments of Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) as they kicked-off the first of four hearing of the Health, Education, Labor, and Pension (HELP) committee hearings over the next two weeks on stabilizing the individual marketplaces.  It was refreshing and encouraging to hear an emphasis on “coming together” and “finding common ground” (remember when this was more common?).  I will be watching to see if the call for bipartisanship is realized.

The challenges are great.  Eighteen million Americans, 6% of all Americans, are enrolled in marketplace plans. The impact of market instability is real and painful to Americans across the country.  Proposed premium rates for 2018 in Tennessee include 21-42% increases because of uncertainty regarding ongoing reimbursement to insurance companies to offset the discounts provided to the lowest income individuals for out-of-pocket costs, including copayments and deductibles.  These reimbursements paid by the federal government, called Cost Sharing Reductions (CSRs) are not bail-outs as they have been characterized by President Trump.  These are justifiable reimbursements to insurance companies for discounts for the poorest marketplace enrollees.  If federal CSR payments are stopped, the insurance companies will recoup cost by increasing premiums for other enrollees.  This is not sustainable.

Another sign of distress is the decline in the number of marketplace plan per counties across the U.S.  Senator Alexander reported that initially only 4% of counties had just one insurer.  This number is now 50%.  Time is another major challenge.  The HELP committee must forge and pass a legislative solution and this policy solution must be approved by Congress by September 27, 2017 to stabilize the individual markets for 2018 as annual enrollment begins.  Americans can do extraordinary things when they have the will and work together.

You can watch live HELP committee hearings via .  Hearings will be held September 7 at 9 am EDT and September 12 and 14 at 10 am EDT.


Carole R. Myers, PhD, RN

September 6, 2017 12 noon


Carole R. Myers

Compassion, Poetry, and DACA

By Joy Jacobson

September 6, 2017

Rio Grande/Rio Bravo, J. Stephen Conn, flickr

“There is nothing compassionate about the failure to enforce immigration laws,” attorney general Jeff Sessions said yesterday, in a surreal usurpation of the word compassion. In announcing the end of the Obama administration’s Deferred Action for Childhood Arrivals, or DACA, program, he made 800,000 young adults brought to this country illegally as children vulnerable for deportation as soon as March of next year.


Compassion literally means “to suffer with.” But like me you may be blocked from this suffering by a bout of compassion fatigue, brought on from the relentless assault of terrible news. Others have called it outrage fatigue or resistance fatigue. But because Sessions bastardized compassion, I think it’s important to reclaim that concept.


To suffer with: I am not vulnerable for deportation, yet I want to cultivate the ability to understand what this policy change means for people who are. I’m also overwhelmed; I’m afraid of the responsibility I bear in our culture; I want to hide from it.


And so I turn to poetry.


Sherman Alexie’s new poem, “Hymn,” is an incantatory series of rhyming couplets through which we can, along with the poet, declaim: “I will sing for people who might not sing for me. / I will sing for people who are not my family.”


Claudia D. Hernandez crossed the Rio Grande/ Rio Bravo with her family when she was 10 years old. “The River Never Happened to Us (ii.)” ends with this startling image: “Yet   we   continued   to trickle / shards   of   mud,   as   if   the river   had never happen to us.” Hernandez’s poem is part of an online collection featuring nine undocumented poets, curated by Christopher Soto and published by Southern Humanities Review.


Li-Young Lee describes his writing of his poem “Immigrant Blues,” which begins with a line his father told him as a boy: “People have been trying to kill me since I was born…” Click the audio link to hear him read the poem, and then listen again.


Eduardo C. Corral provides the poetic perspective of a child of an undocumented immigrant. “In Colorado My Father Scoured and Stacked Dishespresents a series of heartbreaking images, told in a heartbroken voice: “Once, borracho, at breakfast, / he said: The heart can only be broken // once, like a window.”


Guatemala-born poet Alex Alpharaoh performed “WET: A DACAmented Journey” in Los Angeles in August. “Soon the witch-hunt will begin,” he chants. “Which one of you brought the matches?” In an interview posted yesterday, he said of people who deny the importance of immigrants to America’s culture: “They’re not paying attention, and they’re not really looking at their history.”


Let’s pay attention. Let’s look at our history. Tell me what you’re reading.

Joy Jacobson
Joy Jacobson is the CHMP’s poet-in-residence and cofounder of our Writing Reflective Narratives for Clinicians program.