I have to admit, Eric Cantor came up with a cynical, but politically effective way to hose Democrats over Obamacare last week. He came up with the idea of extending the federally-funded high risk pools for people with pre-existing conditions by pulling earmarked funds out of the Prevention Fund. The Prevention Fund was the brainchild of Senator Tom Harkin, who believes that public education and prevention efforts are as powerful as treating the diseases themselves.

Because funds for the federally-funded high risk pools have been exhausted earlier than expected, Eric Cantor hatched his plan. He would introduce a bill called the Help Sick Americans Now Act, which would extend the federal high risk pools with funds taken from the Prevention Fund. Democrats would then be forced to vote against a measure that would fund pools to insure them from now until January 1, 2014 when the pre-existing conditions exclusion disappears and the exchanges open for individuals to purchase health coverage.

It's important to point out that those who are already covered in the high-risk pools won't lose coverage, but because funding is exhausted, no new entrants can use that program. That means some people will be without access to insurance coverage for the next eight months or so, unless they are employed by someone who offers group insurance.

Ted Cruz and the Tea Party purists threw a hissy fit over it, and Buzzfeed has the leaked emails to prove it. Here are some snippets of the catfight:

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Batten down the hatches, everyone, and don't be distracted by the ongoing Republican breast-beating about how their policies are so great but they just aren't communicating them in a happy way. Forget about that, because the oligarchs are rumbling, shaking their fists and stomping their hooves over Obamacare.

Yes, that's right. Now that it will not be repealed and will be the law of the land, they're making no bones about it. You've already heard about the miserable jerk who prayed with his employees before letting over 100 of them go, but it's about to get better.

Papa John's Pizza

Like Susie, I can't stand their pizza anyway, but evidently enough people like it to keep their stock price at acceptable levels while paying decent rates of return. Still, that's not enough for CEO John Schnatter, who has declared he will cut employees' hours to bring them below the full-time threshold which would require him to provide full coverage for them.

Evidently that 14 cents per pizza is just too onerous for customers and Wall Street to bear.

"The good news is 100 percent of the population is going to have health insurance. We're all going to pay for it," he said, estimating the new law would cost the business $5 million to $8 million annually.

Under the Affordable Care Act, full-time employees — those working 30 hours or more per week — would have to be provided with insurance at companies with more than 50 workers. Schnatter said it was likely that some franchise owners would reduce employees' hours in order to avoid having to cover them.

"That's probably what's going to happen," he said. "It's common sense. That's what I call lose-lose."

He also said he had a duty to shareholders to provide the maximum rate of return. Might be worth knowing who the shareholders are. 74 percent of Papa John's stock is institutionally owned; that is, owned by other investment firms and Wall Street funds. For 2012, the earnings per share is targeted to be about $2.60, up from 2011 earnings of $2.20 per share, which was an increase of 22.2 percent over 2010.

Papa John's has a market cap of $1.15 billion, and this guy is whining about a cost of around $6-$8 million per year, or 14 cents per pizza?

I call bullsh*t. This is a temper tantrum, plain and simple. Mr. Schnatter isn't the only one, either.

Darden Restaurants: Red Lobster, Olive Garden, LongHorn Steakhouse, Bahama Breeze, Seasons 52, The Capital Grille, Eddie V's and Yard House

Yes, Darden Restaurants join the whambulance over Obamacare too. Actually, they've been whining about it for a couple of years but now they're getting serious. Like Papa John's, Darden Restaurants is public but owned by bankers and hedge funds to the tune of about 84 percent.

Darden's solution to the problem is to cut employees' hours to under the minimum required to provide health insurance because they just will not tolerate the idea of actually doing something that might cost them a little bit in order for employees to live happier, healthier lives

By the way, Darden is forecasting annual growth of 12 percent. But no Obamacare for their employees, because that might reduce the big profits down to 11.8 percent or something!

Again, shall we call bullsh*t on this one together?

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The first email I saw today was written in an anguished tone by an anguished person. A friend who had been putting off seeing a doctor for what he knew to be a hernia finally became so wracked with pain he made the decision to go to the emergency room. He hoped they'd have a look and tell him they'd have him fixed up in no time. That didn't happen. This did:

The emergency room......put me on the street with a prescription & a referral.

I was afraid of this. He's been in pain for awhile, and we'd been urging him to get to a doctor or even the emergency room. Hernias aren't life-threatening unless they become strangulated. If that happens, immediate surgery is necessary to prevent gangrene from setting in.

I suppose my friend can take some solace in that, but he doesn't because he is still suffering. In a series of follow-up emails, I asked him to tell his story, not only about where he is in this whole stupid process, but how he got to this place. He's not the type to open up, so it took a series of questions and answers. Here are the high points about where he is in the process.

The ER gave me the WRONG number for Community Health Net. I had to call [them] back for the right number.

Community Health Net won't give me a "sliding-fee" appointment until I've applied for Medical Assistance & been denied.

Community Health Net is a community health clinic funded with federal dollars. Those are the clinics Bernie Sanders fought so hard for in the middle of the health care reform battle, and he won. Funding was stepped up considerably for those clinics, though Congress has tried very hard to pull that funding back in the last two years. According to their website, anyone who is uninsured can apply for reduced payment on a "sliding fee" scale according to their income and ability to pay.

But as you see from his response, there appears to be an additional requirement. It seems that he first must apply for insurance and be denied before they will see him on an "ability to pay" basis. Unless, of course, they are homeless and have joined the "health care for the homeless" program. Then they pay nothing.

My friend has a full-time job which requires him to spend long hours on his feet. His payscale is what one might expect for this kind of job, between $9 and $10 per hour. As his condition has gotten worse, he's found himself in a situation where he has to take short breaks and lay down on the floor to, as he says, "let everything slither back in."

Otherwise, he's in pain from the moment he stands up to the moment he sits down. Searing, debilitating gut pain. In his words:

I can't stay on my feet longer than half an hour or so due to the pain. I can't walk properly. I can't work without risking my guts tearing loose. I am disabled.

His job, of course, depends on him being able to stand up for more than 30 minutes at a time, and when he says he's disabled, that doesn't mean he's regarded as disabled for employment purposes.

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If I hear you say this one more time...

"We don’t have a setting across this country where if you don’t have insurance, we just say to you, ‘Tough luck, you’re going to die when you have your heart attack,’  ” he said as he offered more hints as to what he would put in place of “Obamacare,” which he has pledged to repeal.

“No, you go to the hospital, you get treated, you get care, and it’s paid for, either by charity, the government or by the hospital. We don’t have people that become ill, who die in their apartment because they don’t have insurance.”

...I swear I will walk to the next campaign stop you have, no matter where it is, and start screaming until you hear me. So just take a minute, shut your stupid campaign advisers up, sit down, and listen.

Let's start with Ann, your very own wife. Your campaign loves to talk about how she fought back against MS and cancer to be here today. Do you truly believe that would have been possible if you didn't have the health insurance and means to make sure her medical bills were covered?

How did Ann discover she had breast cancer? Did she find a lump and go to the doctor? Or did she have a mammogram? Was it covered by your health insurance? If so, then imagine yourself penniless (I know, it's a stretch of your imagination, but try). Do you think it would have been caught early enough to be handled with a lumpectomy? Because it wouldn't have.

What if you were poor instead of rich in 1998 when Ann started having MS symptoms? Do you think she would have been able to go to a doctor? No, here's how that would have gone. Perhaps she felt dizzy from time to time, or had pain she couldn't explain. Maybe her vision got weird or she was having memory lapses. Whatever the symptoms, if you were not insured and did not have any money, the emergency room would not have helped you one bit.

Here's what would have happened. You might have taken her to the emergency room, where they would take your information including employer, Social Security number, driver's license number, and other information. They would immediately have seen that her condition was not life-threatening and sent her on her way. Whatever costs were incurred would follow her to wherever she worked and lived.

No diagnosis for Ann, but if she actually was lucky enough to get a job and be eligible for her employer's health insurance, that visit to the emergency room meant a pre-existing conditions exclusion would be slapped on her for six months or so, while the MS went untreated. And because the MS went untreated, she might not be able to actually hold onto that job due to cognitive or physical disability.

So now she can't get insurance and she still has no diagnosis, and there's no available treatment for her because she can't afford it, and no neurologist will take her as a patient without some way to pay. While all of this is going on, you and your pals are busy cutting back Medicaid benefits, making eligibility so impossible to meet that it covers children, but not their parents unless they're living in dumpsters and maybe not even then. Because all of your children are adults by the time these symptoms appear, Medicaid might not even cover her at all ever, since she has no dependent children to meet those eligibility requirements.

And still, the emergency room will not treat or medicate the symptoms of MS. Nor will there be any dressage horse for Ann, nor will there be any alternative treatments, nor will there be any traditional treatment, nor will there even be a diagnosis! Because there is no money for those things. Food, shelter, transportation, and clothing take the money. No money for medicine or doctors. None.

Yet you have the audacity to say that emergency rooms are adequate, that they're not going to let you have your heart attack in an apartment.

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During last night's debate, Mitt Romney made a big deal out of how he gave a rat's @ss about people with pre-existing conditions. Only, he doesn't really care much at all. Not in the least.

After the debate, his campaign clarified his remarks about what would happen to those with pre-existing conditions:

“With respect to pre-existing conditions, what Governor Romney has said is for those with continuous coverage, he would continue to make sure that they receive their coverage,” said Eric Fehrnstrom, referring to existing laws which require insurance companies to sell coverage to people who already have insurance, or within 90 days of losing their employer coverage.

In other words, screw you people with pre-existing conditions. You'd better hope you live in a state where they're covered and have the money to pay for it.

President Obama had a different idea on that:

“There are two ways of dealing with our health care crisis. One is to simply leave a whole bunch of people uninsured and let them fend for themselves, to let businesses figure out how long they can continue to pay premiums until finally they just give up, and their workers are no longer getting insured, and that's been the trend line. 

Or, alternatively, we can figure out, how do we make the cost of care more effective? And there are ways of doing it.”

Also, a PS to Mitt Romney. The coverage of kids up to age 26 was not done before Obamacare was passed. Yes. Obamacare did that. Not that facts matter or anything, except yes, they really do.

Of course, the pundits were all abuzz over this, right? Yeah...in my dreams maybe.

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Willard just can't resist the lie, especially when he's desperately trying to save himself. Today was no exception. Mittens, Ryan, or surrogates appeared on every single Sunday show this morning to avail themselves of the free advertising while hoping not to hang themselves on their own self-braided ropes.

When it comes to health care, that rope is long and tangly and even a little magical.

I'm sure the resounding cheers for the Affordable Care Act from Charlotte were heard by the Romney campaign just about everywhere they went. So Mitt, who would sooner die than tell the truth about anything, said this:

MITT ROMNEY: Well, of course not. I say we're going to replace Obamacare. And I'm replacing it with my own plan. And even in Massachusetts when I was governor, our plan there deals with pre-existing conditions and with young people.

DAVID GREGORY: So you'd keep that part of the federal plan?

MITT ROMNEY: Well, I'm not getting rid of all of healthcare reform. Of course there are a number of things that I like in healthcare reform that I'm going to put in place. One is to make sure that those with pre-existing conditions can get coverage. Two is to assure that the marketplace allows for individuals to have policies that cover their family up to whatever age they might like. I also want individuals to be able to buy insurance, health insurance, on their own as opposed to only being able to get it on a tax advantage basis through their company.

My, how generous of him! Except for one small detail. Affordability in Mitt-land and affordability to everyone else are worlds apart. Something has to give, and in Mitt's plan, it's affordability.

Here's the dirty secret about Romney's "replacement": It's no different than what existed before the Affordable Care Act passed. Not one whit. Romney's plan allows people who are already covered by insurance and have pre-existing conditions to pay for it themselves. That's called COBRA continuation. Under HIPAA, individuals who paid their 18 months of COBRA continuation could continue their coverage too.

Yes, they could continue their coverage. For a price. A hefty one, a price no one could possibly afford unless, of course, they were Mitt Romney with his bazillions to spend each month. Nothing to see here, move along.

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Yes, he really said that. He really, truly did, and it's a BFD. digby writes:

Although it sounds ridiculous, Rush is in the process of making his followers believe that the pre-existing condition provision in the health care reforms is something bad and shameful. The reason he's doing this, of course, is because this is the most popular piece of the bill and the one on which the rest of it hinges. If they can divide people on that, the repeal of the plan will be much easier.

Absolutely 100% on the money. The rest of the Affordable Care Act, along with any other proposal for reform like single payer or a public option hinges on one single provision: No exclusion for pre-existing conditions. So the Corpulent One knows that the only way to marshall support for complete repeal is to erode support for covering people with pre-existing conditions.

It drives me crazy now just as it did during the whole debate that there wasn't more focus on effective dates. Waiting until January 1, 2014 for the requirement to cover pre-existing conditions was risky and opens a window for a long, sustained attack. Whether they had passed Medicare for All, a robust public option as part of the overall bill, none of that, or all of that, the heart of the debate is over people who have pre-existing conditions, which are defined by insurers and have been broadened more and more over time. This is only one of many salvos which will be thrown over and over and over again.

digby, again:

People thought it was insane for Rush to say that he wanted the president to fail. But he held the line and made the GOP come crawling for even suggesting that he was wrong. And the party just became more and more radical. They don't see health care reform as sacred and they will feel absolutely no remorse about destroying it.

Here's what concerns me, no matter what side of the Medicare-for-All/SinglePayer/Public Option debate you are on: If they succeed at repealing the requirement to cover people with pre-existing conditions, there will be no possibility of modifying, adding, expanding, or creating a better health care program for this nation. It will all be privatized and Medicare will become a memory we had of our grandparents' day instead of our own.

This is a line they cannot cross.

Well! That worked well, didn't it? (As opposed to Medicare for all, I mean.) Possibly the president and our congressional leadership is beginning to understand just what happens when you invite the health insurance vampires into your house:

Several health insurance companies have announced that they are ending insurance coverage for children because the new law won't let them turn away the sick ones anymore. That's right - WellPoint, CoventryOne and others are refusing to issue new child-only policies because the companies will no longer be able to deny coverage to children with "pre-existing conditions." They blame their actions on the new health care law, not their own greed. Even for the insurance industry this behavior is surprisingly brazen. They don't like the rules, so they're going to take their ball and go home.

The insurance companies announced their plans to turn away sick kids only days before Sept. 23, when important parts of the health insurance law take effect. These include consumer protections that end the worst of insurance company abuses. The law puts an end to odious practices like dropping people because they got sick, putting annual and lifetime limits on how much coverage you can get from the insurance policy you rightly thought covered everything, and denying children coverage because they're sick.

Once the law is fully implemented, insurance companies will not be able to deny any of us coverage because we have an illness, or drop us when we do, or force us into bankruptcy because of caps on how much of our health care they'll pay for (you can read a summary here). That's why this law really is a BFD, and that's why this latest move by the insurance companies is so over the top.

See? Dems running away from the bill (after helping to neuter it in the first place) have created a favorable environment for this game of political "chicken." Now it's coming back to haunt them -- and this time, they'd better not blink.

I received an email from someone I know on Twitter saying that she was getting amazing runaround from Anthem Blue Cross. After raising her individual policy premium by 20% for the 2010-2011 policy year, they were unable to offer her any alternatives for other policies she might switch to. Furthermore, they let her know that she would have to make a decision by September 22, 2010, because everything was changing on September 23rd.

The only problem with that? The service reps she spoke with had no idea what alternatives were available. In addition, they were working very hard to box her into the old policy at the new rate by telling her that any addition of a "preventive package" would result in a higher premium under a new policy but they couldn't tell her what that higher premium would be.

From her summary:

In theory I am entitled to switch to a lower cost plan with fewer benefits without new underwriting if I do it before October 1, 2010. But because some provisions of the health care reform act go into effect there are some plans I can only switch to before September 22, 2010. Today is Sunday, September 19, 2010.

Last week I tried to get information about what plans I could switch to without underwriting. On Wednesday, Sept. 15 and Thursday Sept. 16 I called the Anthem customer care line and spoke to a total of four Anthem Health Plan Advisers (H.P.A.s). Not one of them could quote me a policy premium for September 22 or 23. They gave me four different versions of how the health care reform act would affect my plan.

Of course, September 23, 2010 is when many of the big consumer protections take effect, including requirements to cover adult children until age 26, include free preventive care, end pre-existing conditions exclusions for children under 19, and eliminate lifetime and most annual limits on benefits. So why, at this late date, are individual insureds receiving confusing and mixed messages about what their options are?

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Health care reform has moved from being a bill to being a law. Part of the law is this: Insurers may no longer exclude children under age 18 for a pre-existing condition.

Insurers raise their middle finger to us and say, "Well, that's not exactly what the law says. As we see it, we may have to stop excluding children's conditions in situations where we already cover them for other medical needs, but there's nothing saying we have to issue new policies."

Yes, this is what they are arguing. The ink is not dry on the law yet, the reconciliation bill has not even been signed into law yet, but that doesn't matter to these beasts. It is their plan to be dragged kicking and screaming into the 21st century clutching their teabags, whining and dragging their feet at every turn.

From the New York Times:

Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the “availability of coverage” for all until 2014.

First, this doesn't affect policies covering children under group insurance provided by an employer, because the law clearly uses the words "shall continue to provide" with regard to those dependents.

This particular argument would apply to someone applying for insurance for their child as an individual policy.

Second, there is absolutely no question that the intent (or what is generally called the "spirit of the law") is for pre-existing conditions exclusions to be ended THIS YEAR for ALL CHILDREN under the age of 19. Period.

With legislation this broad, there will always be areas where either a technical correction is needed or a regulation. It's likely that a regulation will suffice to create the clear bridge from no exclusions to guaranteed issue. Frankly, if insurers think it's a good idea to continue to thumb their collective noses at the Congress and President of the United States by either creating or inventing loopholes, they're likely to find themselves without any leverage and little voice in what their future regulatory environment will look like.

They know the spirit and intent of the law. They think they've found a loophole to exploit for PR gains only, since clarification will be forthcoming:

A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.” But lawyers said the rules could be challenged in court if they went beyond the law or were inconsistent with it.

One thing is guaranteed: Picking on children and finding excuses to let them linger with illnesses that either bankrupt their parents or force them onto state Medicaid rolls is not going to make them more popular in Washington, nor with the general public. When insurers exclude newborns with heart defects requiring immediate surgery, it doesn't play well in the news. This is what they will no longer be able to do, and what they've come to expect they are entitled to do anyway.

We are watching one of the most powerful lobbying machines in the United States squeal in anger at its defeat. It's likely to squeal louder before it is vanquished entirely or dies a natural, long overdue death.

Update 4:10pm HHS Secretary Kathleen Sibelius confirms that regulations will require all insurers to cover children AND issue new policies to children regardless of pre-existing conditions.

"To ensure that there is no ambiguity on this point, I am preparing to issue regulations in the weeks ahead ensuring that the term 'pre-existing condition exclusion' applies to both a child's access to a plan and to his or her benefits once he or she is in the plan," the secretary added.