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Topic: Anyone ElseTerrified about Repeal of ACA Bill

Forum: Employment, Insurance, and Other Financial Issues —

Employment, insurance, and financial concerns are common. Meet others here to discuss and for support.

Posted on: Jul 15, 2017 07:35AM

sfar wrote:

Just wondering how people are coping with the constant threat to our health care coverage due to our pre-existing conditions. I've always believed that you need to take action when you're feeling stressed and threatened and this health insurance issue is driving me crazy. I have contacted my senators but both of them are on the same page with me. When I tried to contact the moderate "on the fence" GOPs, they don't accept email from people outside of their state. It just seems so out of our control right now and I hate that feeling. Any thoughts or ideas?




Dx 2/24/2016, IDC, Right, 2cm, Stage IIA, Grade 3, 0/1 nodes, ER+/PR+, HER2+ (FISH) Surgery 3/29/2016 Lumpectomy: Right; Lymph node removal: Sentinel Chemotherapy 4/19/2016 Carboplatin (Paraplatin), Taxotere (docetaxel) Targeted Therapy 4/20/2016 Herceptin (trastuzumab) Radiation Therapy 9/11/2016 Whole-breast: Breast Hormonal Therapy 10/16/2016 Arimidex (anastrozole)
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Jul 18, 2017 02:37PM peggy_j wrote:

Here's the proposal Collins floated in Jan:

https://www.collins.senate.gov/newsroom/cassidy-co...

Repeals: This proposal repeals burdensome federal mandates imposed by the Affordable Care Act, such as the individual mandate, the employer mandate, the actuarial value requirements that force plans to fit into one of four categories, the age band requirements that drive up costs for young people, and the benefit mandates that often force Americans to pay for coverage they don't need and can't afford.

Keeps: This proposal keeps essential consumer protections, including prohibitions on annual and lifetime limits, prohibition of pre-existing condition exclusions, and prohibitions on discrimination. It also preserves guaranteed issue and guaranteed renewability and allows young adults to stay on their parents' plan until age 26, as well as preserving coverage for mental health and substance use disorders.

***

I like what it keeps, but I don't know how you can protect people w/ pre-existing conditions w/o having a mandate. (high risk pools haven't worked). I'm really glad she vocalized the need to not have annual and lifetime caps. (under the other GOP plans caps could be re-instated). Also, looks like oldsters could pay a lot more. (under the ACA, older patients can only be charged 300% the amount of young people. The GOP wanted to raise that to 500%).

Dx 2/2011, IDC, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Jul 18, 2017 03:11PM pupmom wrote:

The three Republican women, who stood up to McConnell about repeal alone, seem to be a lot more compassionate and reasonable than the rest of their caucus. But, any changes to the ACA, hopefully big improvements, have to be done through a broad bipartisan effort. Anything less will fail.

Life is what happens while we're making other plans. Dx 10/18/2011, IDC, Right, 1cm, Stage IIA, Grade 1, 2/21 nodes, ER+/PR+, HER2-
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Jul 18, 2017 03:55PM Spookiesmom wrote:

An article in Huffington Post suggests sending the 3 ladies thank you notes for saying they would vote against.

Ironic that horrible bill was written by 13 men, defeated by 3 women.

Reoccurrence 3-19. Dx IDC, Stage IIIA, Grade 3
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Jul 18, 2017 05:54PM ChiSandy wrote:

And Sen Capito (WV) said, “I didn’t come to Washington to hurt people.”

So what was so terrible about the ACA that it got the GOP’s shorts in a knot? First, the nickname “Obamacare,” which Obama & Congressional Dems. were okay with adopting, as they saw it as Obama’s legacy.

Second, even though it was an exact duplicate of the Mass. plan devised by the Heritage Foundation and implemented by Romney as Gov., it was too much for ultra-conservatives, whose heroes were the prudent industrious Ant in Aesop's tale of “The Grasshopper and the Ant,” and cynical libertarian novelist Ayn Rand, who are dead-set against government support of anyone (except via tax breaks to campaign donors). Two flaws in that: the first example was a fable; and Ayn Rand was a novelist—not an economist nor even a philosopher—whose attitude was shaped by the Communist misery in the USSR from which she fled. She swung way too far in the opposite direction—there was neither incentive for work nor opportunity for enterprise in the USSR, so she dreamed up a binary fantasy world of “makers” (good, to be rewarded) and “takers” (lazy, who should be hung out to dry). Sadly, too many of post-Reagan Republicans are Ayn Rand fanboys. And they are infuriated by the thought of Medicaid for the indigent, the purchase mandate, and any restrictions on corporations’ ability to make a buck any way they see fit.

Third, even though dozens of millions of people finally were able to get meaningful and affordable health care coverage, it is true that a small but significant minority who were not poor enough for Medicaid or a premium subsidy did see their premiums increase dramatically in the later years of the ACA. Part of that was because their pre-ACA plans didn’t cover essential services and had to be canceled in favor of compliant plans, which because these services cost more to render, had their costs passed on to consumers in the form of higher-premium-and-deductible compliant plans. But most people whose premiums rose under the ACA either still paid lower premiums for better coverage than before, or saw their premiums & deductibles rise at a slower rate and far less steep curve than they had in the years before the ACA. A third component was that too many young, healthy (and not poor) people thumbed their noses at the purchase mandate, which was enforced halfheartedly if at all. And the fourth blow to the ACA’s gut was the 2015 slashing (via a stealthy poison-pill amendment to a defense-funding bill) of the "risk-corridor indemnity payments" to insurers—which, put in plain terms, had been the government subsidies to keep the "no-preexisting-conditions” part of the ACA from bankrupting insurance companies. Once the indemnity payments got slashed, insurers began dropping out of markets that were unprofitable, mostly full of older & sicker people and already short on healthcare providers.

The solution needs to start by acknowledging that Obama—though he did not knowingly “lie”—was (perhaps naively) mistaken when he told people they could “keep their doctors” and that they & their employers “keep” their “insurance plans” if they liked. First of all, nobody can force doctors to keep treating patients nor remain in-network regardless of whether they’re being adequately paid for their services. That’s basically involuntary servitude. Second, nobody can prohibit insurers from creating networks and choosing which providers they wish to include or exclude. Whoever wrote Obama’s speeches with his unfortunate assurances, and those who didn’t vet them first and say “whoa, we can’t guarantee that" need to be taken out back behind the shed.

So the Democrats need to realize that while the ACA was a good start and (if adequately funded) a good framework, it’s time to realize it was just the first step and that anything going forward needs to be distinguished from Obama’s achievements. It would keep the best parts of the ACA alive and satisfy Republicans who spent 8 years unsuccessfully repealing “Obamacare” and then promising to “repeal and replace” it.

Then it’s time to tell the Ayn Rand fanboys they need to grow up and realize that novelists aren’t economists. The most critical flaw of the ACA, the one both sides can admit—the higher premiums & deductibles for the unfortunate 15% too well-off for Medicaid or purchase-subsidies—is the first thing that needs fixing. And that means restoring the risk-corridor indemnities, increasing the purchase-subsidies, and enforcing the mandate.

Next, stop making accepting Medicaid money “optional” for state governments, and stop letting them allocate it without any regulations on how to do so.

Then give it another name—neither “Obamacare,” the ACA, BCRA, nor “Trumpcare.” Something neutral like “Americare.”

And if that doesn’t work, create three tiers: Medicaid for the indigent; Medicare for all (with basic premiums based on income and age, and the ability to buy supplemental plans just like in the current Medicare system); and for those who want elective “lifestyle” care on their own schedule and dime, allow the for-profit system to exist. (It won’t flourish). Allow Medicaid & Medicare to negotiate drug prices and reimport drugs (including allowing patients to bring in prescription meds across borders, without confiscation or penalty).

BTW, it’s a fallacy that insurers “should be allowed to sell across state lines.” They already are. But most don’t want to, unless those other states have more profitable consumers and laxer regulations.

Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters.... Dx 9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 9/23/2015 Lumpectomy: Right Radiation Therapy 11/2/2015 3DCRT: Breast Hormonal Therapy 12/31/2015 Femara (letrozole)
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Jul 18, 2017 06:27PM MelissaDallas wrote:

AMEN Sandy!

I'm in the dreaded "no Medicaid, no subsidy" class. I have extremely expensive (higher than mortgage payment) coverage with such high copays and deductible I am terrified to use it. Additionally, it all depends on where you live - the coverage networks here are absolute crap. Half the time the "primary care provider" who is the only medical staff in a clinic is a PA or RN. Some of the facilities don't even have a doctor on site. You certainly can't use UTSW.

I worked in health insurance for years. Insurance companies have always "sold across state lines." They filed the same policy form in multiple states, except for differences of specific state requirements. The main difference from say, Texas to Florida would be the pricing for the same plan varied by cost of living/medical care. Some states mandated a lot of "special stuff" and some didn't.

LCIS, extensive sclerosing adenosis, TAH/BSO & partial omentectomy for mucinous borderline ovarian tumor.
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Jul 19, 2017 10:13AM - edited Jul 19, 2017 10:19AM by marijen

Feature Essay

Understanding the American healthcare reform debate BMJ 2017; 357 doi: doi.org/10.1136/bmj.j2718 (Published 07 June 2017)Cite this as: BMJ 2017;357:j2718
  1. Donald M Berwick, president emeritus and senior fellow
    Author affiliations
  1. dberwick@ihi.org

If you don't understand American healthcare, join the crowd. Donald M Berwick explains US government attempts to repeal and replace the Affordable Care Act

Debates over the US healthcare reform law—the Affordable Care Act (ACA) or "Obamacare"—have raged for almost a decade, with new fury now in the "repeal and replace" initiatives of the Trump administration. The act is complex, the more so because its provisions build on an already tortuous non-system of financing and delivering care to the people of the United States.

Here I present a quick tour of that non-system, an explanation of the basics of the ACA, and an analysis of the present attempts to undo it. Although I have tried to be technically correct, I make no claim to be non-partisan. I was President Obama's appointee as administrator of the US Centers for Medicare and Medicaid Services between July 2010 and December 2011, which provides insurance at a cost above $820bn (£640bn; €730bn) to over 100 million Americans and which was and is responsible for implementing and managing more than 70% of the provisions of the ACA. I am a fan of the ACA, and I strongly oppose its repeal.

Understanding the ACA and its critics requires an understanding of how the US funds its healthcare. There are seven main routes of funding (box 1).

Box 1: How the US funds healthcare
  • Employer sponsored insurance for about 160 million people—workers and their families—in which premium costs are shared between employers (usually 60%-80% of the costs) and employees
  • Medicare—the tax supported federal health insurance scheme established in 1965 for Americans over 65 years of age (about 50 million people) and some others with disabilities
  • Medicaid—tax supported insurance, also begun in 1965, managed through the states and funded by a sharing of costs between states and the federal government, covering the care of people with low income, including those in long term care facilities. (Each state determines eligibility criteria.) About 70 million people each year have Medicaid coverage at some time during the year, but it is an ever changing pool as people come into and out of poverty
  • Children's Health Insurance Program—essentially a Medicaid-like federal programme for about 8 million children
  • Department of Defense's healthcare system for service members and their families (8 million)
  • Veteran's Health Administration for military veterans and their families (8 million)
  • The individual and small group market—consists of roughly 20 million people who do not qualify for any of the other forms of coverage and who either find insurance on their own or go without

The funds flowing through these channels now amount to about $3tr a year, 18% of the entire US economy. Healthcare costs account for more than 25% of the federal government's budget and are by far the fastest growing component of public expenditure in the US.

Closing the coverage gap

When President Barak Obama took office, around 50 million Americans lacked any health insurance because they did not fit into any of the existing payment streams. Many were simply unable to find affordable insurance or, because they had pre-existing medical conditions, could not find any insurance company willing to cover them.

President Obama made closing that coverage gap his flagship domestic policy initiative (allegedly against the advice of many of his staff). With enormous political conflict and through a long list of compromises with stakeholder groups, he was able to get the Affordable Care Act passed by Congress in March 2010, 14 months after his inauguration.

The ACA is hard to summarise briefly. It has 10 "titles" (sections) and is well over 1000 pages long. It may be best understood as, in effect, two bills in a single package.

One major theme is to improve healthcare insurance by extending coverage to more people and by placing insurers under new requirements that effectively make coverage more comprehensive and robust. More people are covered through Medicaid by setting a single, national threshold for eligibility (anyone whose annual income is less than 138% of the federally defined "poverty" definition). The act also established either state or federal "exchanges" (now called marketplaces) in which individuals between 138% and 400% of the federal poverty level can find commercial policies and receive a subsidy from the federal government to help them buy that coverage. In its initial design, the ACA was estimated to cover 16 million more people in Medicaid and 16 million more people in the exchanges. The ACA also introduced a popular provision that made children eligible for coverage under their parents' health insurance policies up to the age of 26 years.

To make this all work, the ACA introduced a range of requirements for the insurance industry. One—"guaranteed issue"—forbade insurers from denying coverage because of pre-existing conditions. Another—"community rating"—required pooling of well and ill beneficiaries in a common actuarial pool so that the premiums would be affordable to people with greater need for care.

Individual mandate

By far the most controversial requirement was the "individual mandate," under which every American had to obtain health insurance or pay a penalty. Without that requirement, given the new guaranteed issue provision, a well person could choose not to buy insurance until he or she became ill, which would make the actuarial pools unsustainable—as if people could wait to buy fire insurance until their house was in flames.

The other main part of the ACA addressed delivery of care. It did this by introducing a wide range of payment mechanisms to create incentives for healthcare providers to work more closely together and to provide more integrated care. Among the best known of these were accountable care organisations (which could in theory unify the aims of hospitals and community based care) and "bundled payment" for episodes of care (such as total joint replacement) rather than elements of care (such as operating theatre time or physician fees). The ACA also created new forms of transparency, public reports, and antifraud enforcement, as well as a new Center for Medicare and Medicaid Innovation with $10bn of funds to support widespread trials of new designs of care.

The costs of the expanded coverage of the ACA—about $1tr over 10 years—were offset with projected savings from better care, some reductions in payments to hospitals and private insurers, and a series of new taxes facing mainly wealthier taxpayers.

Problems with Obamacare

The ACA achieved many of its aims. For example, by the time of President Trump's January 2017 inauguration, more than 20 million additional people had health coverage, the rate of rise of healthcare costs had somewhat slowed, major innovations in care and payment were being widely tested, reductions in hospital complications and readmissions were well documented, and the quality of insurance had generally improved. Problems were developing in many of the exchanges because of instability in enrolments in the fraught individual and small group market, and drug costs—never targeted by the ACA—were rising rapaciously. And, during the Obama years, the US Supreme Court weakened the Medicaid expansion provision by denying the federal government the authority to require expansion. As a result, when Obama left office, 19 states had still not expanded Medicaid.

More to the point, the prominence of the ACA as ground zero for political attacks from the Republican party never abated during the seven years between the ACA's passage and the election of Donald Trump as president. Their rhetoric was unremittingly negative, and the Republicans vowed that once in office they would repeal the law forthwith.

But despite Republicans getting control of the White House and Congress in 2016, the repeal of Obamacare has not gone to plan. Two headwinds developed.

Firstly, it has proved difficult, if not impossible, for the Republican party to agree internally on the exact terms of ACA repeal. Secondly, the American public has begun to experience and notice benefits from the ACA that most people are now reluctant to give up. People with pre-existing conditions feared loss of insurance if the ACA requirements were weakened. The 31 states that had expanded their Medicaid programmes (many of them Republican states) were enjoying newfound federal dollars to cover impoverished patients whose care would otherwise have to be paid for by states and their local charities. And hospitals found that the formerly "free care" populations they had to serve without payment now had insurance coverage.

It seemed politically unwise to wrench those improvements from the public, but the far right wing of the Republican Party—the Freedom Caucus—refused to support any repeal-and-replace bill that maintained the federal subsidies and requirements that would have been required to avoid that implosion.

Effect of repeal bill

The bill that finally passed the US House of Representatives on 4 May 2017, in a close vote (217 to 213), acceded to many of the Freedom Caucus's demands. It in effect would end the Medicaid expansion support (taking coverage away from about 14 million poor people and nursing home residents), end income based subsidies for purchase of policies in the exchanges (substituting inadequate age based subsidies), weaken guaranteed issue requirements, weaken community rating (thus putting insurance premiums for sicker people out of reach for millions), weaken coverage requirements (by permitting policies without such formerly required benefits as maternity care and mental healthcare), and begin to move Medicaid from a federal state partnership to a "block grant" in which states would assume much more risk for coverage costs. The bill also would end the ACA's investment in a crucially important Prevention Fund, intended to advance the work of the US Centers for Disease Prevention and Control and others on social determinants of health and the upstream causes of illness.

The non-partisan Congressional Budget Office determined that if the House bill became law about 23 million people would lose coverage, federal Medicaid contributions would fall by more than $800bn over 10 years, and Americans in higher income brackets (about $250 000 annual income) would experience about $1tr in lower taxes over 10 years. Compared with the ACA, the House bill thus amounts to a transfer of about $1tr over 10 years from older, sicker, and lower income Americans to those in the top 2% of the income distribution.

More hurdles

Each chamber in Congress has to come up with its own bill and then reconcile them. So the American Health Care Act (AHCA) being proposed will be substantially changed. The legislative ball has now shifted to the US Senate, where more moderate Republican voices tend to be heard than in the House. Republican Senate leaders have publicly stated that the House bill cannot pass the Senate, and are apparently shaping their own repeal-and-replace proposal. What that will be, and whether the Venn diagram overlaps at all with what could pass the House, is yet to be known.

In the meantime, a minor but important chorus has been developing, almost as a sideshow, not yet embraced by any visible bipartisan Congressional leaders, and not at all by the White House. That voice identifies a discrete set of technical problems with the ACA, such as in the details of the supports for the individual and small group market on the exchanges, ways to encourage young and healthy people to obtain insurance, and providing reinsurance and other supports to insurance companies who find themselves covering riskier populations than they had estimated.

In happier, less partisan times, an enterprise to improve an important and largely successful law based on empirical evidence and experience would seem obvious. And the wisest path would not only repair the ACA but also go on to address the needs of the people—over 20 million of them—that, even with the ACA, still lack insurance. But, for the present, that productive approach seems, sadly, out of reach.

It should not go unnoticed that a vocal minority of critics of the current American health insurance system argue persistently that the most straightforward remedy would be, not the amalgam of financing of the ACA, but rather a "single payer" system—essentially Medicare for all. That idea has not yet gained political traction, largely because of the opposition of powerful lobbying interests, most importantly the healthcare insurance industry, which would stand to lose the most.

Massive step backwards

Whatever the next act will be in the ACA drama, perhaps the most important fact of all is that the United States, despite its wealth, remains the only Western democracy that has not embraced universal healthcare, explicitly or implicitly, as a human right.

The Affordable Care Act, though imperfect, was the largest step towards that goal that the US has taken since the creation of Medicare and Medicaid in 1965. The AHCA in anything like the form the House approved would be a massive and immoral step backwards, leaving tens of millions of Americans once again to face needless risk, greater suffering, and, for many, destitution. The hope is that wiser heads and more compassionate hearts will prevail among the nation's leaders.

Biography

Donald M Berwick, a paediatrician by background, is a global authority on healthcare quality and improvement and a former administrator of the US Centers for Medicare and Medicaid Services.

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Jul 19, 2017 10:35AM ruthbru wrote:

Keep contacting your senators, keep contacting your senators, keep contacting your senators; and have your friends (especially if they are non-political) contact them too.

"Invisible threads are the strongest ties." Friedrich Nietzsche Dx 2/2007, Stage IIA, Grade 3, 0/11 nodes, ER+/PR-, HER2-
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Jul 19, 2017 01:56PM sybilskelton wrote:

What has baffled me for years is how the hell healthcare became a political football. I've become more and more discouraged in recent years that we as a society can't even agree on something as fundamental as everyone being entitled to medical care, and there are politicians who use the issue to raise money so they can further alienate us so they can raise more money. Lather, rinse, repeat. It's very depressing.

Dx 7/17/2014, DCIS, Left, 3cm, Stage 0, ER+/PR-, HER2- Surgery 8/8/2014 Lumpectomy: Left; Lymph node removal: Left, Sentinel Chemotherapy 9/9/2014 Abraxane (albumin-bound or nab-paclitaxel), Adriamycin (doxorubicin), Cytoxan (cyclophosphamide) Chemotherapy 11/7/2014 Taxol (paclitaxel) Radiation Therapy 3/2/2015 Breast, Lymph nodes
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Jul 20, 2017 08:46PM peggy_j wrote:

BTW, the ACA requires Congress to use ACA insurance. The new GOP plans specifically exempt Congress and their staffers. Coincidence? Maybe if this were required the plans would be better.


What if, each time we contact our elected Reps, that we include this requirement too?

Dx 2/2011, IDC, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Jul 20, 2017 11:56PM - edited Jul 20, 2017 11:59PM by voraciousreader

regarding a fundamental right to healthcare... the details are what prevents that possibility... and, not to be a contrarian, there are issues with that philosophy... one need only look over the pond to Britain where the infant Charlie Gard's life is grabbing headlines around the world... we see in that situation where the government and its single payer system usurps the rights of the patient and in this situation, the parents. And, need I remind many of you how often you will hear some older person in the US say, "Could you believe Medicare won't pay for such and such." So, what might look good on paper, may not work in everyday life. I believe that the present system, Obamacare, was doomed before it started. Mandating that people purchase it without a large penalty for those who wouldn't participate was the kiss of death for the plan.


Now with respect to fixing it, I am not sure that it can be fixed so that at the end of the day premiums would be affordable and we can still have among the world's best hospitals and doctors.


My maternal family is filled with Canadians and from my own personal experience, two Canadian family members were trained in Canada to become physicians and bolted the country and now practice in the US. A third, American family member went to Canada for their medical training and left before it was time for their mandatory service....


So, I think one must be careful in what it is they wish for. While it is noble to create a healthcare system that doesn't bankrupt an individual, nor a country, it is extremely important not to disrupt a healthcare system that supports the best and brightest doctors who choose to practice in the United States. I am just not sure how those competing forces can be corrected...


The only thing I am sure of is that Obamacare is in a death spiral with insurance companies pulling out of the marketplace. Are we to subsidize them to keep them participating? It is similar to how the government bailed out the banks during the 2008 meltdown and what we know now is that many bankers got awfully rich while the country went into further debt. And look to the east to see who us buying up all our debt.... China!


Our country doesn't need any more debt. So we all better hope that our politicians and policy wonks come up with a solution. Our economy and our lives depend on it.


And finally, there is lots to blame on both sides of the aisle. I pine for those longago days when there was bipartisan cooperation.


Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Jul 21, 2017 12:18AM voraciousreader wrote:

one last point that I omitted and is worth mentioning... private health insurance also denies treatments. However, since most specialties have standard of care guidelines, patients will be offered the standard of care. Experimental care, like what is being proposed for little Charlie, is not usually offered in the US unless it is part of a clinical trial. But what seems so cruel in Britain is that the government is standing in the way of permitting that experimental care which is being offered. I don't recall that ever happening here in the US. If a person qualifies for a clinical trial, our government does not stand in the way of a patient receiving it.



Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Jul 21, 2017 01:23AM ChiSandy wrote:

Charlie Gard’s family was finally given permission today by the NHS to bring him here.

And enough with the conservative talking points about “Obamacare death spiral.” The ACA was finally beginning to click just before the Senate went Republican in 2014’s midterm and Rubio’s poison pill amendment—slipped into an unrelated defense appropriations bill—stabbed the ACA in the gut by slashing the risk-corridor indemnities that allowed insurance companies to survive guaranteed-issue/community rating. Citing the b.s. meme “Obamacare death spiral” is like killing your parents and then demanding mercy because you’re an orphan.

BTW, I am a cardiologist’s wife. He’s been in private practice for 34 years. Yes, he earns a nice living, but he has to spend more time on paperwork, jumping through insurance companies’ hoops for pennies on the dollar of what he bills, than he can rendering the personal care he wants to (and used to be able to) provide. He works till late at night, and then has to spent 2-3 hrs. at home dictating charts and EMRs. The original concept of HMOs—cooperatives that focused on maintaining health to reduce sickness and the costs of treating it—has become perverted over the years into “managed care” where treatment decisions are made not by doctors and experienced hospital administrators but by lay bean counters fresh out of business school.

Wanna know the definition of “managed care?” “We don’t care, but you’ll have to manage."

Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters.... Dx 9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 9/23/2015 Lumpectomy: Right Radiation Therapy 11/2/2015 3DCRT: Breast Hormonal Therapy 12/31/2015 Femara (letrozole)
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Jul 21, 2017 08:54AM - edited Jul 21, 2017 09:21AM by voraciousreader

Sandy....my son-in-law is also a physician AND my husband's best friend was counsel to one of the largest insurance providers, so I am extremely familiar with the architecture of Obamacare. In fact, while Obamacare was in the discussion phase, my husband's best friend was invited to The White House and personally discussed the creation. Once it was approved, he said that the program would be unsustainable. At the time he reasoned that because the penalty was so low, it would not draw enough young people into the program. He said within 5 years it would collapse....which it is doing, hence, death spiral.


I am affected by Obamacare. I purchased a policy after I was told my previous policy was being terminated due to Obamacare. So, I couldn't keep my plan. So, I signed up for Obamacare and wasn't offered any supplement by the government. That company became insolvent after two years. Some of my doctors were not paid for their services. I, along with 30,000 of my fellow New Yorkers, then had to choose from among the remaining insurance companies. I am now paying more in premiums than I did from BEFORE Obamacare AND not only can I not see some of my physicians, I can't even go to the hospitals of my choice. In the event of an emergency, I can go to any hospital, but I would have to be moved, once stabilized, to one of the hospitals in my plan.


Sandy...you do realize that I am lucky though...if you want to call it "lucky" because in my state I still have choices among insurance companies, but today, many insurance companies are pulling out of state exchanges and have left almost a quarter of the people who need health insurance with only one insurance provider. Not good. Furthermore, because premiums have become so expensive, some people are choosing ONLY catastrophic insurance. That is what I am considering doing....


And little Charlie, the British government has not yet given his parents permission to take him to Columbia Presbyterian Hospital in New York. There is a sense of irony if their government give his parents the right to take him there, because, since I signed up for Obamacare, I can't go to Columbia Presbyterian Hospital. And, more to the point, at least, here in America, once a child is admitted to a hospital, parents don't automatically lose their rights to choose their child's treatment....


That said, whether liberal or conservative, the underlying problem is that the ACA was doomed to failure from the moment it was passed and what needs to be done now requires bipartisan cooperation. Sadly, I doubt that will happen....and, what I would be doing now is DEMAND term limits for our elected officials. I think we need new blood in government... I think when Obamacare was decided, our career politicians cared more about retaining power than devising a workable and affordable healthcare model. Based on the conversations that I had with my husband's best friend, it appears that when the ACA was developed, most of the politicians, including Obama, were deaf and now, we, including myself, are paying the price for their ineptitude...



Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Sep 17, 2017 09:50PM swg wrote:

FYI - they're trying to repeal the ACA again!!!!

This time it's called the Graham/Cassidy bill...PLEASE CALL YOUR SENATORS..they would need to pass this by Sept 30th. CALL CALL CALL!!

Dx 9/11/17. IDC grade 2, stage 1. 1.2cm. in right breast. ER+/PR+, HER2- 2nd tumor in right breast found 10/22/17. Dx 9/11/2017, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (IHC) Dx 10/23/2017, DCIS/IDC, Right, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 11/28/2017 Mastectomy; Reconstruction (right): Tissue expander placement
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Sep 20, 2017 03:43PM Fallleaves wrote:

Rand Paul already came out against, so we need 2 more senators to vote no to kill this bill. The most likely to vote no are Susan Collins of Maine (202)224-2523, Lisa Murkowski of Alaska (202)224-6665, and John McCain of Arizona (202) 224-2235. This bill is the worst version yet, and would allow insurance companies (through waivers) to reinstate lifetime caps on coverage, and hike premiums for preexisting conditions.

Dx 7/5/2013, IDC, 2cm, Stage I, Grade 2, 0/2 nodes, ER+/PR+, HER2- Surgery 8/19/2013 Lumpectomy: Right
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Sep 21, 2017 06:53PM swg wrote:

I was going to post about how STRESSED I have been ever since I found out about this latest repeal effort. This is SO disgusting. I'm on the ACA. I'm self-employed and I cannot afford insurance w/out it!

Everyone on this forum has cancer, which is a pre-existing condition. The ACA makes it unlawful for insurance companies to gouge us for having cancer. That protection will be stripped from us if this bill passes. So..it doesn't matter if you're covered now. You could lose your coverage in the future, and never be able to get insurance again.

I'm going to be honest--if I didn't have my affordable health insurance plan, I would NOT have gotten by breast dimple checked out. I would've figured it's too expensive to go to the doctor. And I probably would have just convinced myself it was nothing..until it got to the point of being too late to treat it.

So, the ACA has already probably saved my life.

I don't know what I'm gonna do without it. I absolutely CANNOT afford health insurance if I lose it. I just can't. It's already hard to pay my co-pays--$60 each to see a specialist.

I've been calling and urging all my friends to call..they know this is a life or death situation for me :(

Dx 9/11/17. IDC grade 2, stage 1. 1.2cm. in right breast. ER+/PR+, HER2- 2nd tumor in right breast found 10/22/17. Dx 9/11/2017, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (IHC) Dx 10/23/2017, DCIS/IDC, Right, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 11/28/2017 Mastectomy; Reconstruction (right): Tissue expander placement
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Sep 22, 2017 11:09AM rainnyc wrote:

McCain just came out as a no vote.

Paul, Collins, Murkowski still up in the air. It's not over, but McCain's giving cover to others who might also vote no.

And yes, I'm self-employed and was diagnosed four months after transitioning from another plan to an ACA plan. So it's life or death for me.

Dx 4/2015, IDC, ER-/PR-, HER2+ Chemotherapy 5/12/2015 Taxol (paclitaxel) Targeted Therapy 5/12/2015 Herceptin (trastuzumab) Surgery 9/22/2015 Mastectomy: Left, Right Radiation Therapy 11/1/2015 Lymph nodes, Chest wall Targeted Therapy Perjeta (pertuzumab)
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Sep 22, 2017 11:31AM lovepugs77 wrote:

Me too, rainnyc. I hope he follows through with that "no" vote.

DX at age 39 Dx 2/17/2017, IDC, Left, 2cm, Stage IIIA, Grade 2, 4/24 nodes, ER+/PR+, HER2- Dx 2/17/2017, DCIS, Right, Stage 0, Grade 3, ER+/PR+, HER2- Surgery 3/28/2017 Lumpectomy: Left, Right; Lymph node removal: Sentinel Surgery 4/13/2017 Lymph node removal: Left Chemotherapy 5/18/2017 AC + T (Taxol) Radiation Therapy 9/27/2017 Whole-breast: Breast, Lymph nodes Hormonal Therapy 11/15/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Sep 22, 2017 12:31PM pupmom wrote:

Paul is a firm NO. Collins is a leaning NO. Murkowski is undecided. Looks like this latest fiasco of a "health care" bill will fail. Good.

Life is what happens while we're making other plans. Dx 10/18/2011, IDC, Right, 1cm, Stage IIA, Grade 1, 2/21 nodes, ER+/PR+, HER2-
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Sep 22, 2017 12:36PM letsgogolf wrote:

I have tried to call Capito for 2 days. Her mailbox is full. Imagine that!

Oncotype DX = 3. IDC with Lobular Features. Sentinel Node had Micrometastases - Estrogen 100%, Progesterone 99.89%, Ki67= 3.3% Dx 2/14/2017, IDC, Left, 1cm, Stage IB, Grade 1, 0/8 nodes, ER+/PR+, HER2- Surgery 2/27/2017 Lumpectomy: Left Radiation Therapy 4/6/2017 Whole-breast: Lymph nodes Hormonal Therapy 6/1/2017 Arimidex (anastrozole) Targeted Therapy
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Sep 22, 2017 03:44PM Artista928 wrote:

Yeah they say last attempt, like they did last time, but there will probably be another last attempt or two. They just can't let it go.

Dx'd at 50. Doing it all, all by myself. Stopped Letrozole after 5 weeks. Debilitating se's. Back on Tamox now. Dx 6/2/2015, IDC, Left, 6cm+, Stage IIIA, Grade 3, 1/4 nodes, ER+/PR+, HER2- (DUAL) Surgery 8/6/2015 Lymph node removal: Left, Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 11/3/2015 AC + T (Taxotere) Radiation Therapy 5/2/2016 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 6/28/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 12/9/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/14/2017 Femara (letrozole) Hormonal Therapy 3/26/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 9/1/2017 Reconstruction (right): Fat grafting, Silicone implant
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Sep 22, 2017 08:27PM Siciliana wrote:

It's looking more and more like the repeal attempt is going to fail. John McCain announced his opposition again!

Dx 12/19/2016, ILC, Right, 1cm, Stage IIA, Grade 2, 1/3 nodes, ER+/PR+, HER2- Surgery 2/23/2017 Lumpectomy: Right; Lymph node removal: Sentinel Hormonal Therapy 6/3/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Whole-breast: Breast, Lymph nodes
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Sep 22, 2017 10:44PM - edited Sep 23, 2017 02:59PM by ChiSandy

They tried to bribe Murkowski by letting Alaska keep the ACA. But every legal expert says that's blatantly unconstitutional, because all imposts & taxes must be levied equally upon all states. I think McCain's announcement today will cause enough other GOP Sens. to jump ship and sink this stinker of a bill.

My husband & I are on Medicare, so we're safe. I was on my husband's office's group plan when diagnosed and completed rads just before going on Medicare. But our son has an individual ACA-compliant Bronze plan, is in a field where employer-provided insurance is rare (he's a freelance not-yet-Equity-eligible actor, writer and improv comic). He also is asthmatic and on lifetime maintenance therapy for depression. Now, heaven forbid he loses that insurance or his premiums skyrocket, we are fortunate enough to have enough socked away to cover his medical needs. But most parents of marginally-employed millennials aren't.

Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters.... Dx 9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 9/23/2015 Lumpectomy: Right Radiation Therapy 11/2/2015 3DCRT: Breast Hormonal Therapy 12/31/2015 Femara (letrozole)
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Sep 23, 2017 07:28AM Artista928 wrote:

I'm astonished Sandy. How the hell can they get away with this??!

Dx'd at 50. Doing it all, all by myself. Stopped Letrozole after 5 weeks. Debilitating se's. Back on Tamox now. Dx 6/2/2015, IDC, Left, 6cm+, Stage IIIA, Grade 3, 1/4 nodes, ER+/PR+, HER2- (DUAL) Surgery 8/6/2015 Lymph node removal: Left, Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 11/3/2015 AC + T (Taxotere) Radiation Therapy 5/2/2016 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 6/28/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 12/9/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/14/2017 Femara (letrozole) Hormonal Therapy 3/26/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 9/1/2017 Reconstruction (right): Fat grafting, Silicone implant
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Sep 23, 2017 09:22AM swg wrote:

You're on Medicare, so you're safe but..aren't they also cutting Medicare with this bill?

I'm an actor and model. So I'm self employed, like your son. Only I didn't start modeling by choice. I had a good job, with DECENT health insurance. Not great health insurance, but I didn't pay much for it. I noticed employer sponsored health plans were getting worse and worse over the years.

Anyway, I got laid off a the height of the recession. People FORGET how bad things were. I could NOT find another job.

When I got laid off, they offered me COBRA..$500/month!! Now how did they expect me to pay for that, when I'd just gotten LAID OFF?

Things were awful before the ACA but the GOP is trying to rewrite history as if everything was hunky dory.

I'm glad what they're doing with Murkowski is unconstitutional. If this passes, maybe a lawsuit is in order?

Dx 9/11/17. IDC grade 2, stage 1. 1.2cm. in right breast. ER+/PR+, HER2- 2nd tumor in right breast found 10/22/17. Dx 9/11/2017, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- (IHC) Dx 10/23/2017, DCIS/IDC, Right, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2- Surgery 11/28/2017 Mastectomy; Reconstruction (right): Tissue expander placement
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Sep 23, 2017 10:01AM - edited Sep 23, 2017 10:02AM by Artista928

Medicare isn't being affected by this bill. Trump vowed not to touch it or social security. Track record shows he keeps his promises so we should be fine. Plus much of his base are the older folks. Imagine the uproar as bad or worse than ACA. Can't lose his base..

Dx'd at 50. Doing it all, all by myself. Stopped Letrozole after 5 weeks. Debilitating se's. Back on Tamox now. Dx 6/2/2015, IDC, Left, 6cm+, Stage IIIA, Grade 3, 1/4 nodes, ER+/PR+, HER2- (DUAL) Surgery 8/6/2015 Lymph node removal: Left, Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 11/3/2015 AC + T (Taxotere) Radiation Therapy 5/2/2016 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 6/28/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 12/9/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/14/2017 Femara (letrozole) Hormonal Therapy 3/26/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 9/1/2017 Reconstruction (right): Fat grafting, Silicone implant
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Sep 23, 2017 10:53AM - edited Sep 23, 2017 10:54AM by voraciousreader

ok...so two of the plans I participated in went belly up. obama lied...can't see my doctors. Program is UNSUSTAINABLE. Must be fixed. Here in NY...paying close to $750 for platinum plan....


Problem is penalty isn't high enough to get enouh people to join. Insurance companies were made unkept promises by government and don't want to assume more risk....



Want to talk about federal flood insurance program too? Ticking time bomb as welll...


Bottom line...present program is unsustainable unless EVERYONE joins and premiums are affordable. Wishing for more of the same is NOT the solution

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)
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Sep 23, 2017 02:53PM - edited Sep 23, 2017 02:54PM by Artista928

No one's wishing for more of the same, but the bills that have been presented kick off the poorer and sick. Sorry you need to pay higher premiums than some but at least having health insurance which is affordable for more than before is better than not, and better than kicking off millions who by the way need it the most by far. I'm rooting for bipartisan effort to sift through the ACA to find solutions, not this quick pull the rug out from those who need hc the most crap repubs are trying to pull. Better yet, single payer like all other countries! Medicare for all. But no profit in that so the repubs and some dems will shoot it down.

Dx'd at 50. Doing it all, all by myself. Stopped Letrozole after 5 weeks. Debilitating se's. Back on Tamox now. Dx 6/2/2015, IDC, Left, 6cm+, Stage IIIA, Grade 3, 1/4 nodes, ER+/PR+, HER2- (DUAL) Surgery 8/6/2015 Lymph node removal: Left, Sentinel; Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Chemotherapy 11/3/2015 AC + T (Taxotere) Radiation Therapy 5/2/2016 Whole-breast: Breast, Lymph nodes, Chest wall Hormonal Therapy 6/28/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 12/9/2016 Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 2/14/2017 Femara (letrozole) Hormonal Therapy 3/26/2017 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 9/1/2017 Reconstruction (right): Fat grafting, Silicone implant
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Sep 23, 2017 03:19PM ChiSandy wrote:

Obama didn't "lie," he himself was misled--at the time he stated "if you like your plan you can keep it and if you like your doctor you can keep him," he actually believed that. He hadn't factored in insurance companies' reluctance to operate in regions without a profit and ability to strictly define provider networks, doctors being reimbursed inadequately and quitting some networks--or being kicked off networks by insurers trying to consolidate claimants and cut costs. Those things had not yet been part of the ACA--they were inserted to win over conservative Democrats in Congress who had insurers as major donors. And he also had not factored into millennials' false sense of invulnerability that led them to flout the mandate and gamble (successfully) that it wouldn't be enforced by the IRS against them. Without the premium dollars produced by the mandate, many insurers couldn't operate profitably (at least not enough to please their shareholders). And the gov't couldn't provide adequate risk corridor subsidies to them for guaranteed insurability and bans on caps.

This bill may not make it through, and Trump/Price are trying their level best to keep sabotaging the ACA by halving the length of the open enrollment period, pulling all ads to get people to sign up and instead using taxpayer dollars to make ads featuring right-wing doctors dissing the ACA and discouraging enrollment, and now shutting down the healthcare.gov website (or making it as barebones and difficult to use as possible).

As to Medicare, unlike Medicaid, the ACA repeal efforts thus far haven't touched it. It and Social Security are the third rails of public policy--any politician who steps on them will be electorally electrocuted. But once we boomers and older Gen-Xers die off, the Ayn Rand-worshipping millennials will be eager to privatize everything--because they don't think they'll ever get sick, need to retire, nor lack retirement income should they choose to retire. As I said, their naive sense of invulnerability is breathtaking.

Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters.... Dx 9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 9/23/2015 Lumpectomy: Right Radiation Therapy 11/2/2015 3DCRT: Breast Hormonal Therapy 12/31/2015 Femara (letrozole)
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Sep 23, 2017 03:48PM voraciousreader wrote:

shame on Obama for being “misled”....then again..we were all hoodwinked when there were no weapons of mass destruction...


The job of the president is to get the best info and then make an informed decision. There was none of that when Obamacare was passed. It was unsustainable from day one.


Single payer? Great when you are well. I speak from experience having been responsible for my Canadian family’s health....


That said...yes...bipartisian agreement...no...to the present unsustainable plan. I wish I could wave a wand and fix the current plan...but there are too many issues with Obamacare and I hold Obama responsible because I know for a FACT that he was informed about the “issues”before it was passed...but he and his supporters CHOSE to pass the legislation that was destined to fail and now we are paying the price both figuratively AND literally....


A mess

Doctor told me regarding my prognosis that I WASN'T on the Titanic! Hmmm...Really?....Okay! 02/2010 Pure Mucinous Breast Cancer, Oncotype DX 15, Stage 1, Grade 1, 1.8 cm, 0/2 nodes, ER+ 90% /PR+ 70% HER2- (+1)

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