[ {"id":"dc344042-9f39-5ba4-a825-6626b096521e","type":"article","starttime":"1493346600","starttime_iso8601":"2017-04-27T19:30:00-07:00","lastupdated":"1493349846","priority":43,"sections":[{"steller":"news/local/columnists/steller"}],"flags":{"top_story":"true"},"application":"editorial","title":"Steller: McSally tinkers with fatally flawed health-care bill","url":"http://tucson.com/news/local/columnists/steller/article_dc344042-9f39-5ba4-a825-6626b096521e.html","permalink":"http://tucson.com/news/local/columnists/steller/steller-mcsally-tinkers-with-fatally-flawed-health-care-bill/article_dc344042-9f39-5ba4-a825-6626b096521e.html","canonical":"http://tucson.com/news/local/columnists/steller/steller-mcsally-tinkers-with-fatally-flawed-health-care-bill/article_dc344042-9f39-5ba4-a825-6626b096521e.html","relatedAssetCounts":{"article":0,"audio":0,"image":2,"link":0,"vmix":0,"youtube":0,"gallery":0},"byline":"Tim Steller\nArizona Daily Star","prologue":"The Affordable Care Act is not \"collapsing under its own weight,\" so it doesn't need a bad replacement.","supportsComments":true,"commentCount":0,"keywords":["affordable care act","health care","obamacare"],"internalKeywords":["#latest","#column","#top5","#topread"],"customProperties":{"arm_id":"76217"},"presentation":"","images":[{"id":"85ba64ec-290f-5a65-9081-21ee51236226","description":"Rep. Martha McSally","byline":"Kelly Presnell / Arizona Daily Star/","hireswidth":1749,"hiresheight":1185,"hiresurl":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/8/5b/85ba64ec-290f-5a65-9081-21ee51236226/5902a134b1f4c.hires.jpg","presentation":"","versions":{"full":{"type":"image/jpeg","width":"1122","height":"760","url":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/8/5b/85ba64ec-290f-5a65-9081-21ee51236226/58af932e8225e.image.jpg?resize=1122%2C760"},"100": {"type":"image/jpeg","width":"100","height":"68","url":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/8/5b/85ba64ec-290f-5a65-9081-21ee51236226/58af932e8225e.image.jpg?resize=100%2C68"},"300": {"type":"image/jpeg","width":"300","height":"203","url":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/8/5b/85ba64ec-290f-5a65-9081-21ee51236226/58af932e8225e.image.jpg?resize=300%2C203"},"1024":{"type":"image/jpeg","width":"1024","height":"694","url":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/8/5b/85ba64ec-290f-5a65-9081-21ee51236226/58af932e8225e.image.jpg?resize=1024%2C694"}}},{"id":"1463d62a-9b6c-5631-9f20-959711aec8be","description":"Tim Steller, columnist for the Arizona Daily Star.","byline":"Mamta Popat / Arizona Daily Star","hireswidth":1803,"hiresheight":1149,"hiresurl":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/1/46/1463d62a-9b6c-5631-9f20-959711aec8be/58cb3684e3dc1.hires.jpg","presentation":"","versions":{"full":{"type":"image/jpeg","width":"1170","height":"746","url":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/1/46/1463d62a-9b6c-5631-9f20-959711aec8be/58cb3684e2ea2.image.jpg?resize=1170%2C746"},"100": {"type":"image/jpeg","width":"100","height":"56","url":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/1/46/1463d62a-9b6c-5631-9f20-959711aec8be/58cb3684e2ea2.image.jpg?crop=1803%2C1014%2C0%2C32&resize=100%2C56&order=crop%2Cresize"},"300": {"type":"image/jpeg","width":"300","height":"169","url":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/1/46/1463d62a-9b6c-5631-9f20-959711aec8be/58cb3684e2ea2.image.jpg?crop=1803%2C1014%2C0%2C32&resize=300%2C169&order=crop%2Cresize"},"1024":{"type":"image/jpeg","width":"1024","height":"576","url":"http://bloximages.chicago2.vip.townnews.com/tucson.com/content/tncms/assets/v3/editorial/1/46/1463d62a-9b6c-5631-9f20-959711aec8be/58cb3684e2ea2.image.jpg?crop=1803%2C1014%2C0%2C32&resize=1024%2C576&order=crop%2Cresize"}}}],"revision":6,"commentID":"dc344042-9f39-5ba4-a825-6626b096521e","body":"

\u2018First, do no harm.\u201d

It\u2019s a medical principle that members of Congress ought to keep in mind when messing with our health-care system.

For Democrats pondering the Republican proposals to replace the Affordable Care Act, the principle is easy to apply. They\u2019ll vote no \u2014 if they ever get the chance to vote \u2014 because the replacement plan, the American Health Care Act, is worse than what it\u2019s intended to replace. It will lead to millions of people losing insurance without many assured benefits other than an end to the dreaded insurance mandate.

But for Republicans like Tucson\u2019s Rep. Martha McSally, the answer is more complicated.

McSally and many other congressional Republicans ran for election on the idea that \u2014 to use the phrase she and others repeated often \u2014 \u201cObamacare is collapsing under its own weight.\u201d

So McSally has taken a tack of trying to fix the problems with the proposed replacements, rather than recognizing that the replacements themselves might be the biggest problem.

In March, she helped negotiate changes to the original replacement bill: Getting an additional $15 billion for mothers, newborns and people with mental illness or substance-abuse problems was one. She also has argued for a longer transition from the old Medicaid subsidies to a new, pared-down system.

Like much of the congressional GOP, McSally has been wedded since last year\u2019s campaigns to the idea of Obamacare collapsing, a phrase suggesting that any replacement would be better than the ultimate failure of Obamacare. Voters seemed to accept this point of view.

But then a funny thing happened. When President Trump was elected and the public was faced with the possible reality of the Affordable Care Act actually being repealed, it became more and more popular. People began to protest, worrying that under the replacement bill, they would again be denied health insurance because of a pre-existing condition or due to impossibly high rates charged in \u201chigh-risk pools.\u201d

The idea that insurance companies would no longer be required to cover 10 fundamental services started to worry people.

Just as important, further examination has shown that the Affordable Care Act is not \u201ccollapsing under its own weight.\u201d It has major flaws \u2014 especially the cost of insurance on the ACA marketplaces for people who are not poor enough to qualify for large subsidies. But it is by far better than any alternative presented so far.

In its assessment of the American Health Care Act, the Congressional Budget office said this: \u201cIn CBO and JCT\u2019s (Joint Committee on Taxation\u2019s) assessment, however, the nongroup market would probably be stable in most areas under either current law or the legislation.\u201d

Get that? The insurance market would be stable under either the American Health Care Act or the existing Affordable Care Act, not collapse. The analysis goes on:

\u201cUnder current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference. The subsidies to purchase coverage combined with the penalties paid by uninsured people stemming from the individual mandate are anticipated to cause sufficient demand for insurance by people with low health-care expenditures for the market to be stable.\u201d

Other analyses have found the same thing: There are problems with the private insurance marketplaces that need fixing, but the Medicaid expansion and the overall reduction in the number of uninsured people has been a success.

But this week, the House made another effort at reviving the American Health Care Act, this time with changes that appealed to the more conservative Republicans. When it was revealed that one provision would allow members of Congress to opt out of some changes \u2014 protecting themselves from the weakening of standards under the bill \u2014 McSally submitted a bill that would remove that provision.

Dr. Daniel Derksen, a professor of health policy at the University of Arizona\u2019s College of Public Health, told me the amended bill is aking to \u201crearranging the deck chairs on the Titanic.\u201d

\u201cThe American Health Care Act would be a catastrophic disaster,\u201d said Derksen, who also heads the UA\u2019s Arizona Center for Rural Health.

Most important, he pointed out, would be the drastic cuts in federal commitments to support state Medicaid programs.

\u201cThis would take us back to having 1.2 million uninsured Arizonans,\u201d he said.

\u201cThere\u2019s nothing inherently flawed in the design\u201d of the Affordable Care Act, Derksen said. \u201cIt\u2019s a matter of how you can improve on it so that insurers will stay in and customers aren\u2019t trying to decide whether they have a provider every year.\u201d

Among the possible improvements: Making it possible for insurance companies and states to agree to participate for longer terms, maybe three years as in other federal programs, so that the year-to-year uncertainty is removed, and doing so across state lines.

So, for all McSally\u2019s work at trying to improve the Obamacare replacement, perhaps the solution is simpler than tinkering around the edges. It\u2019s to do no harm by saying no.

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Tommy D\u2019Amore estimated that his father\u2019s coaching record was 2,500 wins and 100 losses.

His brother, Doug D\u2019Amore, disagreed. \u201cHe didn\u2019t lose 100 games,\u201d he said. \u201cMore like 10.\u201d

To which their youngest brother, Tyler D\u2019Amore, further stirred the debate. \u201cI lost two games in my whole career with him,\u201d he said. \u201cI remember both of \u2019em.\u201d

The D\u2019Amore brothers are a force of energy and personality, a cross between a Billy Crystal dialogue and an episode of \u201cCheers.\u201d They are the product of their father, \u201cBig Doug,\u201d who was like a character from a 1970s sitcom wearing old Bike brand shorts, high socks with his wallet tucked inside, and big glasses that covered the square footage of his face.

If you grew up north of Ina Road, you (and your kids) surely crossed paths with Big Doug D\u2019Amore. He coached softball at Sports Park, baseball at Arthur Pack, basketball at Tortolita Junior High and every sport in every conceivable league in Oro Valley.

\u201cAt every game, he was the first to arrive,\u201d says Tyler, an all-city quarterback at Ironwood Ridge High School. \u201cWhen the lights went off at Arthur Pack, he\u2019d be the last to leave.\u201d

When Big Doug died last week of a heart attack, 66 years young, the D\u2019Amore brothers got hundreds of text messages and phone calls from those whose lives Big Doug touched: Ka\u2019Deem Carey of the Chicago Bears, former White Sox outfielder Brian Anderson, ex-Nevada Wolfpack shooting guard Michael Perez and on and on.

Every call had the same message: Your dad changed my life.

Over the years, the D\u2019Amore siblings became widely known in Tucson for their athletic careers. Tyler played football at Nebraska-Kearney and basketball at Pima College. Doug, the boys basketball coach at Catalina Foothills High School, played at Idaho State and in Europe. Tommy was a 3-point shooting machine at Montana-Billings. Their sister, Sheri, is married to former Stanford wide receiver Jon Pinckney.

\u201cWith all that we accomplished in sports, it doesn\u2019t compare to what my dad accomplished,\u201d Doug says. \u201cWhen I run into someone around town, it\u2019s not \u2018how are you doing or how\u2019s your team doing,\u2019 it\u2019s \u2018how\u2019s your dad?\u2019 \u201d

After moving to Tucson from Milwaukee in the early 1970s, Douglas John D\u2019Amore, a pool hustler of note, spent more time playing basketball at Bear Down Gym than he did in his UA classrooms. He chose to influence lives rather than work the 9 to 5 shift.

For 35 years, he ran a boys group home near Canyon del Oro High School. Every day was fourth-and-goal with young boys placed into foster care through the state\u2019s welfare and juvenile system.

\u201cAlthough my dad coached basketball and everything else, he coached kids first,\u201d says Tommy. \u201cHis life was like a tornado all around him, but he was perpetually optimistic. He was always saying \u2018take the shot,\u2019 rather than give in.\u201d

At Christmas last year, 68 of Big Doug\u2019s closest friends showed up. The door was always open.

When the D\u2019Amore brothers began the process of going through their father\u2019s possessions, they discovered a letter written 22 years ago by Rene Dulaney, father of former Mountain View High School all-state basketball standout Regan Dulaney.

Tears fell.

Mr. Dulaney\u2019s letter to Big Doug began this way: \u201cYour calling in life is definitely to work with the young. You have a rapport, a strength, a softness and a sense of what to say and what to do to aid young people during their formative years.

\u201cThey all love you and are secure that you love them regardless of their shortcomings. What a blessing you are to so many.\u201d

Tyler played basketball at Ironwood Ridge, stepping into a significant role after the Nighthawks won the 2008 state championship. Big Doug was at all the games. Sometimes he\u2019d get there at 3:30 p.m. for a game that didn\u2019t tip until 7.

\u201cI\u2019d say, \u2018Dad, the game doesn\u2019t start for three hours,\u2019\u201d Tyler remembers. \u201cHe\u2019d always have some of the kids from the group home with him. On the way home we\u2019d talk about how I could\u2019ve done things differently. He\u2019d say, \u2018I agree with 60 percent of what you did, but the coach is in charge; never humiliate the coach.\u2019\u201d

Brian Peabody, who coached Tyler D\u2019Amore at Ironwood Ridge, says that he saw Big Doug at every game. \u201cBut not once did he talk to me about changing Tyler\u2019s role or doing something this way or that way. He was a good man.\u201d

As Foothills reached the Class 4A state semifinals in February, Big Doug was always in the bleachers. He\u2019d get restless, nervous, like all fathers. \u201cHe\u2019d say, \u2018tell Dougie to press,\u2019 or, \u2018I can fix that kid\u2019s shot,\u2019\u201d Tommy says. \u201cBut that was just him. He could negotiate anything with anybody. His heart was in a good place; he quoted John Wooden about doing things the right way.\u201d

The D\u2019Amore boys had difficulty choosing a facility at which to hold their father\u2019s celebration of life Saturday at 3:30 p.m. How many seats will they need? Is 350 enough? Or maybe 500?

Ultimately, they chose Vistoso Funeral Home.

\u201cHe has 150 kids who call him dad,\u201d Tyler says. \u201cI hope he can look down from heaven and see how many lives he touched.\u201d

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Early in his freshman season at Empire High School, Deion James went through a break-in period in which he didn\u2019t make a basket against St. David, Bisbee, Tanque Verde and the Canyon State Academy.

Goose egg after goose egg.

James was a 5-foot-11-inch point guard at one of Southern Arizona\u2019s newest high schools playing in obscurity against Sells Baboquivari, Red Rock, Whiteriver Alchesay and Tombstone.

\u201cHonestly,\u201d said Pima College basketball coach Brian Peabody, \u201cnobody had a clue about what type of potential Deion had.\u201d

On Tuesday afternoon, Deion James, who is now 6-8, walked into the weight room near Peabody\u2019s PCC office, where the phone rarely stops ringing with inquiries about the former Empire Ravens point guard.

Coaches from Iowa State, Illinois, LMU and new UC Santa Barbara coach Joe Pasternack are hopeful James will consider playing at their school. This was barely 24 hours after James returned from a recruiting trip to Washington State, and before that, Fresno State and Colorado State.

\u201cI\u2019ve been a head coach for 25 years and I\u2019ve had a few higher-recruited players,\u201d Peabody said. \u201cBut I\u2019ve never had anyone recruited by more schools than Deion. I bet he has over 50 Division I offers.\u201d

A week earlier, James was selected the NJCAA Division II Player of the Year. There are 128 schools in Division II junior college basketball, or 640 starting positions. Of that group, Deion James is No. 1.

\u201cI always had a vision in my head that I would be successful when I chose to enroll at Pima,\u201d James said, modestly. \u201cIt was starting on a new path, making some changes in my life. But to be the player of the year? Nobody would\u2019ve thought that.\u201d

A year earlier, James sat on the bench at a woeful North Carolina A&T, whose coach, Cy Alexander, was fired at midseason. James didn\u2019t play in 10 games for a team that finished 10-22.

He returned home to Tucson and regrouped, mingling with Peabody\u2019s returning Pima Aztecs, joining them for pickup games. When asked about his year in Greensboro, the soft-spoken James didn\u2019t go into detail, didn\u2019t talk about the 10 games he didn\u2019t get off the bench, didn\u2019t talk about the time Notre Dame beat A&T 107-53.

Peabody watched James\u2019 body language and was impressed. He didn\u2019t big-time anyone, didn\u2019t play hero-ball in pickup games, but rather was part of the gang.

\u201cOne day last summer Deion sat in a chair in my office and we talked about where he might play,\u201d Peabody remembers. \u201cHe\u2019s such a good kid; it wasn\u2019t me-me-me, but eventually I made it about him.

\u201cI said \u2018Deion, if you go somewhere else, you\u2019re a piece of the puzzle. If you play for Pima, you are the puzzle.\u201d

James led the Aztecs to the Region I championship, to a No. 7 finish nationally, and to 22 victories, the most at PCC since 1990. He led the ACCAC in scoring (20.8) and was second in rebounds. And remember this: the ACCAC is probably the most talented league in junior-college basketball.

It wasn\u2019t just a success, it was fun.

\u201cPlaying in Brian\u2019s system was so much different than last year,\u201d James said. \u201cWe averaged 100 points. You\u2019d look at our box score and one guy would have 22, another would have 17, another 15, another 13, another 10. Everybody had a role. I was fortunate to be part of it.\u201d

In one key period, James scored 33 against South Mountain, 31 against Scottsdale and, in the opener of the NJCAA championships, 30 against Waubonsee College of Illinois. Coaches from Utah State and UTEP showed up in the PCC gymnasium to introduce themselves.

Isn\u2019t that what the 2016-17 was at Pima College? A time to introduce the Aztecs as a national contender?

How did this happen to a former 5-11 point guard who evolved into the definition of modern basketball\u2019s coveted \u201cstretch 4\u201d power forward?

\u201cI pretty much sprouted from 5-11 to 6-8 or so in my days at Empire, about 2 inches a year,\u201d he said. \u201cI just kept growing. We were kind of surprised because my dad is about 6 feet and my mom maybe 5-7 or so.\u201d

His point guard skills as a teenager didn\u2019t go away; one of the reasons more than 50 Division I schools pursue James is because he can dribble effectively with either hand, shoot accurately from 3-point distance, play with his back to the basket and score with both hands around the basket.

\u201cHe\u2019s probably the most skilled 4-man west of the Mississippi who\u2019s still being recruited,\u201d said Peabody. \u201cA lot of guys try to do things they can\u2019t do; that\u2019s not Deion. In the year we had him, he figured himself out. Wherever he chooses to go, they\u2019ve got a winner.\u201d

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For years, people have been trying to figure out how to reward Arizona\u2019s high-performing schools.

No matter how complicated the formula, though, the efforts usually turned into the same old thing: New ways of giving more money to schools where the students are already well off.

The reason is simple and well-known: Students in wealthier schools tend to score higher on standardized tests that are the basis for rewarding high-performing schools. So when you pay more to schools and districts where students score high on tests, the rich usually get richer and the poor are usually left out.

That remains partially true in the governor\u2019s latest effort to give more money to high-flying schools.

But there are signs the legitimate criticisms of these efforts are finally penetrating the halls of power in Phoenix.

This week, the Arizona Board of Education took a step toward rewarding what may be the most relevant measure of a school\u2019s performance: The students\u2019 progress from year to year.

The Arizona Legislature passed a law last year requiring the state Board of Education to impose letter grades on schools again, but allowing the board to develop new measures.

The letter grades aren\u2019t a very good idea in and of themselves. For parents, they\u2019re useful only as a quick, glancing guide to the quality of schools. They\u2019re so simplistic, though, that they obscure as much as they enlighten. That is, if all you\u2019re judging on is a letter grade, then you\u2019re not making a very informed judgement.

\u201cIt\u2019s a simplistic way to distill out the essence of a school,\u201d Chris Kotterman, government relations director for the Arizona School Boards Association, told me. \u201cWe\u2019d rather have a dashboard \u2014 a uniform set of indicators for parents to look through.\u201d

Still, Kotterman and the association were among many who supported the new system for determining grades, even if they don\u2019t like the idea of letter grades in general. The reason: The board is finally rewarding schools for how much students improve while under their supervision, not simply how well students score.

To see the difference, imagine Student A, a pupil at a well-off school district scoring 92 on a standardized test one year, then 94 the next year. That\u2019s a great score, but the student didn\u2019t improve much. In the past, schools were rewarded simply for their students getting these high scores.

Then imagine Student B, who attends a poorer school and scores 70 on a standardized test one year then 82 the next. Even with the improvement, the student still scored worse than the kid at the wealthier school. But the poorer student improved much more. That\u2019s an improvement for which the school should get some credit \u2014 and will, now.

That growth is what the new letter-grade system for K-8 schools will emphasize, more than the actual score.

For those schools, 50 percent of their letter grade will be determined by the aggregated improvement in scores on standardized tests. Just 30 percent of the grade will be based on \u201cproficiency\u201d \u2014 the actual value of the aggregated scores.

There were proposals to make this a 40-40 split: 40 percent of the grade based on growth and 40 percent based on proficiency, but people who wanted the board to avoid rewarding wealth prevailed in that argument.

For high schools, the grades will be different, but again the board decided to de-emphasize proficiency, the face value of the schools\u2019 test scores. Instead of basing 40 percent of a high school\u2019s letter grade on proficiency, the board reduced that figure to 30 percent. Another 20 percent will be based on growth in test scores. Most innovative: 20 percent of the high schools\u2019 scores will be based on measures of career or college readiness and 20 percent on graduation rates.

\u201cThat was due to very strong public input to decrease the correlation with socioeconomic status,\u201d Calvin Baker told me.

Baker is superintendent of the Vail School District, a member of the state Board of Education and also co-chaired the committee that designed the new letter grade system.

In short, the board took a stinky assignment \u2014 creating a new A-F letter grading system \u2014 and came out smelling like creosote before a summer rain.

But the tendency to reward wealth still lurks in a proposal by Gov. Doug Ducey, even if it is somewhat improved over previous efforts. Ducey\u2019s budget proposal includes $38 million in \u201cresults-based funding.\u201d

The money would be sent on a per-pupil basis to schools scoring in the top 10 percent on the AZ Merit test. The proposal does recognize the socioeconomic gaps between schools: It would award $400 per pupil to schools with poor student bodies that score high on the test. And it would award $250 per pupil to schools attended primarily by middle- and upper-class students.

But an analysis by the Arizona Republic showed the system would still reward wealth along with test scores. By rewarding the top 10 percent, $13.5 million would go to schools with at least 60 percent of the students qualifying for a free and reduced lunch. The remaining $25 million would go to middle- or higher-income schools. A full $15 million, or 40 percent of the new money, would go to the wealthiest schools.

\u201cThe idea here is, let\u2019s recognize the challenge \u2014 that these schools are truly beating the odds \u2014 with more money,\u201d Ducey spokesman Daniel Scarpinato said, referencing the higher reward for poorer schools. Overall, he said, the program \u201cprovides an incentive for schools to move up their achievement ranks .\u201d

But while that proposal recognizes the difficulties faced by poorer schools, it still rewards wealth disproportionately. And just as important, it ignores improvement \u2014 that is, rewarding schools who take lower-achieving students and help them become average or better performers.

All these measures are based largely on test scores. That remains a problem because it requires teachers to teach to the test. But at least the high-school level grades are de-emphasizing test scores.

And in the future, the governor or legislatures can avoid making up their own rewards systems. Instead, they can defer to the letter grades for a more accurate measure if they want to reward high-performing schools.

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