The Great Obamacare Conundrum

John Hanno    June 26, 2017

The Patient Protection and Affordable Health Care Act was a game (life) changer for many 10’s of millions of workers locked into a dead-end crap job, because they needed (often because they or a family member had a pre-existing condition) the mediocre health insurance plans offered by their employers.

Soon after the ACA was passed and folks were allowed to participate in the exchanges, and after concerned, responsible or self-serving employers advised many of their low wage employees that it would then be financially beneficial for these workers (and also the employer, who would no longer have to subsidize their premiums) to switch to the ACA, the shackles were finally thrown off these indentured servants. 10’s of thousands of workers changed jobs or were finally able to leave the workforce altogether.

Even after the U.S. Congress stripped some common sense parts of the original ACA, including the public option, the ACA was head and shoulders above many of the pre-Obamacare plans. That’s the reason every individual ACA benefit, with the exception of the mandate, is overwhelmingly popular with Americans (even conservatives) and why the Republi-cons are having such a hard time trying to now Indian-give these life saving benefits.

The ACA finally eliminated all restrictions to pre-existing conditions and allowed young people to stay on their parents policies through age 26, a huge benefit to families with students in college. All ACA plans cover the same set of essential health benefits. Every health plan must cover the following services: Ambulatory patient services (outpatient care you get without being admitted to a hospital.) Emergency services. Hospitalization (like surgery and overnight stays). Pregnancy, maternity, and newborn care (both before and after birth.) Mental health and substance use disorder, including behavioral health treatment (this includes counseling and psychotherapy.) Prescription drugs. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills.) Laboratory services. Preventive and wellness services and chronic disease management. Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits). Additional benefits: Plans must also include the following benefits: Birth Control coverage. Breastfeeding coverage

Essential health benefits are minimum requirements for all plans. Specific services covered can vary based on each state’s requirements. Plans may offer additional benefits, including: Dental coverage. Vision coverage. Medical management programs (for specific needs like weight management, back pain, and diabetes.)

I think if any of us were tasked with formulating a quality, comprehensive healthcare plan that we wouldn’t mind paying for, if we had premium subsidies based on our income, Obamacare (the Patient Protection and Affordable Care Act) would be exactly what we would come up with.

The Republic-con House and Senate plans would eliminate or diminish most of these essential requirements of Obamacare, probable 8 of 10. This is ‘Back to the Unhealthy Future.’

The ACA, admittedly, didn’t do enough to control healthcare costs. The ability to negotiate with drug companies, hospitals and other providers was booted from the original ACA proposals in order to get 60 votes in the senate. Both Republicans and some Democrats in health insurance and Pharma states objected to holding insurance and drug companies greedy feet to the American health care system run-away wild-fires. And the public option (another erstwhile Republican idea that was removed) would have added more competition to the insurance companies mix. But the Republi-cons rejected their own common sense prescription.

Unfortunately, too many healthcare providers complain about the reimbursement rates typical for Medicare, Medicaid and even treatments for Veterans and consequently refuse to participate in these plans or treat these patients.

But the poop hit the reality fan long ago. American’s on average spend $9,541 per person on healthcare, almost 3 times what other developed countries spend and with lower health outcomes to boot. Trump and the Republi-cons really need to stand up for the American consumer, not the Koch brothers and the super rich. We are at a tipping point. Healthcare is 1/6th of our economy and climbing.

Big Pharma, for profit health insurance companies, hospitals, doctors and other health care providers should prepare themselves for more scrutiny and lower incomes and profits, and take advantage of the reprise and grace period granted by the Obama administration and the Democrats to fundamentally restructure their business model. America can no longer afford the 30% or more they skim off the top of America’s unsustainable health care gravy-train.

Reluctant doctors and other healthcare providers should prepare themselves for a healthcare system that will rely on more inclusive government plan participation and on reduced reimbursement rates for their services, just like the rest of the developed world. Doctors in Germany and the rest of Europe and Scandinavia (who’s other workers earn substantially more on average than those in the U.S.) earn approximately half of what doctors earn in the U.S. and doctors in the rest of the developed world earn even less, between 25 and 30%.

Unscrupulous and greedy employers, who are supporting the Republi-con Obamarcare replacement boondoggle, should in reality, prepare themselves for paying much better wages and compensation if they want to attract and retain valuable employees. Baby Boomers are retiring by ten’s of thousands a month and employers who abet or stand silent while Republi-cons in Congress punish the remaining workers between 50 and 65 years of age, (pre-Medicare) with sky-rocketing health insurance premiums and deductibles, and with renewed obstacles to pre-existing conditions and over-all crappier insurance plans, will only exacerbate their self-inflicted worker shortage dilemma.

And transferring the Medicaid program to States who can’t run deficits, minus the substantial backing of Federal dollars (now more than 95%), will not end well. Medicaid covers more than 76 million Americans. Medicaid covers 12 percent of all adults, 20% of all Americans, 30% of all adults with disabilities, 39% of all children, 40% of all poor adults, 49% of all American births, 60% of all children with disabilities,  64% of all nursing home residents and 76% of all poor children.

Trump and the Republi-cons scream daily that Obamacare is dead and dying but that’s only in Red States where Republicans are in control of the levers of governance, the apparatus that can and has opposed or crippled implementation and support of their own citizens access to Medicaid and the Obamacare exchanges.

Obamacare attempted to not only “protect patients” but to also “control costs.” They succeeded for the most part on both counts; with the exception of many Red States controlled by Republi-con governors and legislatures, in particular those that not only refused to support their own citizens, by disallowing their expansion of Medicaid, but by doing everything they could to oppose and cripple the ACA exchanges. They either refused to set up their own state exchanges and or refused to support the federal ones.

Obamacare reduced the typical cut for the insurance industry from 30% to 15% of premiums. And for the first time, the ACA substantially emphasized preventative care, in order to head off expensive emergency room visits and ultimately to avoid the astronomical costs for untreated end stage health care consequences like cancer and diabetes. Many of the issues in the ACA were originally “conservative Republican” proposals. But no matter how Trump and the Republi-cons try to obfuscate the truth, increases in premiums under Obamacare were at the lowest rates in 20 years.

But it’s obvious the Republic-con lapdogs in congress and the right’s media (not true conservatives at all) take their marching orders from the rich and powerful like the Koch brothers empire. Their modus operandi is and will continue to be: (1) To keep employees poor and desperate enough to stay at crappy jobs offering substandard wages and benefits, (2) To return control of our healthcare back to the insurance industry, (3) To refuse to allow the American health care consumer (just like the rest of the world) negotiate equitable prices for drugs and health supplies and services, (4) Propose policies like killing Obamacare, to somehow attempt to reverse the tanking American labor participation rate (5) Propose a plan, as the Trump administration just did, to have the government and public schools pay for training or retraining workers for the growing number of job openings, left unfilled because industry refuses to pay living wages for these touted mythical openings. (6) Attack the Veterans Administration Health System, as Trump just did. The V.A., just like Medicare and Medicaid, has long ago negotiated lower drug prices and costs for services. In spite of some past problems at the historically underfunded V.A., veterans overwhelming hold their V.A. system in high regard and want control of their healthcare to remain with the V.A., not the private sector, as Trump and the Republi-cons propose. (7) And of course above all else, A-to cut taxes, B-to cut taxes and C-to cut taxes for the richest 1% or 1/10th of 1%, while passing the bill off onto the rest of American taxpayers and health care consumers, including small businesses.

Only 16% of American’s approved of the House passed AHCA and the new Senate proposed plan doesn’t fare much better (12 to 17% approval).

And all this “repeal and replace pain” will be foisted on the unsuspecting American middle class, poor, elderly and disabled, just so the Republi-con panders can reward their rich benefactors, with what they gleefully hail as the largest tax cut in our history. Their goal was never to improve Obamacare, never to actually “improve” our healthcare system; that was obvious to anyone with half a brain. This is a tax cut plan, pure and simple. All the lipstick on this pig can’t cover that up. Repeated attacks on the exchanges and the Medicaid expansion for the most vulnerable Americans was a primary goal; and of course trying to overturn or diminish anything accomplished by President Obama and the Democrats to reverse the right’s decades long campaign to reverse New Deal remedies, was gravy on the Republi-cons anti-labor and anti-middle-class agenda.

Trump and the Republi-cons should take note that California and other states are already on their own “yellow brick road” to single-payer, universal health insurance plans. It could be 3 years or 5 years or a bit longer, but most or all of America will soon have a single payer, universal healthcare system, just like the rest of the developed world.

But unless voters in the Red States held back by Republi-con ideologues, demand the same, they will remain crippled by the evildoers loyal to campaign contributors and not the American public. We may ultimately have 2 separate health systems. One for blue states and one for red.

Women, including those that depend on Planned Parenthood for their primary healthcare, nurture and build better families. Families unburdened by overwhelming healthcare debt and the threat and consequences of bankruptcy contribute to better communities. Better communities build better states. A healthy America, with healthy states is a more prosperous and stronger country.

John Hanno,   www.tarbabys.com

Associated Press

Donors to GOP: No cash until action on health care, taxes

Steve Peoples, Associated Press     June 26, 2017 

COLORADO SPRINGS, Colo. (AP) — At least one influential donor has informed congressional Republicans that the “Dallas piggy bank” is closed until he sees major action on health care and taxes.

Texas-based donor Doug Deason has already refused to host a fundraiser for two members of Congress and informed House Majority Leader Kevin McCarthy, R-Calif., his checkbook is closed as well.

“Get Obamacare repealed and replaced, get tax reform passed,” Deason said in a pointed message to GOP leaders. “You control the Senate. You control the House. You have the presidency. There’s no reason you can’t get this done. Get it done and we’ll open it back up.”

Indeed, there was a sense of frustration and urgency inside the private receptions and closed-door briefings at the Koch brothers’ donor retreat this weekend in Colorado Springs, where the billionaire conservatives and their chief lieutenants warned of a rapidly shrinking window to push their agenda through Congress and get legislation to President Donald Trump to sign into law.

No agenda items mattered more to the conservative Koch network than the GOP’s promise to overhaul the nation’s tax code and repeal and replace President Barack Obama’s health care law. At the moment, however, both are bogged down by GOP infighting that jeopardizes their fate.

At least one Koch official warned that the Republican Party’s House majority could be in jeopardy if the GOP-led Congress doesn’t follow through.

“If they don’t make good on these promises … there are going to be consequences, and quite frankly there should be,” said Sean Lansing, chief operating officer for the Koch network’s political arm, Americans For Prosperity.

Deason, who is keeping the “Dallas piggy bank” closed for now, said he was recently approached by Rep. Mark Meadows, R-N.C. and Rep. Jim Jordan, R-Ohio, about hosting a fundraiser.

“I said, ‘No I’m not going to because we’re closing the checkbook until you get some things done,'” Deason said, noting he’s encouraged nearly two dozen major Texas donors to follow his lead.

“There is urgency,” said AFP president Tim Phillips. “We believe we have a window of about 12 months to get as much of it accomplished as possible before the 2018 elections grind policy to a halt.”

The window for action may be even smaller, some Koch allies warned at the three-day donor retreat that drew roughly 400 participants to the base of the Rocky Mountains. The price for admission for most was a pledge to give at least $100,000 this year to the Kochs’ broad policy and political network. There were also at least 18 elected officials on hand.

Some hosted private policy discussions with donors while others simply mingled.

In between meetings, Rep. Dave Brat, R-Va., predicted dire consequences in next year’s midterm elections should his party fail to deliver on its repeated promises.

“If we don’t get health care, none of us are coming back,” he said in a brief interview. “We said for seven years you’re gonna repeal Obamacare. It’s nowhere near repealed.”

It’s the same for an overhaul of the tax code, Brat said: “We don’t get taxes through, we’re all going home. Pack the bags.”

While some donors threatened to withhold campaign cash, Koch’s team outlined a broader strategy to help shape the debate.

Already, Americans For Prosperity claims a paid staff of more than 400 full-time activists in 36 states. Koch officials said that the network’s midterm budget for policy and politics is between $300 million and $400 million.

The group is actively lobbying Senate Republicans to change their current health care proposal, which it views as insufficiently conservative.

“We are not committed to the Senate bill in its current form, but there is still time to make changes and we’re actively working to improve it,” Phillips said.

At the same time, Koch’s allies are aggressively pushing forward on taxes.

The network is running what it describes as “a first wave” of digital ads calling on more than 50 House and Senate Republicans in both parties to overhaul the tax code. Later in the summer, Philips said, his organization will begin hosting rallies and other events to generate momentum for a tax overhaul in all 36 states where they have full-time operations.

Another Koch donor, Chris Wright, of Colorado, predicted Republicans have a 10-month window before any chance of major policy action is suffocated by next year’s midterms.

“If we don’t get anything done by then, the elections probably don’t go very well,” Wright said. “They may not go well anyway.”

 

Chicago Tribune

CBO: 22 million more would be uninsured by 2026 under Senate health bill

Amy Goldstein, Washington Post

Senate Republicans’ bill to erase major parts of the Affordable Care Act would cause an estimated 22 million more Americans to be uninsured in the coming decade — about 1 million fewer than similar legislation recently passed by the House, according to the Congressional Budget Office.

The forecast issued Monday by Congress’ nonpartisan budget scorekeepers also estimates that the Senate measure, drafted in secret mainly by Majority Leader Mitch McConnell and aides, would reduce federal spending by $321 billion by 2026 — compared with $119 billion for the House’s version.

The CBO’s analysis has been awaited as a crucial piece of evidence as McConnell and other Republican leaders try to hurry a vote on the bill this week. But they are navigating an expanding minefield of resistance from their own party’s moderate and conservative wings, while Democrats are united against it.

Several moderates have said they will decide whether they can support the Better Care Reconciliation Act based on how it will affect Americans who have gained coverage under the ACA during the past few years, while their conservative colleagues are focused on its impact on the federal deficit.

Of the 22 million who stand to lose coverage, 15 million of them would have no insurance next year, the nonpartisan budget office said. That could be a particular concern to Sen. Dean Heller, R-Nev., who faces perhaps the toughest 2018 re-election race of any Senate Republican and who’s said he can’t support a health care package that cuts Medicaid like the GOP plan and takes coverage from “tens of millions of Americans and tens of thousands of Nevadans.”

The fresh figures come as President Donald Trump, in a sharp pivot from the praise he initially lavished on the House bill, is urging the Senate to provide Americans more generous help with health insurance. On Sunday, the president repeated during a “Fox and Friends” TV appearance a word he had used in a private White House lunch earlier this month with a group of GOP senators: that the House’s version is “mean.”

The CBO has been regarded over its four-decade history as a source of neutral analyses devoid of political agenda. Its current director, Keith Hall, is a conservative economist who served in the administration of President George W. Bush and was appointed to his current role two years ago by a Republican Congress.

Nevertheless, senior Trump aides have repeatedly sought to cast doubt on the budget office’s credibility. “If you’re looking at the CBO for accuracy, you’re looking in the wrong place,” White House press secretary Sean Spicer said on the March day that the budget office issued its cost estimate of a preliminary version of the House GOP’s health-care legislation.

While they differ in important details, both the Senate GOP’s plan and the American Health Care Act narrowly passed by House Republicans in May share the goal of undoing central aspects of the sprawling health-care law enacted by a Democratic Congress seven years ago.

Both bills would eliminate enforcement of the ACA’s mandate that most Americans carry health insurance, relying on subtler deterrents to keep people from dropping coverage. The House version would let insurers temporarily charge higher rates, while the Senate added a provision Monday that would let health plans freeze out customers for six months if they let their coverage lapse.

In different ways, both would replace federal subsidies that help the vast majority of consumers buying coverage through ACA marketplaces, instead creating smaller tax credits that would provide greater assistance to younger adults while making insurance more expensive for people from middle age into their 60s.

After two years, both also would end subsidies that now help about 7 million lower-income people with ACA health plans afford deductibles and co-pays. And both would repeal an array of taxes that have helped to pay for the ACA’s benefits, including levies on health insurers and on wealthy Americans’ investment income.

For the Senate bill, the CBO’s estimates of insurance coverage and federal spending are influenced by the fact that its forecast covers a 10-year window and the legislation’s most profound changes for the nation’s health-care system are tilted toward the latter part of that period.

The bill would, for instance, leave in place the ACA’s expansion of Medicaid through 2020. After that, it would begin a three-year phaseout of the federal money that under the ACA has paid almost the entire cost of adding 11 million Americans to the program’s rolls in 31 states.

That means the extra funding wouldn’t disappear until the mid-2020s — roughly when sharp new restrictions on federal payments for the entire Medicaid program would take effect.

Over the weekend, the senior Democrat on the Senate subcommittee that oversees the CBO said in a tweet that he had asked the budget office to estimate the Senate bill’s effect on insurance coverage over a longer time horizon. “GOP is hiding the worst Medicaid cuts in years 11, 12, 13 and hoping CBO stays quiet,” wrote Sen. Chris Murphy, D-Conn.

The Associated Press contributed to this report.

Business Insider

Medicaid cuts in the Senate healthcare bill could be brutal for people living in nursing homes

Lydia Ramsey,  Business Insider    June 26, 2017

• Medicaid covers health care expenses of 74 million low-income Americans, including nursing home care for those who can’t afford it.
• Medicare, a program that covers medical expenses for Americans over 65 does not cover nursing homes.
• The New York Times reports that 42% of Medicaid spending goes to services like nursing home care. Cutting spending in the program would hit the elderly, or put pressure on nursing home operators to cut back.

Republicans in Congress are eager to make cuts to government spending on health insurance plans for low-income people. On June 22, Senate Republicans released their version of a plan to repeal and replace Obamacare. The plan, like one passed by the  House of Representatives, rolls back many of the provisions of Obamacare, including taking deep cuts from Medicaid — the federal program that covers medical expenses for low-income Americans.

That rollback in Medicaid funding could particularly hit one unexpected group of people: elderly people living in nursing homes. Even though elderly Americans get medical coverage from Medicare — that program doesn’t cover long-term stays in nursing homes. For the most part, people pay out of pocket for nursing homes. Once that gets depleted, residents start to qualify for Medicaid to cover their stay.

Medicaid covers more than 74 million Americans, including low-income people, families, and kids, as well as pregnant women, people with disabilities, and the elderly. The New York Times detailed the impact of Medicaid cuts on nursing home care in a story this weekend, and reports that — even though they only make up 6% of all Medicaid enrollees — those who use long-term services like nursing homes account for about 42% of total Medicaid spending.

Cuts to Medicaid spending could put those services on the chopping block.

“Moms and kids aren’t where the money is,” Damon Terzaghi, senior director at the National Association of States United for Aging and Disabilities told the Times. “If you’re going to cut that much money out, it’s going to be coming from older people and people with disabilities.”

Under the Senate’s bill, titled the Better Care Reconciliation Act, the Medicaid expansion that took place under the Affordable Care Act (or Obamacare) would be phased out. In other words, those who gained coverage through the expansion would be without once again, though they could access coverage through the individual insurance market.

The bill also scales back federal funding for Medicaid — which is more than half the spending for the program at the state level. That would leave states — which also fund the program — with fewer resources.

By law, state Medicaid programs have to cover nursing homes. If those states receive less funding from the federal government, it could increase the pressure on the operations of nursing homes, in turn possibly limiting who can qualify for care.

Here’s a breakdown of the percentage of federal funding each state receives, with those in dark blue receiving the most support. Ultimately it’s these dark blue states that are most likely to feel the cuts being proposed by Republicans.

Daily Kos

Trump Threatens Blackmail if Murderous Republican “Health Care” Scam Is Not Passed.

By Dartagnan     June 26, 2017 

It’s no surprise that threatening the lives of Americans comes remarkably easy to an Administration knee deep in an FBI investigation of its own criminality. With its willing Republican allies in the U.S. Congress, apparently it comes even easier:

During an off-camera briefing on Monday, Press Secretary Sean Spicer signaled that the Trump administration is willing to use low-income Americans’ health insurance as a bargaining chip to persuade Congress to pass Trumpcare, which will result in tens of milliuons of Americans losing their health insurance.

The “bargaining chip” is the lives and health of seven million Americans who receive Federal subsidies (known as cost-saving reductions or “CSR’s”) in order to afford co-payments and deductibles for their health insurance under the Affordable Care Act (“Obamacare”). The issuance of this thinly veiled blackmail threat was delivered today by the White House Occupant’s mouthpiece, Sean Spicer:

Spicer made clear that the administration will do what it can to continue to destabilize Obamacare exchanges by only committing to the CSR payments one month at a time.

“We committed to making them last month, and that’s as far as we will go at this time,” Spicer said. “We’re not committing to them this month.”

But Spicer then signaled that the “dynamic” will change if the Senate passes a health care bill.

So with the lives of seven million “expendables,” i.e., Americans without the political clout to buy off a Republican Senator, in the balance, and with the insurance exchanges and insurers that support the only lifeline those people have threatened with ruin due to deliberate underfunding by a malevolent President, this Administration today coldly revealed its inner Ratfucking Self to anyone who hadn’t already taken note of the complete lack of concern anyone in the Trump regime has ever expressed towards the welfare of the American people it was elected to serve.

Let’s go over that again, just to clarify what Trump told Americans today:

“If we can pass health care overall, then that changes the dynamic,” Spicer said. “It will ultimately be up to the president to decide.”

We are told it would “change the dynamic” if Americans are willing to trade their health and lives and those of their families so that some sociopathic billionaires like Robert Mercer and Sheldon Adelson are allowed to shove their snouts deeper into the public trough via some massive tax cuts. Because that’s what this charade of Republicans actually “caring” about ordinary Americans’ health care has always been about. It’s certainly not about keeping people healthy or alive.

The Blackmailer-in-Chief let his support flow from his mentally disturbed fingers earlier today: Yes, let it “crash and burn” along with the lives of all of those expendable people in need of basic health care. Just another threat, like the non-existent tapes of his conversations with the former FBI Director.

What a heartless thing to say, even for this…person in the Oval Office. But no one should be surprised:

In an interview with The Economist in May, Trump signaled he will eventually stop paying CSRs — the only question is when.

“[T]here is no Obamacare, it’s dead. Plus we’re subsidizing it and we don’t have to subsidize it. You know if I ever stop wanting to pay the subsidies, which I will,” Trump said. “Anytime I want.”

It’s difficult to imagine a real American President saying something so blithe, callous and juvenile.  He makes Nixon look positively angelic by comparison.

CNN

Koch brothers’ political network critical of Senate healthcare bill

By Maeve Reston, CNN        June 25, 2017

Story highlights:

• Donor group plans up to $400 million in spending in run-up to 2018 midterm elections
• “Senate bill needs to get better,” says top lieutenant

Colorado Springs (CNN) As growing opposition imperiled passage of the Senate version of the healthcare bill, leaders of the conservative Koch network voiced sharp criticism of the legislation at their donor retreat here — stating that the bill needed dramatic changes before they would support it.

The Koch network announced Saturday that they plan between $300 and $400 million on their political and policy objectives during the 2018 political cycle as Democrats wage an intense battle to win control of the House. The network has made the repeal of Obamacare a central focus of their political and policy work. They believe that neither the House, nor the Senate version achieve that goal.

“This Senate bill needs to get better. It has to get better,” said Tim Phillips, a top lieutenant in the network who recently met with White House officials to outline their proposed changes to the health care system.

The proposed changes to Medicaid, Phillips said, were unacceptable, because they just amount to tinkering around the edges rather than reforming the program. The Senate bill would dramatically scale back federal support of Medicaid and phase out the money that the government has provided to expand eligibility for Medicaid in the states.

Several GOP senators have announced their opposition to the Senate bill in its current form. Among them are conservative senators Mike Lee and Ted Cruz, who believe the bill does not go far enough and are attending the Koch network donor retreat this weekend. For several other senators, like Nevada Sen. Dean Heller, the cuts to Medicaid go too far. Senate Majority Leader Mitch McConnell can only lose two members in order to win passage for the bill.

        ‘The bill is not going to fix healthcare’

The Koch network has strongly opposed the expansion of Medicaid under Obamacare — arguing that by adding people to the rolls, the quality of care for the most vulnerable Medicaid recipients has plummeted.

“It was a struggling — frankly failing — program before this dramatic expansion,” said Phillips, President of Americans for Prosperity, the Koch network’s political organizing arm.

“To simply say we’re going to do a slight nip and tuck to a program that — because of Obamacare — has added millions and millions of people is frankly immoral. It’s not right to do that.”

“At the end of the day, this bill is not going to fix healthcare,” said James Davis, a spokesman for the network during an afternoon session with reporters. “We are going to be focusing our efforts out into the future on how we can fix it.”

Phillips, a top lieutenant with the network, noted that the organization was louder in their opposition to House version earlier this year, because they wanted to remind White House and Congressional officials that repealing Obamacare “was a promise that had been made to repeal Obamacare during four consecutive national elections beginning in 2010, and that the vast majority of members had pledged that.”

Republicans now living some of Democrats’ Obamacare nightmares.

Activists with the network have been more engaged in negotiations on the Senate bill, which is one reason they are in a wait-and-see mode.

                  ‘We are more optimistic’

Charles Koch, who was a vociferous critic of Donald Trump during the 2012 presidential campaign, did not mention the bill or the President as he welcomed hundreds of donors to the historic Broadmoor Hotel at the foot of Cheyenne Mountain Saturday evening. (Koch met with Vice President Mike Pence on Friday). Instead he praised the depth and breadth of his organization, which will hold a series of seminars this weekend focused on their legislative priorities, including criminal justice reform, education, tax reform and poverty.

“We are more optimistic now about what we can accomplish than we have ever been,” he said in remarks to donors, noting the group’s work propelling the confirmation of Neil Gorsuch to the Supreme Court.

Earlier Saturday, the network announced a new partnership with football star Deion Sanders. The Koch network pledged to spend $21 million on the joint initiative with Sanders to reduce persistent poverty in Dallas.

Six senators are taking part in the seminars this weekend: Senators John Cornyn, Cory Gardner, Jeff Flake, Ben Sasse, Ted Cruz and Mike Lee; along with four Governors: Greg Abbott of Texas, Matt Bevin of Kentucky, Eric Greitens of Missouri, and Doug Ducey of Arizona.

ThinkProgress

White House threatens to sabotage insurance of low-income people if Trumpcare isn’t passed

The Trump administration is putting poor people in a lose-lose situation.

Aaron Rupar, Journalist ThinkProgress     June 26, 2017

During an off-camera briefing on Monday, Press Secretary Sean Spicer signaled that the Trump administration is willing to use low-income Americans’ health insurance as a bargaining chip to persuade Congress to pass Trumpcare, which will result in tens of millions of Americans losing their health insurance.

Spicer detailed the administration’s position in response to a question about whether the Trump administration will cover next month’s cost-sharing reduction (CSR) payments for low-income people who purchase health insurance on the Obamacare exchanges. As Thinkprogress has previously detailed, the payments “partially subsidize deductibles and co-payments for more then 7 million low-income Americans, making it possible for many of them to afford their insurance. Cutting off the payments could potentially kick millions of people off the state exchanges, pushing some private insurers to withdraw as well. Premiums could shoot up across the board.”

Spicer made clear that the administration will do what it can to continue to destabilize Obamacare exchanges by only committing to the CSR payments one month at a time.

“We committed to making them last month, and that’s as far as we will go at this time,” Spicer said. “We’re not committing to them this month.”

But Spicer then signaled that the “dynamic” will change if the Senate passes a health care bill. The bill on the table — which was written in secret by Republican senators and hasn’t been subject to a hearing — is in some ways harsher than the House version that would result in 23 million Americans losing their health insurance. But unlike the House bill, the Senate version continues to temporarily provide tax subsidies for consumers to buy health insurance on exchanges, albeit ones that are much less generous than Obamacare.

“If we can pass health care overall, then that changes the dynamic,” Spicer said. “It will ultimately be up to the president to decide.”

Spicer then made an explicitly political case for why Trump won’t commit to making the CSR payments — an assurance that would undermine the administration’s ongoing effort to blow up Obamacare by encouraging insurance companies to continue to offer plans on the exchanges.

“If the president were to hypothetically say he’s going to make the payments in perpetuity or for a year, I think that continues to prop up a failed system and continues to do wrong by the American taxpayer and it also doesn’t lend itself to the expediency that I think we want to help get a new health care system in place,” he said.

Trump himself alluded to the chaos ending the CSR payments would sow in insurance markets in a tweet earlier Monday in which he threatened to let Obamacare “crash & burn!”

In an interview with The Economist in May, Trump signaled he will eventually stop paying CSRs  — the only question is when.

“[T]here is no Obamacare, it’s dead. Plus we’re subsidizing it and we don’t have to subsidize it. You know if I ever stop wanting to pay the subsidies, which I will,” Trump said. “Anytime I want.”

As The Weekly Standard detailed, the administration’s posture on CSRs “has already accelerated the collapse of health care exchanges as insurers move to limit their risk by raising prices or withdrawing from markets altogether.”

Washington Post Analysis

Another day, another poll showing how deeply unpopular the GOP health-care bill is

By Philip Bump     June 22, 2017

The day that Republican members of the House were first supposed to vote on the American Health Care Act, the legislation that would overhaul the Affordable Care Act (a.k.a. Obamacare) by cutting taxes on wealthy Americans and reducing spending on Medicaid, Quinnipiac University dropped a big, juicy fly in the ointment.

Only 17 percent of the country approved of the bill, a poll from the university showed — including less than half of Republicans.

Over time, those numbers haven’t really improved. Earlier this month, the most recent Quinnipiac poll showed the same figure: 17 percent approval. Support from Republicans, which had come oh so close to 50 percent in late May, was back down to about 4 in 10.

On Thursday, Senate Republicans introduced their own bill, the Better Care Reconciliation Act. It was crafted behind closed doors, and there’s no polling available on Americans’ views of it. But at noon on the day it dropped, so, too, did a new poll from NBC News and the Wall Street Journal.

Only 16 percent of Americans said the House bill was a good idea — including only a third of Republicans. That’s down 7 percent from last month.

It’s hard to overstate what a disaster those numbers are for the Senate Republicans. The best possible defense — and the defense that appears to have motivated the manner in which the bill was drafted — is that this is a poll number on a different piece of legislation. This is probably what Senate Majority Leader Mitch McConnell (R-Ky.) et al. are hoping will happen: They say, “Hey, this is the BCRA, not the AHCA, not sure how you made that mistake,” and then rush the bill to a vote before people realize how similar the two pieces of legislation are.

And they are similar, in the places that will affect the most people. A Washington Post analysis shows that the big-picture effect is to cut certain taxes (that mostly benefit the wealthiest Americans) and to cut Medicaid benefits (that heavily benefit the poor and disabled) with the likely net effect of substantially increasing the number of Americans who don’t have insurance. It won’t take much time for the similarities between the two bills to be made obvious, and therefore, for this bill to similarly fare poorly in the polls.

The Kaiser Family Foundation polled on the elements of the AHCA (that’s the House bill; these acronyms are confusing) a month ago. Even among Republican voters, most of the components were pretty unpopular.

The work requirement is in the Senate bill, in a form, and that’s popular with most Republicans, as are the high-risk pools. But so are the Medicaid cuts, the tax reductions — and the least popular provision, charging more for older customers.

Again: This is among Republicans. Is this a recipe for a more popular piece of legislation?

Republican senators are being asked to stand with party leadership on this bill to meet the Republican commitment to repeal Obamacare. That commitment powered a lot of grass-roots energy within the Republican base — but while that’s enough to ensure victory for some members of the party’s caucus, others need an awful lot of votes from independents (and even some Democrats) for whom that commitment was never appealing.

Shortly after Obamacare passed in 2010, the Kaiser Family Foundation found that it was more popular than not, although still had less than 50 percent approval. By that November, polling was about even — but the Democrats were demolished in House elections in part (but by no means solely) because of the party’s efforts to reform health care. Some Democrats took a tough vote for Obamacare — and lost their jobs.

On a bill that was about as popular as it was unpopular.

What’s the case McConnell makes to Republicans from moderate states who are up for reelection next year on voting for his unpopular bill?

Yahoo News

Trumpcare fixes nothing

Rick Newman     June 22, 2017 

There are a lot of big problems with the US healthcare system. Costs and spending are way too high, with Americans shelling out far more per person on healthcare than other advanced nations and generally less for their money. Employers that provide insurance bear a huge cost burden their competitors in other countries don’t. The difficulty getting insurance outside an employer leads many workers to stay in jobs they’re not well-suited for, depressing economic dynamism and entrepreneurship. All told, an outdated and inefficient healthcare system is one reason economic growth in the US is chronically weak.

Congress is hard at work on sweeping healthcare legislation—that addresses none of these issues. Instead of aiming at the biggest problems affecting the most people, Republicans and Democrats are waging legislative war over a part of the system that affects only about 8% of everybody with healthcare. As for everybody else, well, if there are problems with cost or coverage, Congress doesn’t seem to be aware of that.

The battle over the Affordable Care Act, which Republicans are now trying to repeal, is, of course, a proxy war for bigger questions of government: Should Uncle Sam solve all big problems? Or have we gone too far in doling out benefits funded by wealthier taxpayers?

The latest move is a new Senate plan similar to one that passed the House in May, which President Trump praised. In general, Trumpcare, as the Republican approach is known, would rescind tax cuts passed in 2010 that help finance coverage for lower-income people who don’t get insurance from an employer. Trumpcare would also reduce the number of people who qualify for Medicaid, while killing the unpopular ACA requirement for nearly all Americans to have coverage. In general, fewer people would end up with health insurance and the government would be less involved in America’s healthcare system. If you’re a small-government conservative who won’t lose benefits under the GOP plan, you’re probably pleased.

Less popular than Obamacare

But the majority of Americans are not. The House bill introduced earlier this year is considerably less popular than Obamacare, which it is meant to replace, and the Senate version seems unlikely to win any new converts. The GOP approach is even less popular than the Wall Street bailouts of 2008 and 2009. AARP opposes Trumpcare because it would raise costs and reduce coverage for some people over 50. The American Medical Association is against it. The American Cancer Society is against it. Three Republican governors oppose it and none has come out in favor of it. It’s hard to think of another instance in which Congress pushed legislation opposed by so many constituents.

If Trumpcare passes and becomes law, America will still have an antiquated, dysfunctional healthcare system—with more uninsured people. The US spends about $9,450 per person each year on healthcare—150% more than the median for advanced nations. Yet the United States ranks 28th in life expectancy and infant mortality. Thirty-eight percent of adult Americans are obese, the highest rate by far among 36 advanced nations. There’s nothing in either the House or Senate bill meant to improve any of this.

If Trumpcare fails to pass in the Senate, and simply dies…. America will still have an antiquated, dysfunctional healthcare system, with no other plans on the books in Congress to do anything about it. In addition to lousy health outcomes, the American healthcare system distorts economic decisions affecting millions of ordinary families. Economists would like to see the “portability” of healthcare benefits, which means workers would get the same benefits for the same price, more or less, regardless of where they work. This would eliminate “job lock,” or the decision to stay in a job simply for the benefits, and allow more workers to start businesses or do something they’re more enthused about. Data is patchy on how widespread job lock is, but some estimates suggest it could affect 25% of the 156 million people who get healthcare through an employer. That’s 34 million Americans who might be more productive and more satisfied in a different job.

The enormous cost to employers

Another growing problem is age discrimination in the workplace, which has a lot to do with the higher cost of healthcare for older workers. Data on this is also incomplete, but many older workers who get laid off and can’t find work insist employers don’t want to hire them because of medical costs. Famed investors Warren Buffett and Charlie Munger addressed the burden healthcare costs put on companies at this year’s Berkshire Hathaway annual meeting. “Our manufacturers have a huge competitive disadvantage caused by the health system, because the manufacturers are providing medical care for all the employees,” Munger told Yahoo Finance editor-in-chief Andy Serwer at this year’s event.

With healthcare costs rising much faster than ordinary inflation, companies that provide healthcare benefits have an enormous cost problem to manage. But don’t worry, they’re handling that by cutting back on the raises everybody gets. While basic wages have barely risen since 1970, when adjusted for inflation, real compensation—which includes healthcare and other benefits—has jumped by 60%. So if you’re wondering where your raise went, it went toward healthcare.

The Affordable Care Act, aka Obamacare, was a flawed attempt to deal with some of these problems, by first extending coverage to more people. Over time, in theory, that ought to improve healthcare outcomes, as more people get better care. Obamacare critics are correct to point out that the law did nothing to lower healthcare costs for most people, and it actually hiked costs for many who buy individual plans and suddenly had to pay for new tiers of mandated care.

But killing the ACA isn’t going to make anything about the US healthcare system better, and it would probably lead to worse healthcare outcomes as more people lose coverage. There’s a chance it won’t pass, since even some Republicans are squeamish about bouncing people off insurance. That may be the best possible outcome, for now. But all the other problems will still be there. Somebody should tell Congress.

The National Memo

Smart, Sharp, Funny, Fearless

Like House Bill, Senate Trumpcare Version Would Deprive Millions Of Coverage

Steven Rosenfeld, June 22, 2017    Reprinted with permission from Alternet.

Senate Majority Leader Mitch McConnell released a summary of the latest Obamacare repeal legislation late Wednesday, ending a Washington waiting game after secret drafting sessions, but depicting a bill that will have dire consequences for much of America.

McConnell’s summary tries to put a softer spin on the Republicans’ most strident attack on health safety nets in decades. It preserves most of the features of the House-passed bill, which repeals Obamacare, shrinks future Medicaid funding by a quarter and rewards the rich with tax cuts. The non-partisan Congressional Budget Office said the House bill would leave 24 million Americans without health care while increasing insurance costs and reducing coverage for almost everyone apart from healthy young adults.

Unlike the House, the Senate bill phases in the cuts to federal health spending over the next few years, instead of immediately pulling the carpet out from millions of Americans who were resting a little easier because they had some measure of health security. It will “rejigger” Obamacare subsidies for lower-income people buying private insurance, while gradually limiting their eligibility.

That’s the takeaway as first reported by the Washington Post. On Thursday morning, McConnell is to meet with “wary senators,” the Post reported, adding he will likely tinker with the bill’s details to try to get to 51 votes to pass it.

“The bill largely mirrors the House measure that narrowly passed last month but with some significant changes,” the Post said. “While the House legislation pegged federal insurance subsidies to age, the Senate bill would link them to income as the ACA [Affordable Care Act, or Obamacare] does. The Senate proposal cuts off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans. It also removes language restricting federally subsidized health plans from covering abortions, which may have run afoul of complex budget rules.”

It’s likely many nasty details will come to light as interest groups, health policy experts, Senate Democrats and their staff parse the legislative language, as opposed to McConnell’s talking points.

In many respects, McConnell’s revisions are not a surprise. They resemble the anti-Obamacare bill he shepherded in late 2015, which included closing government health care exchanges, scrapping subsidies for premiums, repealing Medicaid expansion in 30 states, ending tax penalties for people who don’t buy insurance and employers who don’t offer it, repealing its taxes on businesses, individuals and medications, and eliminating funding for Planned Parenthood. Variations of those features have been resurrected in the new Senate bill, although there is new language giving states some flexibility in how they will draw down their Medicaid spending. The brunt of that may not take effect until 2020. But the end result is the same: Republicans have used the rallying cry of repealing Obamacare not just to gut the law, but to structurally change and shrink Medicaid and give wealthy people a tax cut.

Washington Post, Power Post

Senate Republicans set to release health-care bill, but divisions remain

By Paige Winfield Cunningham, Juliet Eilperin and Sean Sullivan, June 21, 2017

Senate Republicans on Thursday plan to release a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law.

The bill is an attempt to strike a compromise between existing law and a bill passed by the House in May as Republicans struggle to advance their vision for the country’s health-care system even though they now control both chambers of Congress and the White House.

The Senate proposal largely mirrors the House measure with significant differences, according to a discussion draft circulating Wednesday among aides and lobbyists. While the House legislation would peg federal insurance subsidies to age, the Senate bill would link them to income, as the Affordable Care Act does. The Senate proposal would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health-care program for low-income Americans. It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.

But on the eve of the bill’s release, Senate Majority Leader Mitch McConnell (R-Ky.) faced the prospect of an open revolt from key conservative and moderate GOP senators, whose concerns he has struggled to balance in recent weeks. Republicans familiar with the effort said Senate leaders have more work to do to secure the 50 votes needed to pass the measure, with Vice President Pence set to cast the tiebreaking vote, from the pool of 52 GOP senators. No Democrats are expected to support the bill.

Republican aides stressed that the plan is likely to undergo more changes to secure the votes needed for passage, but there were major concerns Wednesday from senators on opposite ends of the GOP spectrum.

“My main concern is I promised voters that I would repeal — vote to repeal Obamacare. And everything I hear sounds like Obamacare-lite,” said Sen. Rand Paul (R-Ky.).

Sen. Shelley Moore Capito (R-W.Va.), whose state expanded Medicaid and has been pushing for a more gradual unwinding of that initiative than many conservatives prefer, said she is waiting to scrutinize what is released but has not seen anything yet that would make her drop her concerns with the proposal.

“Up to this point, I don’t have any new news — tomorrow we will see it definitively — that would cause me to change that sentiment,” she said.

Like the House bill, the Senate measure is expected to make big changes to Medicaid, the program that insures about 74 million elderly and lower-income Americans and was expanded in most states under the ACA. In effect, the revisions would reduce federal spending on the program.

The Senate measure would transform Medicaid from an open-ended entitlement to one in which federal funding would be distributed to states on a per-capita basis. The Senate measure would also seek to phase out the program’s expansion — although at a more gradual rate than the House version.

Yet the Senate bill is expected go further than the House version in its approach to cutting Medicaid funding in the future. In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill. That move could prompt states to reduce the size of their Medicaid programs.

That provision, a nod to conservative lawmakers led by Sen. Patrick J. Toomey (R-Pa.), risks alienating moderates, including Capito and Sen. Rob Portman (R-Ohio), who also represents a state that expanded Medicaid under the ACA. Some Republicans worry that such a move would force states to cut services or coverage, potentially leaving millions of low-income people without sufficient health care.

The growth rate that is applied to Medicaid spending going forward has major implications, said Sen. Susan Collins (R-Maine). “That inflater is critical, because it translates into billions of dollars over time,” she said.

Portman and Capito have also been pushing for the inclusion of a $45 billion fund to treat and prevent opioid addiction. As of early Wednesday afternoon, the opioid money was not included in McConnell’s proposal, according to a top GOP senator and Senate aide familiar with the discussions.

“I don’t think there is right now,” Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) said when asked whether the legislation includes a distinct opioid fund. “It might have to be considered separately.”

But Portman and Capito, like all senators, will have a chance to introduce amendments to the bill when it heads to the Senate floor, which McConnell said is likely to happen next week. This process will allow senators to draw attention to the causes they have championed and potentially change the final bill.

Moderates who are on the fence about whether to support the Obamacare overhaul are likely to be pleased at the bill’s approach to insurance subsidies because they would be based on financial need, potentially preserving coverage for more people who got insurance under the ACA.

Subsidies are currently available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.

That provision, said Larry Levitt, senior vice president for special initiatives at the Henry J. Kaiser Family Foundation, would be “a real benefit to poor people in states that don’t expand Medicaid.”

In a move that will please the health-care industry, the draft also proposes repealing all of the ACA taxes except for its “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.

It would also eliminate Medicaid reimbursements for Planned Parenthood for one year. Federal law already prevents taxpayer funding to pay for abortions except to save the life of the woman or in the case of rape or incest. But some Republicans want to ban all federal funding for Planned Parenthood, which also provides health services such as birth control, because their clinics provide abortion services.

Like the House measure, the Senate bill would eliminate two central requirements of the current health-care law: that individuals provide proof of insurance when filing their annual tax returns and that companies with 50 or more employees provide health coverage for their workers.

In a move that is critical to insurers, the Senate measure would continue to fund for two years cost-sharing subsidies that help 7 million Americans with ACA plans. House Republicans have challenged the legality of the $7 billion in subsidies — which help cover consumers’ deductibles and copays — in court, and insurers have warned that they will have to increase premiums dramatically next year unless the federal government commits to continuing the payments.

McConnell has told Republican senators that he wants to maintain protections for people with preexisting conditions under the law. But it was not clear to some lawmakers Wednesday what that would entail.

“I haven’t seen the draft yet. I like the idea of preexisting conditions being more firmly clarified,” Portman said.

Paul criticized GOP leaders for potentially keeping some of the ACA’s “most expensive regulations,” which he says are the primary drivers of higher premiums.

“It may well be that prices don’t come down at all,” he said.

But the Senate proposal may change rules for waivers that states can file with the Centers for Medicare and Medicaid Services that could allow them to potentially scale back some of these federal mandates.

While the details of McConnell’s proposal are expected to be made public Thursday, much of focus in recent weeks has been on the process used to draft the bill.

Democrats and even some Republicans have been critical of Senate GOP leaders for crafting the proposal behind closed doors without hearings and consideration of the legislation by the relevant committees.

Several GOP senators have expressed concern about moving quickly to a vote before they fully understand how it would impact health insurance markets and their constituents.

Sen. Ron Johnson (R-Wis.) said that in addition to reading the bill, “I’ll also want to get full input from constituencies in Wisconsin.”

Given that there may be just a week between the bill being posted and a final vote, he added, “I find it hard to believe we’ll have enough time.”

Amy Goldstein and Kelsey Snell contributed to this report.

Paige Winfield Cunningham covers health policy and authors PowerPost’s daily tipsheet The Health 202. A St. Louis native, she graduated from Wheaton College in Illinois and started her journalism career as a county board reporter at the Naperville Sun.

Juliet Eilperin is The Washington Post’s senior national affairs correspondent, covering how the new administration is transforming a range of U.S. policies and the federal government itself. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998. 

Sean Sullivan has covered national politics for The Washington Post since 2012.

ThinkProgress

We finally know what’s going to be in the Senate version of Trumpcare — and it’s not pretty

An ugly process begets an ugly bill.

Judd Legum, Editor-in-Chief, ThinkProgress       June 21, 2017

For weeks, Senate Republicans have negotiated their version of Trumpcare in near total secrecy. There have been no public hearings — just private meetings among a select group of Republicans about a bill that could reshape one-sixth of the American economy. For many Americans, the contours of the bill could be a matter of life and death.

Text of the bill was released on Thursday, but key details began to leak Wednesday night (some from lobbyists who learned about the bill before the American people). Majority Leader Mitch McConnell (R-KY) is insisting on a vote before the July 4th holiday, which means everyone has a week to learn about this bill — including many of the senators who will be voting on it.

So let’s get started. Here are the most important things you need to know.

The bill would strip health care coverage from millions of low income Americans by rolling back the expansion of Medicaid — and then making even deeper cuts.

The core of the Senate bill, like the House version, is a massive cut to Medicaid, which millions of low income Americans rely on for health care coverage. The Senate bill will reportedly phase out the expansion of Medicaid under Obamacare, although the process won’t start until 2021. In the end, the impact is the same. The Congressional Budget Office found that rolling back Medicaid expansion would cost 14 million people their health insurance.

But the Senate bill makes even deeper, more dramatic cuts to Medicaid that, over time, would leave more low income Americans without health coverage. Instead of a program that pays for health coverage for people who need it, the House and Senate versions of the Republican health care bill place per capita caps on the program. In other words, the federal government will only send states, who administer the program, a certain amount of money no matter what the actual cost of care may be.

The Senate version, according to a report in Bloomberg, makes even deeper cuts than the House.

The House bill ties these per capita caps to the “growth rate of medical inflation (CPI-M) plus 1 percentage point.” The Senate version, however, ties caps to the general rate of inflation (CPI-U). Since medical costs consistently grow at a much faster rate than overall costs, this means states would receive a smaller and smaller percentage of the actual cost of care each year.

The bill would follow the Obamacare subsidy model, but help fewer people.

In the House version of the Republican health care bill, people receive premium subsidies based on their age. The Senate bill retains the Obamacare model where subsidies increase as incomes go down.

But while Obamacare provided subsidies to anyone making up to 400 percent of the poverty line, the Senate bill ends subsidies at 350 percent of the poverty line. This means fewer people will get help. For some people, the impact of this change could be dramatic.

The Senate bill is a massive tax cut for the rich.

At it’s heart, Trumpcare is less a health care bill than a tax cut bill. There was speculation that the Senate bill would leave more taxes in place, but it will largely mirror the House version, according to the Washington Post.

The Senate bill will repeal hundreds of million of dollars in taxes that Obamacare used to help more people afford health care providing a massive transfer of wealth to people with incomes over $200,000.

The bill will mean higher out-of-pocket medical costs for many people with insurance.

Republicans would like to reduce health care premiums. But the only mechanism to do so in the Senate bill is to allow insurers to provide fewer benefits. That means, for some people, premiums may be slightly lower. But those same people will end up with far greater costs if they do get sick.

The Senate bill will reportedly give “states more leeway in opting out of the ACA’s insurance regulations through expanding the use of so-called ‘1332’ waivers already embedded within the law.” (The House bill creates a new waiver program.) The waivers are not expected to allow states to let insurers reject or charge more to people with pre-existing conditions. But the waivers will let states allow insurers to offer skimpier plans, potentially leaving consumers with huge medical bills.

The bill also reportedly changes what percentage of costs, on average, an insurance plan must cover from 75 percent to 58 percent. This means more deductibles and out-of-pocket expenses. The Senate plan could increase these costs by 68 percent.

The bill will seek to limit the ability of insurers to provide coverage for abortions.

Senate rules may prevent the Republican health care bill from including explicit restrictions on coverage for abortion. The Senate is exploring an arcane way to limit abortion coverage anyway, according to Axios. The Senate may create a “stabilization fund” that insurance companies can tap into through the Children’s Health Insurance Program (CHIP). Most insurers will want to take advantage of this fund. But CHIP already has a restriction on abortion coverage. So insurers that take advantage of the stabilization fund will not be able to include coverage for abortion.

The bill will hit older Americans especially hard.

Across the board, older Americans who use the exchanges will be expected to pay a larger share of their income for health insurance. Those who make over 350 percent of the poverty line will now be expected pay full price.

Trumpcare’s passage is far from certain, with a number of moderate and conservative Republicans raising objections. Conservatives are likely to balk at keeping the basic Obamacare subsidy structure. Moderates are likely to object to the aggressive Medicaid cuts, particularly in states that have expanded Medicaid.

This is a developing story and will be update as we learn more details about the Senate bill.

Washington Post, Power Post

Senate Republicans set to release health-care bill, but divisions remain

By Paige Winfield Cunningham, Juliet Eilperin and Sean Sullivan, June 21, 2017

Senate Republicans on Thursday plan to release a health-care bill that would curtail federal Medicaid funding, repeal taxes on the wealthy and eliminate funding for Planned Parenthood as part of an effort to fulfill a years-long promise to undo Barack Obama’s signature health-care law.

The bill is an attempt to strike a compromise between existing law and a bill passed by the House in May as Republicans struggle to advance their vision for the country’s health-care system even though they now control both chambers of Congress and the White House.

The Senate proposal largely mirrors the House measure with significant differences, according to a discussion draft circulating Wednesday among aides and lobbyists. While the House legislation would peg federal insurance subsidies to age, the Senate bill would link them to income, as the Affordable Care Act does. The Senate proposal would cut off expanded Medicaid funding for states more gradually than the House bill but would enact deeper long-term cuts to the health-care program for low-income Americans. It also would eliminate House language aimed at prohibiting federally subsidized health plans from covering abortions, a provision that may run afoul of complex Senate budget rules.

But on the eve of the bill’s release, Senate Majority Leader Mitch McConnell (R-Ky.) faced the prospect of an open revolt from key conservative and moderate GOP senators, whose concerns he has struggled to balance in recent weeks. Republicans familiar with the effort said Senate leaders have more work to do to secure the 50 votes needed to pass the measure, with Vice President Pence set to cast the tie-breaking vote, from the pool of 52 GOP senators. No Democrats are expected to support the bill.

Republican aides stressed that the plan is likely to undergo more changes to secure the votes needed for passage, but there were major concerns Wednesday from senators on opposite ends of the GOP spectrum.

“My main concern is I promised voters that I would repeal — vote to repeal Obamacare. And everything I hear sounds like Obamacare-lite,” said Sen. Rand Paul (R-Ky.).

Sen. Shelley Moore Capito (R-W.Va.), whose state expanded Medicaid and has been pushing for a more gradual unwinding of that initiative than many conservatives prefer, said she is waiting to scrutinize what is released but has not seen anything yet that would make her drop her concerns with the proposal.

“Up to this point, I don’t have any new news — tomorrow we will see it definitively — that would cause me to change that sentiment,” she said.

Like the House bill, the Senate measure is expected to make big changes to Medicaid, the program that insures about 74 million elderly and lower-income Americans and was expanded in most states under the ACA. In effect, the revisions would reduce federal spending on the program.

The Senate measure would transform Medicaid from an open-ended entitlement to one in which federal funding would be distributed to states on a per-capita basis. The Senate measure would also seek to phase out the program’s expansion — although at a more gradual rate than the House version.

Yet the Senate bill is expected go further than the House version in its approach to cutting Medicaid funding in the future. In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill. That move could prompt states to reduce the size of their Medicaid programs.

That provision, a nod to conservative lawmakers led by Sen. Patrick J. Toomey (R-Pa.), risks alienating moderates, including Capito and Sen. Rob Portman (R-Ohio), who also represents a state that expanded Medicaid under the ACA. Some Republicans worry that such a move would force states to cut services or coverage, potentially leaving millions of low-income people without sufficient health care.

The growth rate that is applied to Medicaid spending going forward has major implications, said Sen. Susan Collins (R-Maine). “That inflater is critical, because it translates into billions of dollars over time,” she said.

Portman and Capito have also been pushing for the inclusion of a $45 billion fund to treat and prevent opioid addiction. As of early Wednesday afternoon, the opioid money was not included in McConnell’s proposal, according to a top GOP senator and Senate aide familiar with the discussions.

“I don’t think there is right now,” Senate Finance Committee Chairman Orrin G. Hatch (R-Utah) said when asked whether the legislation includes a distinct opioid fund. “It might have to be considered separately.”

But Portman and Capito, like all senators, will have a chance to introduce amendments to the bill when it heads to the Senate floor, which McConnell said is likely to happen next week. This process will allow senators to draw attention to the causes they have championed and potentially change the final bill.

Moderates who are on the fence about whether to support the Obamacare overhaul are likely to be pleased at the bill’s approach to insurance subsidies because they would be based on financial need, potentially preserving coverage for more people who got insurance under the ACA.

Subsidies are currently available to Americans earning between 100 percent and 400 percent of the federal poverty level. Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill — but anyone below that line could get the subsidies if they’re not eligible for Medicaid.

That provision, said Larry Levitt, senior vice president for special initiatives at the Henry J. Kaiser Family Foundation, would be “a real benefit to poor people in states that don’t expand Medicaid.”

In a move that will please the health-care industry, the draft also proposes repealing all of the ACA taxes except for its “Cadillac tax” on high-cost health plans in language similar to the House version. Senators had previously toyed with the idea of keeping some of the ACA’s taxes.

It would also eliminate Medicaid reimbursements for Planned Parenthood for one year. Federal law already prevents taxpayer funding to pay for abortions except to save the life of the woman or in the case of rape or incest. But some Republicans want to ban all federal funding for Planned Parenthood, which also provides health services such as birth control, because their clinics provide abortion services.

Like the House measure, the Senate bill would eliminate two central requirements of the current health-care law: that individuals provide proof of insurance when filing their annual tax returns and that companies with 50 or more employees provide health coverage for their workers.

In a move that is critical to insurers, the Senate measure would continue to fund for two years cost-sharing subsidies that help 7 million Americans with ACA plans. House Republicans have challenged the legality of the $7 billion in subsidies — which help cover consumers’ deductibles and co-pays — in court, and insurers have warned that they will have to increase premiums dramatically next year unless the federal government commits to continuing the payments.

McConnell has told Republican senators that he wants to maintain protections for people with preexisting conditions under the law. But it was not clear to some lawmakers Wednesday what that would entail.

“I haven’t seen the draft yet. I like the idea of preexisting conditions being more firmly clarified,” Portman said.

Paul criticized GOP leaders for potentially keeping some of the ACA’s “most expensive regulations,” which he says are the primary drivers of higher premiums.

“It may well be that prices don’t come down at all,” he said.

But the Senate proposal may change rules for waivers that states can file with the Centers for Medicare and Medicaid Services that could allow them to potentially scale back some of these federal mandates.

While the details of McConnell’s proposal are expected to be made public Thursday, much of focus in recent weeks has been on the process used to draft the bill.

Democrats and even some Republicans have been critical of Senate GOP leaders for crafting the proposal behind closed doors without hearings and consideration of the legislation by the relevant committees.

Several GOP senators have expressed concern about moving quickly to a vote before they fully understand how it would impact health insurance markets and their constituents.

Sen. Ron Johnson (R-Wis.) said that in addition to reading the bill, “I’ll also want to get full input from constituencies in Wisconsin.”

Given that there may be just a week between the bill being posted and a final vote, he added, “I find it hard to believe we’ll have enough time.”

Amy Goldstein and Kelsey Snell contributed to this report.

Paige Winfield Cunningham covers health policy and authors PowerPost’s daily tipsheet The Health 202. A St. Louis native, she graduated from Wheaton College in Illinois and started her journalism career as a county board reporter at the Naperville Sun.

Juliet Eilperin is The Washington Post’s senior national affairs correspondent, covering how the new administration is transforming a range of U.S. policies and the federal government itself. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998.

Sean Sullivan has covered national politics for The Washington Post since 2012.

Vox

How Fox News dealt with CBO saying 23 million would lose coverage under the AHCA

We watched every instance in which Fox News had to confront the number.

Updated by Alvin Chang    May 31, 2017

The morning after a nonpartisan analysts reported that the Republican replacement for Obamacare would cause 23 million people to lose their health insurance — many of them in the reddest states — Fox & Friends invited President Trump’s budget director, Mick Mulvaney, onto the show.

The exchange went like this:

BRIAN KILMEADE (host): 23 million will lose insurance. True or false?

MULVANEY: False. If you look at the methodology, they assume that folks who were on Medicaid, which is free, will choose to get off Medicaid when the mandate goes away. Now you tell me if this sounds like the real world.

STEVE DOOCY (host): Sure. And I know the [Congressional Budget Office] looked at it. Millions of Americans are not going to buy insurance if they don’t have to because they don’t want to.

It was one of the rare instances Fox & Friends mentioned the “23 million” number, but a quintessential example of how the Fox News Channel has often covered the devastating CBO analysis — by obscuring details and blaming the source, which is similar to how right-wing news sites cover this administration.

Mulvaney does both, saying CBO erred in saying people would voluntarily leave Medicaid. He (and the hosts) fails to mention that the bill kicks low-income adults without children off Medicaid and makes it easier for states to kick people off the program.

It’s part of a pattern on Fox News, which often framed the CBO score in two ways. The first was that the CBO analysis is wrong, or that CBO has been unreliable in the past. The second is that Obamacare is failing and this bill gives people the freedom to escape that failure.

Not thinking too hard about the human cost

As my colleague Jeff Stein writes, this bill is a bigger liability for Republicans than Trump’s scandals. It’s what Democrats are campaigning on and what seems to have the most resonance, perhaps because people don’t want to be in the traumatic situation of having to choose between financial ruin and medical treatment.

Many of those who stand to lose insurance live in states that voted heavily for Trump. The bill hurts a host of demographic groups that support Trump — including older Americans, those who live in more rural areas, and areas suffering most from the opioid crisis.

The CBO scores get at the heart of these fears.

So the injection of these numbers into the AHCA debate caused a dissonance on several Fox News shows. When Fox & Friends had to confront these numbers, the reaction was to minimize the CBO analysis. For example, in March, after the first CBO report, Kilmeade acknowledged that Trump voters would be hurt but assured them this was part of a larger plan:

They say the people that are going to be hurt most under the current plan, the way the calculus is done by the CBO, are Americans between the age of 50 and 64. Right before Medicare, the older part and last leg of their career. That translates into mostly Trump voters.

But then you factor in the fact that this is a three-phase plan. The second phase is when [Health and Human Services Secretary] Tom Price is supposed to theoretically sit there and put in regulations that’ll make this more of a conservative project.

Host Ainsley Earhardt questioned the CBO, saying:

Here’s the thing. Donald Trump says the Democrats are the ones that put us in this mess. They are complaining about this.

Can you really trust the CBO? Can you trust the report?

Jonathan Gruber, the architect of Obamacare, he said blatantly — we played the sound bites for you yesterday — he said we can trick the CBO, call them mandates and not taxes, and they will pass this thing through.

Then on May 4, the House prepared to vote on the second version of the AHCA without a CBO score showing the policy’s impact. That morning, Doocy confronted the “24 million” number by saying it’s better because it “reduces taxes and stuff like that”:

When you saw that figure a month or two ago, where something like 24 million would wind up losing their health care: That is a great political ad for the Democrats, whoever is going to run against any of the Republicans coming up in 2018.

But here’s the thing: What if it’s — the hope for everybody is this is actually better. Reduces taxes and stuff like that.

And ultimately, when it comes to politics, this is going to redeem Speaker Paul Ryan. Plus, it’s going to give President Trump his first big — and it is big — legislative win.

I’m largely focusing on Fox & Friends because it has one very important viewer — President Trump — who has praised the show multiple times, and even thanked them for helping him win the presidency. It is the inner monologue of a president who has aggressively criticized most other media outlets for their reporting of his presidency.

Some shows on the network were slightly more nuanced, saying that people will choose to be uninsured because Obamacare will no longer mandate people to have insurance.

The bottom third also suggests the new version of the bill protects people with preexisting conditions. It does not.

There was little talk of why the mandate existed in the first place, and the mechanism the AHCA uses in its place: a penalty for people who want to buy insurance on the marketplace after a lapse in coverage.

Painting the CBO — and subsequently the media — as biased

Occasionally a guest would be on a Fox News show to represent the opposing viewpoint, and they would defend the 24 million number, though almost immediately a conservative guest or the host would reframe the discussion around CBO’s credibility or Obamacare’s failure. But it was this inherent conflict — between left and right, between “them” and “us” — that framed the coverage around the CBO report.

After watching the nearly 100 times people on Fox News confronted these numbers, the CBO report stopped feeling like a number describing humans. Rather, it felt like a political concoction — a number whipped up to make Obamacare repeal harder.

In fact, media outlets and experts who cited the CBO score were also treated with contempt. Below is a screenshot of a segment on how unfairly the mainstream media is treating the AHCA after the CBO score:

It’s cruel to disorient people like this

American health care is complicated. This AHCA debate is complicated. Yet it’s these complicated details that determine the cost and quality of care for our bodies.

So when nonpartisan analysts say that a bill will cause 23 million to lose insurance in 10 years and make costs skyrocket for older and poorer Americans, it should clarify our political opinions.

But Fox News has taken advantage of television as a medium to try to convince its viewers that “23 million” is a partisan tool, not an evidence-based projection. It’s basing its rhetoric on personality, on partisanship, on tribalism, and insisting that people trust them, not the mainstream media or the nonpartisan analysts who are desperate to take down Donald Trump.

Let’s put it this way: When our satellites tell us a powerful hurricane is headed toward us, it’s irresponsible not to tell everyone to get out of the way. But convincing the people that the tools are malfunctioning, that the hurricane isn’t coming their way, that the rest of the news reports are wrong? That’s cruel.