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.”