The GOP Health Plan -or-If You're Not Wealthy You're Screwed

[Lord Jim]

they know that R senators don't need to know any facts before they vote, only what the party is telling them to do.

Yes, that's why the bill sailed through with all 52 GOP senators voting for it...

Oh wait...

[Econoline]

I keep hearing Republican pols saying, "We HAVE to do this because we PROMISED voters we were going to 'repeal and replace' Obamacare."

NO.

That is NOT what you promised, asshole.

You promised to repeal Obamacare and replace it with something BETTER.

You've had 7 YEARS to come up with "something BETTER" and you haven't. You blew it. You've ALREADY failed.

[Bicycle Bill]

-"BB"-

[RayThom]

For $1 Million. Hmm, that's a tough one.

For me it would depend on where the child lives, who do I know that knows the child, and could I be arrested for manslaughter, or an extreme indifference to human life?

[Econoline]

From NPR (reporting from the rural, Republican northeast corner of California):

• [ ... ] Clinics struggled getting people to sign up for Medi-Cal. "They feel like it's a handout and they're too proud, they don't want to," says Carol Morris, an enrollment counselor for the Mountain Valleys Health Centers in Shasta County.
  
  One way clinic workers get around the stigma is to avoid calling it Medi-Cal. Instead, they promote the name of the insurer that manages the Medi-Cal contract in that region. People get a card for "Partnership Health Plan" and may not realize they're actually covered by a government program.
  
  "It feels like it's more of an insurance," Morris says. "It's like a laminated, wallet-sized card that's got your numbers on it. It just looks exactly like an insurance card."
  
  One patient at the Mountain Valleys clinic in Bieber, Kay Roope, 64, knew she had Medi-Cal, and she liked it.
  
  "It did me good," she says.
  
  Now she has a subsidized commercial plan through Covered California with modest premiums and copays, and she likes that, too.
  
  "It's OK, 'cause I'm at the doctor's at least once a month," she says.
  
  But when asked what she thinks of Obamacare overall, she says she doesn't like it.
  
  "Because of Obama himself," she says with a laugh. "I rest my case."
  
  The confusion and the contradictions are common among patients, explains Morris, the enrollment counselor.
  
  "People just don't understand the different names," she says. "But of course, it's the same thing."
  
  Morris has seen the difference the Affordable Care Act has made for people in the region. She has seen patients get treatment for diabetes and breast cancer, or get knee surgery that they otherwise wouldn't have gotten.
  
  Those patients won't fight for Obamacare, Morris says, so that's why the clinics have to.

Haw haw haw. Yup, she sure made her case, didn't she?

[Lord Jim]

McConnell Takes a Risk With Talk of Bipartisan Health-Care Bill

Senate Majority Leader Mitch McConnell is taking a risk by calling for a bipartisan health-care plan if the Republican-only bill fails: While his comments may encourage conservatives to fall in line with his approach, party moderates may be emboldened to abandon the GOP legislation.

McConnell told a home-state Kentucky audience Thursday that if Republicans can’t “agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur.”

His remarks to a Rotary Club luncheon in Glasgow could serve as a warning to holdout conservative Republicans most ideologically opposed to Obamacare -- but also may give wavering moderates cover to oppose the GOP plan, which combines tax cuts and deep reductions in health spending.

Republicans can’t leave the Affordable Care Act untouched, as insurers are pulling out of some areas, but prospects of a dramatic rewrite are dimming under the party’s wafer-thin 52-48 majority, analysts said. Republican leaders can lose no more than two votes in their party amid united Democratic opposition.

“It’s what you might call bipartisanship at gunpoint,” [that's frequently how bipartisanship is achieved] said Ross Baker, a political scientist at Rutgers University in New Brunswick, New Jersey. “Republicans have to do something. They can’t do nothing. It is clear that McConnell with all of the legerdemain of a veteran magician has not been able to put together 50.”

McConnell was forced to delay action on the measure last week after about half a dozen Republicans objected. He has spent the July 4 recess studying possible revisions that might win support of holdouts once he unveils a new plan as early as the week of July 17. Republican leaders have indicated they want to move on to other issues, including a tax-code overhaul, if they can’t agree on a health bill before a month-long August break.

Senate Democratic leaders have said they would be willing to consider a measure that would bolster Obamacare’s troubled insurance exchanges, which have been buffeted by decisions by top insurers to exit the market in regions of Iowa, Missouri, North Dakota and many other states.

Democrats have accused President Donald Trump of injecting uncertainty in those markets by not providing clear support for Obamacare’s cost-sharing subsidies that help lower-income people buy individual coverage on the exchanges.

Senate Minority Leader Chuck Schumer treated McConnell’s remarks as a breakthrough.

“As we’ve said time and time again, Democrats are eager to work with Republicans to stabilize the markets and improve the law,” Schumer said in a statement Thursday. “At the top of the list should be ensuring cost-sharing payments are permanent, which will protect health care for millions.”

Since the House passed its version of an Obamacare replacement in May, Senate Republicans, including John Thune of South Dakota and Ron Johnson of Wisconsin, have said that they would seek a Plan B if the Republican bill stalls in their chamber. The effort to pass a Senate bill grew tougher after the nonpartisan Congressional Budget Office said last month that an initial proposal by McConnell would cause 22 million Americans to lose insurance by 2026.

There is already broad support among Republicans to shore up the exchanges, reflected in McConnell’s bill. It includes $50 billion over four years to bolster insurance markets, in addition to added cost-sharing subsidies. It also includes a state innovation pool of $62 billion over eight years that would allow funding for high-risk pools, reinsurance and other items.

A Senate GOP aide said that a revised bill is likely to boost proposed spending to further stabilize premium costs in Obamacare’s insurance exchanges.

McConnell is considering additional changes designed to attract more Republican support for the effort. That will likely include revisions to Medicaid after talks among Republican senators about the varying needs of their home-state Medicaid beneficiaries, the Republican aide said.

While no final decisions have been made, Republican leaders are considering axing plans to repeal nearly all of the tax increases that help finance the Affordable Care Act, said the GOP aide. Tax cuts that could be removed from the GOP health bill include a repeal of a 3.8 percent investment tax on high-income earners, and a Medicare earned income surcharge on the wealthy.

Those two tax increases generate nearly $231 billion in revenue over a decade, according to the Joint Committee on Taxation, so leaving them in place could create budget wiggle room for Medicaid or other health expenditures demanded by holdout moderate Republicans.

Trump complicated McConnell’s negotiations with conservatives late last month, tweeting that if Republican senators can’t strike a deal, they should simply repeal Obamacare and replace it later. That’s a reversal of Trump’s earlier position and could give conservatives a reason to oppose McConnell’s bill.

Tougher yet is the public’s reaction to the Senate GOP plan. Just 12 percent of Americans support the Senate GOP Obamacare replacement, [In other words, the Senate healthcare bill is about as popular as the dollar coin] according to a June 24-27 poll of 1,000 registered voters by USA Today and the Suffolk University Poll. A full 53 percent of respondents said Congress should leave Obamacare alone or address its problems while leaving its framework intact.

More here:

https://www.bloomberg.com/news/articles ... -care-bill


It's understandable why McConnell is now looking at a possible new approach; if there's one thing Mitch knows how to do it's count votes:

Senate health care plan: Recess isn't helping McConnell's hunt for 50 votes

(CNN)There was a reason Mitch McConnell badly wanted a vote on the Senate health care bill before July 4.
Senate Republicans are back in their home states for a weeklong break, and already, some of them have gotten an earful on the controversial GOP legislation to dismantle Obamacare. The message from their home-state constituents: Don't you dare vote for that bill.

That's not great news for Senate Majority Leader McConnell, who was forced to postpone a vote last week and is hoping to reschedule it for soon after lawmakers return to Washington next week.

Republican Sen. Susan Collins told reporters at a July 4 parade in Eastport that many Maine residents that she has spoken with while in her home state support her decision to oppose the legislation.

"What I've been hearing the entire recess is people telling me to be strong, that they have a lot of concerns about the health care bill in the Senate, they want me to keep working on it, but they don't want me to support it in its current form," said Collins, a moderate.

Sen. John Hoeven of North Dakota said at a roundtable in Grand Forks this week that he "doesn't support the bill as it stands," according to the Bismarck Tribune, becoming the tenth Republican senator to come out against the proposal in its current form.

Similar to when House Republicans were considering their own Obamacare repeal bill earlier this year, protesters across the country are again eager to confront their senators.

McConnell was keenly aware of the political pressure that his colleagues would face on the health care bill when they went home. It was one of the key reasons he had worked furiously to try to have a vote before members left town.

But a flurry of meetings and closed-door negotiations still left the majority leader far short of the minimum 50 "yes" votes he needs to get the bill through the upper chamber. And within hours of his announcement to postpone the vote last week, three more members came out as "no" votes, bringing up the tally of Republicans publicly against the legislation to nine.

With 52 Republicans in the Senate, that's not a small number of senators McConnell has to move from the "no" column to the "yes" column. But the public opposition this week could make it that much more difficult for senators who are already against the bill -- and others who are on the fence -- to get to a "yes."

[RayThom]

Mitch And The Democrats: a cautionary tale.

[Econoline]

I know which of those two groups I trust: the group that'll screw you and won't deny that they're screwing you while they're screwing you...

[Econoline]

Monty Python Explains The Cruz Amendment In Under One Minute

[Lord Jim]

I think McConnell's end game on this has now become pretty clear:

He's lost 2 votes, (Collins and Paul, who have both already come out against "Trumpcare 3.0") so he can't afford to lose any more...

He's counting on getting the other 3 right-wingers who came out against the last version back on board by incorporating the Cruz Amendment...(which wouldn't eliminate the ACA so-called "Essential Benefits" plans, but allow the states to offer more stripped down options in addition to those plans...)

Then, by eliminating the tax cuts that were in the House version, he's planning to use a portion of the cash that frees up to make individual deals with the remaining moderates opposed to the last plan, (providing more money for opiod treatment, more generous subsides for low income folks, providing exemptions to some individual states for some of the provisions of the bill...the same sort of thing that Senator Slime did to round up the last few votes for the ACA... remember the “Cornhusker Kickback" ?)

Whether or not this will work remains an open question. Most of the moderates who opposed the last version are still waiting for the CBO score that is due next week on the latest bill...

If it still shows 20 million plus losing healthcare, that's going to remain extremely problematic for GOP senators in states that took the Medicaid expansion, (especially Dan Heller in Nevada, who is considered the most vulnerable Republican Senator up for re-election in 2018; but also for Senators like Portman in Ohio, Murkowski in Alaska and Capito in WV, with a large number of constituents who benefited from the expansion)

Mitch is very skilled, but I give him no better than an 50-50 chance of threading this very tiny needle...(how's that for a prediction cop-out? )

If he does manage to somehow pull it off, that raises a whole new problem...


Unless the House passes the exact bill that the Senate passes, (and with the tax cuts eliminated, it's highly questionable as whether the "Freedom Caucus" types would stay on board) then the bill is still dead...

That's because the alternative to the House passing the Senate bill would be the two chambers going to Conference to hammer out a compromise between the two bills, and under Senate rules any bill reported out by Conference Committee is subject to filibuster and would require 60 votes to pass...

(This is the exact same situation the Democratic House faced when the ACA was originally passed. Because the Dems lost their 60 vote majority in the Senate with Scott Brown's victory in the special election to fill Ted Kennedy's seat, the Dems in the House had no choice but to simply accept the Senate bill, or see the legislation die.)

[ex-khobar Andy]

And of course we now have some of the major insurance company players saying it can't be done:

Big players in the insurance industry, which has mostly held back public criticism of the GOP’s Obamacare repeal push, eviscerated a Sen. Ted Cruz (R-TX)-sponsored provision that was included in the latest version of the Senate legislation.

“It is simply unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market,” Blue Cross Blue Shield and America’s Health Insurance Plans said Friday in a rare joint letter to Senate leaders.

The Cruz proposal, known as the “Consumer Freedom Option,” would allow insurers to sell plans that would be free of many Affordable Care Act mandates if they were also selling Obamacare-compliant plans.

Of course these are some of the folk who realized that healthcare was complicated before the rest of us (do we have an 'I am being sardonic' emoticon?) and although I don't usually look to the insurance industry (present company excepted, Major General) to have our best interest at heart, this may be one of the times when in fact they do because it is parallel to their own.

[ex-khobar Andy]

And with McCain out for surgery progress with this bull seems even more unlikely.

ETA : 'bull' above is a typo for 'bill.' But on second thoughts it's not inappropriate.

[rubato]

It gives them another week to twist Murkowski's arm. Assuming Rand Paul and Collins are solid "noes" and there isn't a democrat they can buy off.


yrs,
rubato

[Sue U]

Seven years of "Repeal Obamacare Tyranny!!!!11!1!" hysteria and the GOP can't even get its own bill(s) through a government it controls. This is not a party that has any coherent plan for actual governance. (Of course, this abject failure of a charade was never about actual healthcare for Americans anyway.) Wonder if Trump is going to You're Fired Congress now, or if it will be the other way around.

[Lord Jim]

McConnell is now saying he's going to put a "repeal with delay, replace later" bill on the floor, (though he's not saying when) ...

This was an approach he rejected earlier because he knew he didn't have the votes...(In fact just a week ago he again rejected the idea)

This idea is even more doomed than the last one (I think McConnell knows it and is only proposing it to make Trump happy, since he came out in favor of it.) He'll get the right-wingers back on board, but he's going to lose even more moderates; (certainly more than the two he could afford to lose) when this approach was scored by the CBO last fall, it had the largest number of all losing healthcare; 32 million.

On top of that, the insurance industry is strongly opposed to this approach, because of the uncertainty it would create in the insurance markets.

Will McConnell put this on the floor and force his members to vote on it even though he knows it will fail, just to please Trump? I highly doubt it. I think this a ploy just to buy time to persuade Trump that doing that would be a bad idea, and it will never be brought up for a vote.

[Big RR]

Persuade Trump that his plan is wrong? Is that even possible? Well, I guess if he can use it to show that only he knows how to govern; maybe he can rant and rave about cowardly legislators and push any chance of a bipartisan bill further into the dustbin, but beyond that, maybe it will drive a wedge between Trump and McConnell.

[Lord Jim]

Here's one vote it doesn't look like McConnell will be getting:

McCain Urges GOP To Hold Hearings, Listen To Dem Input On Health Care

After the Senate bill to repeal and replace Obamacare faltered Monday night with two more senators coming out against the bill, Sen. John McCain (R-AZ) urged the Senate GOP to hold hearings on health care and work with Democrats to replace the Affordable Care Act.

“One of the major problems with Obamacare was that it was written on a strict party-line basis and driven through Congress without a single Republican vote. As this law continues to crumble in Arizona and states across the country, we must not repeat the original mistakes that led to Obamacare’s failure,” he said in a statement. “The Congress must now return to regular order, hold hearings, receive input from members of both parties, and heed the recommendations of our nation’s governors so that we can produce a bill that finally provides Americans with access to quality and affordable health care.”

Senate Majority Leader Mitch McConnell (R-KY) does not appear to be taking the approach laid out by McCain. Late Monday night, he announced that he will push to bring the Hosue repeal bill to the floor and allow senators to vote on an amendment to repeal Obamacare with a two-year delay.

http://talkingpointsmemo.com/livewire/m ... are-repeal

[Lord Jim]

Persuade Trump that his plan is wrong? Is that even possible?

Trump has made very clear that he doesn't actually have a plan nor is he particularly committed to any other plan that has been put forward, (even a plan he embraced like the House bill, which he later called "too mean")

He doesn't have any real interest in this, and he certainly doesn't know anything about it. All he knows is that he "wants a win"; the substance is completely dis-interesting to him.

He only took up this "repeal now replace later" refrain because a couple of right-wing Senators called him and told him it would pass. I believe McConnell will now convince him that it won't pass, and thus won't give him his "win".

[Big RR]

I agree with everything you say, but since when has not having a plan or not understanding the issues stopped Trump from fighting for his "position". He wants a win, and thinks this is a holy quest given to him, and I doubt he will just say--OK, it can't pass so I'll let it go. The man never let's anything go, a common trait of assholes.

ETA: FWIW, I don't think Trump has ever had any plans or even positions. He just tells people what he thinks they want to hear so he can stir them up and feel important, and then he pats himself on the back and says he did the most wonderful job in the history of the universe.

[ex-khobar Andy]

The irony of all this of course is that the 'repeal and replace' vote is not taking place because one elderly senator is being treated under the finest insurance that money (our money, not his) can buy. I wish McCain a full recovery; but I have to wonder how many constituents of his would have had that little clot discovered during a routine physical? Is it possible that his extraordinary confusion during the Comey hearings led to a checkup? That's government provided health care for you.