There Will Never Be A Republican Replacement for the ACA, Cont’d
[ 158 ] January 27, 2017 | Scott Lemieux
Andrew Prokop has more on the utter disarray of the Republicans on health care:
When congressional Republicans went off to Philadelphia for a retreat this week, they hoped to make at least some progress toward a consensus about how to proceed with repealing and replacing Obamacare.
However, secret recordings of closed-door discussions at the retreat obtained by the Washington Post’s Mike DeBonis reveal that the party remains divided, uncertain, and deeply concerned about how to move forward.
It’s long been clear that there are a great many unsettled questions regarding the legislative and policy details of the GOP’s repeal effort. These include:
How quickly should repeal go into effect?
What, exactly, would the replacement be — can Republicans come up with a replacement that would be affordable for sick people who need insurance?
Should Obamacare’s Medicaid expansion be repealed?
Should the rest of Medicaid be transformed into a “block grant,” program as Paul Ryan has long supported, which would almost surely mean major reductions in the number of people it serves?
Should an Obamacare repeal bill also defund Planned Parenthood?
Does Donald Trump’s administration have a plan, or can his aides offer any more specifics about what they want policy-wise?
The Post’s report reveals that every single one of these questions remains completely unsettled, and that at least some within the party have grave concerns about all of them.
Republican House members representing blue states appear to be particularly worried. Rep. Tom MacArthur of New Jersey worried about pulling “the rug out from under” people covered by Obamacare, Rep. Tom McClintock of California warned that the GOP would own “the market we’ve created … lock, stock and barrel,” and Rep. John Faso of New York said defunding Planned Parenthood in a repeal bill would mean “walking into a gigantic political trap” that could end up with “millions of people on social media” protesting repeal.
Meanwhile, Trump’s top domestic policy staffer, Andrew Bremberg, is quoted speaking in only the vaguest banalities and broadest strokes, offering no substantive guidance whatsoever besides saying that HHS Secretary nominee Tom Price is a “compassionate” guy and a good doctor.
This was inevitable, because there’s no alternative to the ACA that 1)could get a non-trivial amount of Republican support and 2)wouldn’t be massively unpopular, because kicking millions of people off of insurance while making insurance much worse for many of those who still have it can’t be made popular. Having a clown without even the most basic understanding of the issues involved in the White House doesn’t help, but the fundamental dilemma would be there no matter what. The only remaining question is whether Republicans care strongly enough about inflicting large amounts of avoidable death and suffering on vulnerable people to help pay for upper-class tax cuts to take the political hit.
In related news, good stuff from Paul Waldman and Harold Pollock about why block-granting Medicaid would be horrible public policy. And read Michael Hiltzik on Aetna lying about its reasons for leaving the exchanges.
Federal Judge: Aetna Lied About Decision to Pull Out of Obamacare
Posted 10:00 AM, January 24, 2017, by CNN Wire
A federal judge has ruled that Aetna wasn’t being truthful when the health insurer said last summer that its decision to pull out of most Obamacare exchanges was strictly a business decision triggered by mounting losses.
U.S. District Judge John Bates concluded this week that Aetna’s real motivation for dropping Obamacare coverage in several states was “specifically to evade judicial scrutiny” over its merger with Humana.
Aetna pulled out of Obamacare exchanges in 11 states last August, including 17 counties in Florida, Georgia and Missouri where the Department of Justice argued the merger would wipe out competition.
That decision to retreat from Obamacare came just a month after the Department of Justice blocked Aetna’s $34 billion merger with Humana on antitrust grounds.
But Bates said this week the DOJ presented “persuasive support” — including internal Aetna emails — for the conclusion that Aetna withdrew from the Obamacare exchanges in those counties “to improve its litigation position.”
“The Court does not credit the minimal efforts of Aetna executives to claim otherwise,” Bates wrote in a ruling following a trial over the merger.
He added that Aetna’s decision regarding participation in the 2017 exchanges in these counties was “in fact manipulated.”
Aetna had warned the government it may need to dump then-President Obama’s signature healthcare law if the U.S. scuttled its deal with Humana.
“It is very likely that we would need to leave the public exchange business entirely…should our deal ultimately be blocked,” Aetna CEO Mark Bertolini wrote in a letter to the DOJ last July that was obtained by the Huffington Post.
However, Bates said it’s clear that “Aetna tried to leverage its participation in the exchange for favorable treatment” from regulators.
The judge said there is “persuasive evidence” that when Aetna later withdrew from the 17 counties in question, “it did not do so for business reasons, but instead to follow through on the threat that it made earlier.”
This critique was buried in a 158-page ruling issued by Bates on Monday, in which he blocked Aetna’s merger with Humana due to anti-competitive concerns.
The ruling deals a big blow to both companies at a time of great uncertainty in the health care industry now that President Donald Trump has talked about rolling back several key provisions of Obamacare.
Aetna-Humana isn’t the only big health care merger in doubt. The DOJ also sued to block the takeover of Cigna by Blue Cross Blue Shield leader Anthem for anti-competitive reasons.
Aetna declined to comment on specifics of the opinion, including the criticism from Bates, because it’s still “reviewing the details.”
Last summer, Aetna explained its decision to withdraw from most Obamacare exchanges by saying its individual policies business had lost $430 million since the exchanges opened in January 2014.
However, the judge noted that Aetna kept its support for exchanges in money-losing states like Delaware, Iowa and Virginia — but dumped Florida, even though that big state was projected to be profitable in 2016.
The ruling quoted an email from Christopher Ciano, president of Aetna’s Florida market, to Jonathan Mayhew, head of Aetna’s exchange business, showing how stunned he was by the decision to leave Florida.
“I just can’t make sense out of the Florida decision. Never thought we would pull the plug all together,” Ciano wrote, adding that Aetna was “making money from the on-exchange business.”
Mayhew responded by requesting to discuss by phone “instead of email.”
Bates said the response from the senior Aetna exec was an example of Aetna’s “repeated efforts to conceal a paper trail about this decision-making.”