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

[Long Run]

Once it is a given that any "fix" or "change" has to accept the nonsensical presumption that there can be no pre-existing condition exclusion (no matter how mild), there can be no fix or change. To allow this subversion of basic insurance principles, the ACA has the (toothless) individual mandate and in fact has a waiting period for getting on the Exchange if a person has not had prior insurance. The Senate bill has a six month waiting period, similar to the ACA Exchange rule but this is of course unacceptable because, well, the R's proposed it. It is hard to see how the Exchanges can be fixed since it looks to be politically impossible to go back to the sound actuarial 6-1 cost ratio/premium cost for insuring an older person versus a younger person; this single subversion of insurance principles has doomed the Exchanges by chasing away healthy young people and incentivizing older unhealthy people to join the Exchanges (it is especially inequitable based on a comparison of the relative income levels of younger workers to older workers at the height of their earning potential).

The ACA Medicaid expansion is also in a fail mode since it was never adequately funded. This is why so many states are having budget crises this year. The replacement bill made the idiotic choice to repeal the tax on high income rather than dealing with that in the tax reform bill. This shows the R's are just as clueless as the D's when it comes to bumping into glass windows like the avian population in my front yard (bird brains in both cases). And for what it is worth, the Medicaid rules can stand some tightening based on the number people I know who shifted from paying for their own healthcare to Medicaid. This one seems solvable if Congress is willing to shell out more funds and allow reasonable flexibility for the states to figure out how to cover their populations, but that makes too much sense so the entertainment will continue on.

[Scooter]

You're correct, the only real solution is to nationalize the health insurance industry and institute universal single payer.

Oh, wait, you were hoping that the insurance companies you shill for would be able to go back to charging outrageous premiums for coverage that turns out to be useless if someone actually gets sick, or figuring out ways to dump them altogether, and to administer your plans in ways that fuel the escalation of health care costs? Sorry, not going to happen.

[Lord Jim]

Three more GOP senators announce opposition to healthcare bill

Republican Sens. Jerry Moran (Kan.), Shelley Moore Capito (W.Va.) and Rob Portman (Ohio) announced Tuesday afternoon that they will vote against the Senate GOP bill to repeal and replace ObamaCare in its current form.

Moran said in a statement on Twitter that the bill "missed the mark," adding that he was "pleased" that the vote on the Senate bill was delayed by Republican leadership until after the July 4 recess.

“The Senate healthcare bill missed the mark for Kansans and therefore did not have my support," Moran wrote. "I am pleased with the decision to delay the vote – now is the time to take a step back and put the full legislative process to work."

"I remain committed to working with my colleagues and continuing conversations with patients and providers in Kansas to find a path forward that truly repeals and replaces Obamacare with a plan that makes certain Kansans will have access to more affordable and better quality healthcare," he concluded.

Senate Republicans decided earlier Tuesday to postpone a vote on legislation to repeal and replace ObamaCare after a number of lawmakers announced their opposition.

Leaders had hoped to wrap up a vote before leaving for the break. But after a Congressional Budget Office score found the legislation would leave 22 million more people uninsured over the next decade, several Republicans said they would not back a procedural vote on the bill.

Portman cited changes to Medicaid and and drug treatment as stumbling blocks for him on the bill.

"I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic," he said in a joint statement with Capito.

“For months, I have engaged with my colleagues on solutions that I believe are necessary to ensure that we improve our health care system and better combat this opioid epidemic. Unfortunately, the Senate draft falls short and therefore I cannot support it in its current form."

Capito echoed those concerns, saying she would "only support a bill that provides access to affordable health care coverage for West Virginians, including those on Medicaid and those struggling with drug addiction."

"As drafted, this bill will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health care providers," she added.

"As drafted, the Senate health care bill is not the right fix for West Virginia, and I cannot support it. My concerns will need to be addressed going forward.”

Nine GOP senators now oppose the bill, which leaves Republicans with a steep climb to get the measure through the Senate. Republicans have a slim 52-48 majority in the upper chamber, meaning they can only afford to lose two GOP votes, assuming no Democrats support the bill.

Republican Sens. Susan Collins (Maine), Dean Heller (Nev.), Rand Paul (Ky.), Ron Johnson (Wis.), Mike Lee (Utah) and Ted Cruz (Texas) are also opposed to the Senate's ObamaCare repeal bill in its current form.

http://thehill.com/policy/healthcare/33 ... hcare-bill

[Scooter]

Collins, Heller and Portman cannot let themselves be bribed by the fig leaves that McConnell is going to try to paper over this catastrophe in the next few days. None of the other snakes can be trusted to hold up under the pressure.

[ex-khobar Andy]

Is there a separation of powers issue here? I understand the need for communication, but it looks as if todays WH meeting with Republican senators is an attempt by Trump to take over the legislative process.

http://www.nydailynews.com/news/politic ... -1.3282063

[BoSoxGal]

It's standard practice for Presidents to lean on Congress to get legislation passed . . . or not.

[Lord Jim]

Jim--I imagine you know the procedure here; if the dems tried to filibuster, could a simple majority vote to end it?

Big RR, the answer is that depending on what's in the bill, under Senate rules it may not be subject to filibuster.

McConnell has brought this bill under a process that's called "reconciliation":

The phrase “budget reconciliation” refers to a process established by the Congressional Budget Act of 1974, in which congressional committees reconcile spending in programs within their jurisdiction to the budget blueprint passed by Congress. In this case, Congress passed a budget in January that required health-care committees to report legislation reducing the deficit by $1 billion—the intended vehicle for an Obamacare “repeal-and-replace” bill.

The Budget Act lays out specific time limits for debate in the Senate—20 hours of debate—and limits amendments to germane (i.e., relevant) topics. Normally, debate in the Senate is much more free-wheeling, with unlimited debate and amendments permitted on any issue. A senator could offer an amendment on Syria policy to a tax bill, for instance.

Under most circumstances, the Senate can only limit debate and amendments by invoking cloture, which requires the approval of three-fifths of all senators sworn (i.e., 60 votes). Because the reconciliation process prohibits filibusters and unlimited debate, it allows the Senate to pass reconciliation bills with a simple majority (i.e., 51-vote) threshold.

That's an excerpt from a an excellent article that lays out the rules and limitations of reconciliation here:

http://thefederalist.com/2017/05/11/nee ... on-senate/

They've even put "reconciliation" in the name of the bill; the official name of the senate healthcare bill is the "Better Care Reconciliation Act of 2017"...

This is why all of the focus of the bill is on money and not all the other things that some would like to get rid of with Obamacare. Technically, this bill is all about "reconciling" the 1 billion dollar reduction requirement in the budget. (Though obviously, that's not what it's really about)

It's also why during the process of passing the House bill, Paul Ryan kept talking about how they had to pass a bill that could meet the Senate standards for reconciliation so it couldn't be filibustered, and that anything else they wanted to do with the ACA would have to be done in another "step".

The more they "tweak" the bill in the Senate, the more they run the risk of having it fall outside the bounds of "reconciliation" and having it subject to a filibuster.

[Long Run]

And, of course, the D's enacted the ACA through reconciliation, so goose/gander. (https://en.wikipedia.org/wiki/Health_Ca ... ct_of_2010). Not a model of good governance in either case.

[ex-khobar Andy]

It's standard practice for Presidents to lean on Congress to get legislation passed . . . or not.

Yes of course: but I don't recall this being done in that wholesale way (all R senators trooping over to the White House for a meeting with the boss) and more the routine one on one arm twisting. LBJ was famously persuasive (see volume 2 of Caro's bio which I think is the best political biography I have ever read except maybe Jenkins on Churchill) but once he was in the White House he largely left that to Mansfield.

[Lord Jim]

Andy, group meetings between Presidents and members of Congress happen all the time regarding specific pieces of legislation. (Sometimes a President even goes over to the Capitol to meet with different groups)

Trump has done a multitude of improper things, but this isn't one of them...

[Big RR]

Jim--thanks for the primer on reconciliation; I wasn't sure what the rules were.

[Burning Petard]

All the GOP congress critters gathering in the White House together seems to me to be a very weak tactic for changing individual votes.

snailgate

[Scooter]

You Can Send A Vibrator To Your Congressperson To Protest The Health Care Bill

Want to protest the Senate Republicans’ health care bill, but don’t know how? After you call your senator and attend a local town hall meeting, you can now also send your Congressperson a vibrator.

Yep, you read that correctly: You can now send your Congressperson a vibrator to protest the health care bill that threatens to defund Planned Parenthood, make deep cuts to Medicaid and take away health care coverage from millions of people.

On Wednesday, Unbound announced a campaign called “Vibes for Congress” that allows people to send any $15 vibrator along with an educational pamphlet on women’s health to a specific representative. As an Unbound spokesperson told HuffPost, they recommend people target congresspeople who are “in favor of the GOP healthcare bill.” Seventy-five percent of the proceeds from each sale will go to Planned Parenthood

“The initiative is meant to shed a light on the importance of women’s health in the face of changes that would threaten it, while demonstrating that women will not stay silent in the face of such dire risks,” an Unbound spokesperson said.

The educational pamphlet included with each vibrator package features facts about women’s health care and the potential repercussions of reducing access to it.

[Lord Jim]

It's highly unlikely that the more light that is shined on this bill, the better it's going to look...

McConnell tried to ram this through with as little consideration by individual senators and public input as possible...

That didn't work...

Two weeks from now, after GOP Senators in states with a lot of people reliant on Medicaid in their states get treated to people in wheel chairs showing up to protest this bill at their Town Hall meetings, it's certainly not going to be any more likely to pass...

Personally, I suspect that McConnell has known all along that there was a near zero chance of actually passing a House-type Healthcare bill in the Senate...

But he wanted to be seen as really trying...

[RayThom]

“Vibes for Congress” that allows people to send any $15 vibrator along with an educational pamphlet on women’s health to a specific representative.

New or used?

[Big RR]

Didn't hear the details, but it seems Trump has now said if the repub senate plan fails, the tactic should be to repeal first and then replace later. What an ass! In sincerely hope Congress is not that stupid.

[Lord Jim]

The proposal that's being floated is that they would vote to repeal now, but also include a one year delay for implementation...

The "thinking" behind this, is that once you have repeal passed, it will create pressure on Democrats to sign on to some sort of replacement plan...

This will give folks like Rand Paul and the Freedom Caucus (who would be delighted if there never was any replacement plan) an orgasm, but if the House Healthcare Bill was Dead On Arrival in the Senate this scheme is Skeletal Remains On Arrival...

The Senate never once (even after the GOP retook the majority in 2014) brought any of the numerous repeal only bills to the floor...

[Big RR]

Would they still be able to do it as a reconciliation bill without the details of a replacement included, or would this be subject to ordinary rules.

[Lord Jim]

That's a really good question...

They couldn't repeal all of the ACA under reconciliation, (not everything in it has a budgetary impact) but they could probably repeal a lot of it...

But the chances that GOP Senators who wouldn't vote for the existing Senate bill because of the number of people it removes from coverage (the CBO score estimates 22 million; 15 million in the first year) would then turn around and vote for a straight repeal, (The CBO scored the effects of a straight repeal last fall; it estimated 32 million would lose coverage) would seem to be nil...

[rubato]

And, of course, the D's enacted the ACA through reconciliation, so goose/gander. (https://en.wikipedia.org/wiki/Health_Ca ... ct_of_2010). Not a model of good governance in either case.

Overall the situations are not similar. The ACA was voted on after long debate and after both sides had the opportunity to offer amendments. This bill was drafted in secret and then taken straight to the floor for a vote.

The text was hidden from even the majority of R Senators because they know that R senators don't need to know any facts before they vote, only what the party is telling them to do.

yrs,
rubato