(yes, I know she actually says "bumpy night"...I'll update the title this evening if need be...)
OK...here's where things stood as of last night...
UPDATE 7/27/17 12:00pm: OK, here's the latest (at least, as of around noon, anyway):
Apparently, in order to win over a few more votes and squeeze the bill in under the "budget savings" wire, they're now planning on scrapping repeal of the medical device tax and delaying repeal of the employer mandate (but still repealing it eventually). They're also going to throw in defunding Planned Parenthood even though that was previously scrapped by the Senate parlimentarian.
Finally, they're apparently bringing back theEssential Health Benefit State Waiver provision, which would, once again, blow a massive hole in the "Guaranteed Issue and Community Rating" rules.
UPDATE: Hey, who's that up there? Why it's the guy who Republicans wanted to become President just 5 years ago, explaining why, if you're going to guarantee solid health insurance policies to everyone regardless of their medical history and without discriminating on price, you have to include some sort of incentive for them to do so: A carrot and a stick. The tax credits and out of pocket maximums are the carrot. The individual mandate and open enrollment period are the stick.
(sigh) I debated whether to even write a post about the last-minute "Skinny Repeal" plan slapped together by Mitch McConnell yesterday morning for a couple of reasons: First, because even if it passes, the sole purpose of "Skinny Repeal" is to get past the 50-vote Senate threshold...at which point it would be scrapped and replaced with whatever Godawful pile of garbage McConnell comes up with via reconciliation afterwards anyway.
Second, and more to the point, they're supposed to be voting on "Skinny Repeal" within the next few hours, so it's possible that it could be a moot point before anyone even reads this.
OK. Here we go. First, just as a refresher: Here's what the Individual Market was supposed to look like under the Affordable Care Act:
Here's what it actually looks like for a variety of reasons, including both legitimate glitches in the ACA itself as well as a whole lot of flat-out sabotage by the GOP over the past 7 years. While there are plenty of other issues which need to be addressed, the most obvious ones are that the tax credits need to be beefed up and applied to enrollees over the 400% FPL threshold, and the mandate penalty should really be increased. In short, two legs of the stool need to be lengthened...to continue the metaphor, we need a couple of shims. Around $12 billion per year or so should do the trick on the tax credit side. As it happens, one of the few useful parts of most of the GOP plans is that they do include a good $120 billion or so in "reinsurance/stabilization" funding over 10 years...which, in practice, would amount to about the same thing. The key is that this funding would have to be added to the existing ACA funding, not replacing it, which is what these plans do instead:
As regular readers know, I've spent the past few months speaking at various political/activist club meetings giving a lengthy presentation which gives a basic overview of the healthcare coverage situation in America, how the ACA was supposed to work, which parts of it are/aren't working, how I think the parts which aren't working should be fixed/improved, and of course what the Republican Party's plan of the day is to screw up everything which works while making the existing problems far, far worse.
By popular demand, I've embarked on a project to bring a version of this presentation to the web, by way of a series of short, simple videos (narrated slideshows, really) which give the basics. The first one can be viewed above.
As I note at the outset: I realize how incredibly basic and crude this is. I actually have some experience in video editing from my wannabe film producer days (long story, don't ask) in the 1990's, but I'm more than a little rusty at it...and frankly, given that the Senate vote is coming up in just a few days, I don't exactly have a lot of time for fancy effects and the like.
NOTE: The original focus of this diary was on the deliberate sabotage by the Trump Administration/HHS Dept. under Tom Price of the individual insurance market in general and HealthCare.Gov in particular, but the screen shot mentioned in passing in the diary below is actually far more important and disturbing the more I think about it than I had originally thought.
As noted below, it's an anonymous note sent to me on Thursday. Since it was sent I’ve confirmed the identity of the sender. This doesn’t prove that their specific claim is true, but there’s absolutely no reason I can think of for this person to risk their job and reputation by lying about this issue, and it matches everything else in the diary.
Several professional journalists have since contacted me and I’ve gotten them in touch with the sender. Stay tuned, this could be a big deal.
(sigh) I'm not really sure what the point of even writing about this is since it doesn't include the Cruz-Lee amendment which is supposedly the only thing keeping the ultra-conservative wing of the GOP Senate on board with BCRAP in the first place, but whatever:
CBO and the staff of the Joint Committee on Taxation (JCT) have prepared an estimate of the direct spending and revenue effects of the version of H.R. 1628, the Better Care Reconciliation Act, posted today on the Senate Budget Committee’s website.
By the agencies’ estimates, this legislation would lower the federal budget deficit by reducing spending for Medicaid and subsidies for nongroup health insurance. Those effects would be partially offset by the effects of provisions not directly related to health insurance coverage (mainly reductions in taxes), the repeal of penalties on employers that do not offer insurance and on people who do not purchase insurance, and spending to reduce premiums and for other purposes.
“The idea that you can repeal the Affordable Care Act with a two- or three-year transition period and not create market chaos is a total fantasy,” said Sabrina Corlette, a professor at the Health Policy Institute of Georgetown University. “Insurers need to know the rules of the road in order to develop plans and set premiums.”
But actually, he thought as he re-adjusted the Ministry of Plenty’s figures, it was not even forgery. It was merely the substitution of one piece of nonsense for another. Most of the material that you were dealing with had no connexion with anything in the real world, not even the kind of connexion that is contained in a direct lie. Statistics were just as much a fantasy in their original version as in their rectified version. A great deal of the time you were expected to make them up out of your head.
Thanks to Emily Gee and the Center for American Progress for this:
This isn't a full/official New Jersey rate hike update, as it only refers to one carrier, and rounds things off a bit, but in the video above, if you watch from around 37:30 to 41:00, you'll hear New Jersey Congressman Frank Pallone talk about the negative impact that the CSR reimbursement threat/uncertainty/sabotage effect is having on Horizon Blue Cross Blue Shield...and since Horizon BCBS happens to hold something like 70% of the New Jersey individual market share (which is confirmed by Pallone in the video), the statewide weighted average rate hike will end up being largely determined by theirs.
The most relevant part:
"So Horizon, which is something like 70% of our market in New Jersey, filed like a 24% increase. And I asked the president (of Horizon) "why are you filing with a 24% increase?" I can't imagine that health insurance costs have gone up that much. And he said "Oh, they haven't, Congressman." I said, "well, what is this?"
Health and Human Services Secretary Tom Price on Sunday made a bold and questionable prediction about the Senate GOP bill to repeal and replace Obamacare: He argued that the legislation could actually provide health insurance to more individuals than the Affordable Care Act, a claim undermined by the Congressional Budget Office’s analysis of the bill.
Price made the comment while discussing how the Senate bill closes a gap that existed in certain states that chose not to expand Medicaid under Obamacare. In those states, there is a section of the population that does not qualify for traditional Medicaid, but makes too little to qualify for subsidies on the exchanges since Obamacare intended to cover it through Medicaid expansion. The Senate bill closes this gap, and Price used that provision to argue that more people would be covered under the new legislation.