Charles Gaba's blog

There's been a lot of talk, by myself and others, about just which populations would be screwed over by a full repeal of the Affordable Care Act. Analysts, reporters and pundits have sliced and diced the numbers every which way...by race, income level, geography and of course political leanings.

Of course, this gets awfully messy right out of the gate because some ACA provisions apply to everyone in the country, such as the cap removal on annual/lifetime coverage limits; the reassurance that you can't be denied coverage for having pre-existing conditions (which applies to those covered by employer insurance as well, I should note, since many of them may have to switch jobs or be without one at some point in their lives), and so on. Other benefits apply to subgroups which aren't talked about much, such as the Medicare fund being extended by years and the Medicare Part D "donut hole" being closed.

Politico, January 26th:

The Trump administration has pulled the plug on all Obamacare outreach and advertising in the crucial final days of the 2017 enrollment season, according to sources at Health and Human Services and on Capitol Hill.

Even ads that had already been placed and paid for have been pulled, the sources told POLITICO.

...Individuals may still sign up for Obamacare plans until the Jan. 31 deadline — but the Trump administration isn't advertising that fact any longer.

It is also halting all media outreach designed to spur signups in the days leading up to the deadline. Emails are no longer being sent out to individuals who visited HealthCare.gov, the enrollment website, to encourage them to finish signing up. Those emails had proven highly successful in getting stragglers to complete enrollment before the deadline.

Ron Pollack, executive director of Families USA, a consumer group that supports the law, called the decision "a mean-spirited effort that can only result in fewer people getting coverage who need it."

 

Robert Costa in the Washington Post:

President Trump called my cellphone to say that the health-care bill was dead

President Trump called me on my cellphone on Friday afternoon at 3:31 p.m. At first I thought it was a reader with a complaint since it was a blocked number.

Instead, it was the president calling from the Oval Office. His voice was even, his tone muted. He did not bury the lede.

“Hello, Bob,” Trump began. “So, we just pulled it.”

...The Democrats, he said, were to blame.

...Trump said he would not put the bill on the floor in the coming weeks. Instead, he is willing to wait and watch the current law continue and, in his view, encounter problems. And he believes Democrats will eventually want to work with him on some kind of legislative fix to Obamacare, although he did not say when that would be.

Late last night, just a few hours ahead of the actual vote in the House of Representatives, the House GOP released their final changes to the American Health Care Act (AHCA), otherwise known as Trumpcare. The last-minute changes range from pointless to insulting to disastrous:

  • It tacks on an additional one-time $15 billion to the "State Stability Fund", supposedly to cover maternity, newborn care and mental health services.
  • It pays for the above by holding onto the existing 0.9% Medicare tax on people earning over $200,000 for another 6 years
  • And, most significantly, it would get rid of the requirement that all qualifying healthcare policies cover the 10 Essential Health Benefits mandated by the federal government.

I want to take a moment to address the first two bullet points above, because they're basically the exact same thing that Paul Ryan did a few days earlier.

The original version of the AHCA would have resulted in older Americans having to pay exhorbitant premiums due to the idiotic restructuring of the tax credit system and the 5:1 age band change. This led the AARP to unleash their army to understandable scream bloody murder at Congressional town halls nationwide.

In response, the GOP added an oddly-worded amendment which "instructed" the Senate to pony up $85 billion which would be used to "increase tax credits for 50-64 year olds" in some vague fashion. Why they didn't simply cross out "$4,000" and replace it with "$10,000" in the language of their own text I have no idea, but whatever. The point is that they gummed up the works for older enrollees, got screamed at for it, and responded by throwing a boatload of cash at those folks to get them to STFU.

 

If it was any other politician, I'd call this a strategic bluff to try and get the bill to pass:

UPDATE: 7:42 p.m.: President Donald Trump is demanding a vote Friday in the House on the Republican plan to repeal and replace Obamacare, White House Budget Director Mick Mulvaney said. If the bill fails, Trump is prepared to move on and leave Obamacare in place, Mulvaney said.

In the case of Donald Trump, however, he could mean it. He doesn't actually give a rat's ass about healthcare or helping people anyway; the only reason he wants to repeal the ACA is because a) it'd let him stick it to Barack Obama; b) it'd give him another tax cut and c) he'd get to brag about "winning" by finally slaying the mighty Obamacare Beast, etc.

A couple of weeks ago, the Congressional Budget Office projected that Trumpcare 1.0, aka the "American Health Care Act" or AHCA would kick 14 million people off their healthcare coverage next year alone, followed by an additional 10 million getting the boot by 2026. It would, however, save the federal government around $336 billion over that time period, which was pretty much the only positive part of their analysis.

Unfortunately, it also meant that a 64-year old earning $26,500 per year would end up having to spend about 60% of their entire gross income in order to pay for health insurance even after their tax credits.

This didn't go over too well with the "moderate" wing of the House GOP, as the AARP crowd wouldn't stop screaming at them during town halls nationwide. Meanwhile, the "Freedom Caucus" (basically, the ultra-batcrap insane wing as opposed to the only-kinda-insane members) was angry because the Trumpcare bill didn't hurt enough people quickly enough.

 

House leaders postpone vote on their health-care plan

House leaders postponed a vote Thursday on their plan to overhaul the nation’s health care system, as they struggled to meet demands of conservative lawmakers who said they could not support the bill.

Earlier Thursday, conservative House Republicans had rebuffed an offer by President Trump on Thursday to strip a key set of mandates from the nation’s current health-care law, raising doubts about whether House Speaker Paul D. Ryan (R-Wis.) had the votes.

Trump met at the White House with the most conservative House Republicans, hoping to close a deal that would help ensure passage of the party’s health-care plan by shifting it even further to the right. But the session ended with no clear resolution, and some lawmakers said they needed more concessions before they would back the bill.

Via Quinnipiac a few hours ago:

March 23, 2017 - U.S. Voters Oppose GOP Health Plan 3-1, Quinnipiac University National Poll Finds; Big Opposition To Cuts To Medicaid, Planned Parenthood

American voters disapprove 56 - 17 percent, with 26 percent undecided, of the Republican health care plan to replace Obamacare, the Affordable Care Act, according to a Quinnipiac University national poll released today. Support among Republicans is a lackluster 41 - 24 percent. 

If their U.S. Senator or member of Congress votes to replace Obamacare with the Republican health care plan, 46 percent of voters say they will be less likely to vote for that person, while 19 percent say they will be more likely and 29 percent say this vote won't matter, the independent Quinnipiac (KWIN-uh-pe-ack) University Poll finds. 

(Granted, most of the 46% who say they're less likely to vote for them are most likely Democrats anyway, but still).

 

Republican Pete Sessions just literally said "Nobody is going to lose their coverage, you'll be able to keep your same doctor," "same plan." pic.twitter.com/nn0f4dFloc

— Tommy Christopher (@tommyxtopher) March 22, 2017

(sigh)

Seven years ago, President Obama repeatedly made an infamous promise: That under the Affordable Care Act, "If You Like Your Plan, You Can Keep It...If You Like Your Doctor, You Can Keep Them."

As a big fan of Obama and a supporter of the ACA, this statement has been making me, and any intellectually honest Democrat, wince ever since.

As I've stated many, many, many times over the years:

This morning Yesterday I noted that Paul Ryan, who apparently just remembered that yes, older white people tend to a) vote in midterms and b) vote Republican, has decided to take measures to win over the missing votes he needs to drag his dumpster-fire-of-a-healthcare bill over the finish line.

The changes in question appeared to include a) hurting even more poor/disabled people more quickly than before by speeding up the Medicaid expansion cut-off and block-granting non-ACA Medicaid...but also a vague reference to beefing up the individual market tax credits for older enrollees.

Now the Medicaid cruelty aside, I've long been an advocate of beefing up the indy market subsidies myself, so this isn't necessarily a terrible idea, although the devil would be in the details. I assumed, for instance, that Ryan & Co. planned on changing the age-based structure from this:

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