And for their latest trick, the House GOP will raise the dead. See the latest Branco Cartoon and pass it along.
And for their latest trick, the House GOP will raise the dead. See the latest Branco Cartoon and pass it along.
This week, a working group of United States senators began meeting on a biweekly basis to reach a consensus on how to repeal and replace Obamacare.
We are still very early in the process, but it is clear already that there is much work to be done before we can find the votes needed to reform our failing health care system.
The first topic the group focused on was rolling back Obamacare’s Medicaid expansion, a program that has given insurance cards to 11 million able-bodied adults without kids at a cost of $64 billion a year without improving their actual health care outcomes.
Conservatives in the room have three big priorities when it comes to Medicaid reform:
Unfortunately, the House health care bill concedes that states will continue to receive federal Medicaid dollars for the new expansion population.
This categorical expansion is already a huge concession and should, at the very least, be part of a program reform that grows at a low rate closely resembling historical growth.
That is why many of my colleagues and I want to put the reformed per capita allotment Medicaid program on a sustainable fiscal path with a growth rate of the Consumer Price Index for All Urban Consumers (CPI-U).
Hopefully, we will be able to also include additional flexibility for states to innovate and adopt new mechanisms that serve the unique needs of each state’s vulnerable populations.
The health care working group also addressed the individual insurance market, where conservatives pushed to repeal as many of Obamacare’s insurance regulations as possible.
The Obamacare regulations drive up the cost of health care the most.
They force insurers to cover everyone at the same price without respect to age, gender, or health status—even if these customers use drastically different amounts of health care each year, or if they wait to purchase coverage until they fall ill.
Another major regulation forces insurers to pay for an expansive list of “essential health benefits,” even when the customer doesn’t need or want to pay for that coverage.
Finally, another burdensome regulation tightly dictates how much insurers must pay out on each health care plan.
All of these regulations have driven up the price of premiums by 100 percent nationwide—in some places, monthly premiums cost more than someone’s mortgage.
Conservatives would like to clear the books of Obamacare’s most costly regulations and free the states to regulate their markets how they wish—even if that means reapplying these regulations to their markets.
Should this not be possible, we should at the very least give states the ability to choose which Obamacare regulations they do or do not want to keep.
All states would start off without any of these federal health insurance regulations, and then they would be able to pick and choose which ones they want to keep.
After the debate in the House, it is no longer news that the differences between the moderates and conservatives in the Republican Party on health care policy are substantial. It is unclear right now whether they can be bridged.
But my colleagues and I will keep trying.
We will keep meeting every week to hash out our differences and find common ground until we get something done that will lower premiums for millions of Americans, while strengthening our safety net programs for those who truly need them.
Deep-blue states continue to defend Obamacare to the death, even as their citizens face unbelievable insurance rate hikes. Are you affected by either of these price increases? – Ed.
Consumers in at least two states face the prospect of double-digit increases in health insurance rates next year, as insurers attempt to price premiums amid uncertainty, including from Congress and President Donald Trump on the fate of Obamacare.
Also driving rate increases is the fact that the millions of Americans enrolled on Obamacare’s exchanges are sicker than the general population.
Insurance companies selling plans in Maryland and Connecticut have submitted their rate requests for 2018, as other insurers decide whether they’ll continue to offer coverage on Obamacare’s state-run and federal exchanges.
Already, Tennessee and Iowa have seen an exodus of major insurers. Consumers in parts of those states are in jeopardy of having no insurers to choose from on the exchange next year.
Humana announced in February that it no longer would sell Obamacare coverage in Tennessee, leaving residents of 16 counties in the eastern part of the state at risk of having no plans available to them.
But BlueCross BlueShield of Tennessee stepped in Tuesday, notifying the state’s insurance commissioner in a letter that it would sell coverage on the Obamacare exchange in those areas.
That coverage, though, may come with a steep price, the insurer warned.
“Given the potential negative effects of federal legislation and/or regulatory changes, we believe it will be necessary to price-in those downside risks, even at the prospect of a higher-than-average margin for the short term, or until stability can be achieved,” J.D. Hickey, president of BlueCross BlueShield of Tennessee, wrote.
In Iowa, Wellmark Blue Cross and Blue Shield and Aetna already said this year they no longer would sell plans in the individual market next year. That leaves just one insurer, Medica, as the only choice for Iowans living in 94 of the state’s 99 counties.
But Medica indicated last week that it would leave Iowa’s individual insurance market.
“Without swift action by the state or Congress to provide stability to Iowa’s individual insurance market, Medica will not be able to serve the citizens of Iowa in the manner and breadth that we do today,” the company said in a statement to The Des Moines Register.
The Republican-controlled House vote to “repeal Obamacare” – if that is what this was – was a stunning mess.
Did they get it right? The answer is obviously no, and that’s inevitable. Just imagine a bill that sets out to reorganize any industry that is currently mostly market driven, such as shirts, software, groceries, or furniture. Would any bill coming from Congress that pertains to the whole of any of these be wonderful? It’s impossible.
This is because the minds of politicians working together – with all their mixed motives of special-interest acquiescence, electoral fears, and general ignorance – cannot possibly replicate, much less improve upon, the brilliant mind of the market at work.
Fortunately, we don’t have to deal with such bills in most markets. But the health care industry is different. It’s been heavily regulated for more than a century. Obamacare went in the wrong direction, toward more rather than less government control. It actually disabled the mind of the market. The result has been soaring deductibles and premiums, insurers going belly up, and average citizens being forced to pay for insurance they can’t afford to use.
Change is necessary. Sadly, any structural change in the industry is pushed through via legislation. That is a tragedy. The challenge is to sort out real vs. fake reform, and do this amidst grandstanding, bombast, posturing, ideological panic, rhetorical bombast, and media mania.
The Miasma of Politics
The House had little more than one day to consider a bill that would affect the lives of every single living American in the most fundamental way. Meanwhile, those of us in the peanut gallery had to try to make sense of whether or not this bill is a promising development, remembering that not backing something necessarily means de facto settling with the legislative status quo.
Even getting the core facts of the legislation was a challenge.
What is the core standard by which any health care bill should be evaluated, given that nothing coming out of Congress that can gain a majority of Republicans will ever be right? The test is this: does this bill take us in the direction of restoring market competition and market signaling, or does it preserve the current managed, artificial, coercive, and unworkable system that relies on government control?
Two main features of Obamacare (explains David Henderson) disable market competition: guaranteed issue and community rating. Guaranteed issue mandates what is covered under all health insurance, thus ruling out flexibility on the part of either buyers or sellers. Community rating forbids insurance pricing from being influenced by risk assessment, which takes the insurance out of insurance. A reform worthy of support must deal directly with these problems.
Donald Trump does not understand this at all. He keeps tweeting that he absolutely insists on keeping the mandate that all health insurance must cover pre-existing conditions. The dogmatic demand painted the Republicans in a corner. They couldn’t repeal the very mandates and disabled-pricing schemes that have created such a mess in the industry.
Republicans cleared a major hurdle on Wednesday in advancing their proposal repealing and replacing Obamacare. But the House GOP’s health care bill is likely to see major changes in the Senate, where Republicans must contend with strict budget rules and slim margins to pass the legislation.
The House passed the American Health Care Act by a vote of 217-213 Thursday afternoon, capping weeks of negotiations that sought to satisfy conservative and centrist Republicans.
The bill repeals a number of Obamacare’s major provisions, including the individual and employer mandates, and replaces the law’s tax credits with age-based, refundable tax credits.
House leaders and the White House worked for weeks to get the health care bill through the lower chamber after conservatives and centrist Republicans came out against the original proposal.
The legislation that passed Thursday included amendments to address the concerns of both factions of the Republican party.
But though the health care plan was narrowly approved by the House, the bill could undergo a major makeover in the Senate.
There, a 12-member group of senators is drafting the Senate’s own proposal repealing and replacing Obamacare, which will include parts of the plan that passed the House.
“The safest thing to say is there will be a Senate bill, but it will look at what the House has done and see how much of that we can incorporate in a product that works for us in reconciliation,” Sen. Roy Blunt, R-Mo., said.
Republicans are using a budget tool called reconciliation to fast-track their Obamacare replacement plan through the Senate, where it will need 51 votes to pass.
Republicans hold 52 seats.
Margins for Senate Majority Leader Mitch McConnell are slim, and already, several GOP senators have been skeptical of the House’s Obamacare repeal plan.
Sen. Susan Collins, R-Maine, criticized the bill in March and opposes efforts to defund Planned Parenthood. The legislation strips the organization of its federal funding for one year.
Additionally, four other Republican senators—Rob Portman of Ohio, Cory Gardner of Colorado, Lisa Murkowski of Alaska, and Shelley Moore Capito of West Virginia—expressed concerns about the bill’s plan for phasing out Obamacare’s Medicaid expansion in March.
Portman reaffirmed his opposition to the legislation Thursday.
“I’ve already made clear that I don’t support the House bill as currently constructed because I continue to have concerns that this bill does not do enough to protect Ohio’s Medicaid expansion population, especially those who are receiving treatment for heroin and prescription drug abuse,” the Ohio Republican said in a statement.
Conservatives, too, have their own concerns with the House’s Obamacare repeal plan.
Sen. Ted Cruz, R-Texas, emboldened his colleagues to “continue to improve the bill.”
“For many weeks, I have been working closely with my Senate colleagues, from across the ideological spectrum, on consensus reforms to make health insurance more affordable,” Sen. Ted Cruz, R-Texas, said in a statement. “We must deliver on that promise.
Conservative members of the Freedom Caucus are holding out hope that the upper chamber repeals more of Obamacare.
“Let’s be honest, when we sent an Obamacare repeal legislation to the Senate, it got better because we had folks like Mike Lee and Sen. [Ted] Cruz and Sen. [Marco] Rubio and Sen. [Rand] Paul and all these conservative senators who pushed the so-called reconciliation rules, who pushed the envelope and made it a slightly better piece of legislation,” Rep. Jim Jordan, R-Ohio, told The Daily Signal. “So we’re hoping that’ll happen again.”
In addition to addressing the concerns of Senate Republicans, GOP senators crafting their own bill must adhere to strict rules that govern the reconciliation process. Those rules ensure the tool is used only on bills that change taxes, spending, or the deficit.
Senators can challenge a provision of legislation by raising a point of order against “extraneous matter” included in the bill if he or she believes it violates the Byrd rule, named for the long-serving Democratic senator from West Virginia, Robert Byrd.
The Byrd rule outlines six tests to determine what constitutes “extraneous matter,” and some tests hold more weight than others.
If a senator objects to a part of a reconciliation bill, the Senate parliamentarian advises members on whether it meets the requirements or not. If the parliamentarian says a provision violates the Byrd rule, it may be removed from the bill, or it may be deemed fatal to the legislation.
House Speaker Paul Ryan said the House GOP’s health care bill was crafted to adhere to the rules of reconciliation.
But health policy experts warn that some provisions of that legislation could pose problems for Republicans in the Senate.
“I think the bill is ultimately going to have to be significantly rewritten to answer some of those concerns and hopefully takes it more toward something approaching an actual repeal of Obamacare,” Chris Jacobs, a senior health care policy expert at the Texas Public Policy Foundation and founder of Juniper Research Group, told The Daily Signal.
Jacobs has previously warned about pro-life protections included in the tax credits, which prevent the use of federal dollars to pay for most abortions, and the Senate parliamentarian has ruled in the past that those pro-life provisions violate the Byrd rule.
“There’s past precedent to suggest that this is ultimately a policy change and may not be permitted under the Byrd rule,” he said. “A policy change with an incidental budgetary impact. Therefore, it’s essentially not permitted under the Byrd rule.”
But removing the pro-life provisions for the tax credits could pose further problems for Republicans in both chambers.
“It raises the entire question of whether or not the tax credits remain politically viable because it will be taxpayer funding for plans to cover abortion, just like Obamacare,” Jacobs said.
Jacobs and other experts raised concerns about the fate of the House GOP’s original bill in the Senate several weeks ago. But since then, Republican leaders have added several amendments to the legislation, including one that allows states to pursue waivers to opt out of some Obamacare regulations and another that allocates money to states to set up programs to protect people with pre-existing conditions.
The Senate parliamentarian hasn’t yet ruled whether those amendments will pass muster in the upper chamber, but Jacobs said an analysis from the Congressional Budget Office would’ve provided some clarity.
Reconciliation bills can’t increase the deficit, and Jacobs said a “score” from the nonpartisan agency will detail the provision’s fiscal impact.
The House voted without an analysis from the Congressional Budget Office, which estimates how many people will lose or gain coverage and what the costs of the bill will be.
Though it’s unclear whether the waiver scheme created by the House GOP’s bill will withstand what’s called a “Byrd bath,” Jacobs said it would’ve been better for Republicans to repeal the regulations outright.
“I think a better solution is to repeal the regulations rather than having this waiver option of if you like your Obamacare, you can keep it,” he said.