The House released its replacement to Obamacare.
A couple of things to note:
1. There is a 30% surcharge if you go 63 days in the previous year without insurance. This is the alternative to the mandate – and basically you could if you are young go years without insurance and then just pay the surcharge when you are sick.
But if you lose your job, and the COBRA cost is through the roof, you may wind up getting locked out of the system.
2. The rating for insurance is gone – so be prepared for the return of junk insurance.
Which the GOP will claim is cheaper.
3. This is an attack on Medicaid plain and simple.
I am sorry to distract some readers from the latest Russian news with data about the House replacement for Obamacare.
So some more information – I will probably just keep adding stuff
The subsidy table courtesy of Charles Gaba. There are two significant changes to note. The subsidy in the house bill is flat, and it varies by age. The flat subsidy is of course a windfall for anyone in the upper half of income. The other is that the subsidies are much lower than was the case under Obamacare.
What about the cost?
Well the House doesn’t care. They are moving forward without a markup. There are two reasons for this:
1. The House Bill repeals all but the Cadillac portion of the Obamacare tax increases. This means that it will explode the deficit unless it relies on drastic Medicaid cuts.
2. Avik Roy, a conservative, suggests the House bill will cover about 20 million fewer Americans.
Charles Gaba has a diary at DKOS – I encourage everyoone to visit.
One of the real questions here is what can be done via reconciliation and what can’t. Here is his list of what needs 60 votes:
- Guaranteed issue (no pre-existing condition denials)
- Community rating (can’t charge different people more for the same policy outside of a tight set of parameters)
- The ACA’s preventative benefits (I’m not sure if this list changes, but I’d imagine not)
No lifetime or annual limits on coverage (a few people have stated otherwise, but this seems to be the consensus) - Required essential benefits for every plan on the private market (ie, group or individual)
Limits on out-of-pocket costs for enrollees - Young adults 19-25 being allowed to stay on their parents’ plan (I’ve noted before that I always suspected this would survive any repeal effort)
- “Removing the lines” to allow carriers to “sell insurance across state lines” (at least not any more so than the ACA already allows them to)
The “Grassley Amendment”: Congressional staffers will still have to enroll via the DC exchange in order to receive tax credits. - The 80/20 Medical Loss Ratio (requires insurance carriers to refund the difference to enrollees if they spend more than 20% of premium costs on anything other than actual, legitimate medical care)
Ryan Lizza in the a href=”http://www.newyorker.com/news/ryan-lizza/paul-ryans-health-care-vise”> New Yorker with as good a take as I have seen ont he politics:
Forced to navigate House Republican politics, the lobbying pressure from the insurance industry, and the obscure rules of the budgeting process, Ryan has produced a bill that nobody would ever propose as a sane solution to the problems with Obamacare. Its only chance is speed. If Ryan can rush and muscle it through the House and Mitch McConnell can do the same in the Senate, it might end up on Trump’s desk. But the more scrutiny this House bill is subjected to, the more likely it is to share the fate of most efforts at health-care reform and die somewhere on its journey to the Senate, and perhaps long before then. If his health-care-reform effort fails, Ryan himself may not survive as the House leader. Meadows and his colleagues catapulted Ryan to the Speakership, and they still have the power to bring him down.
Plagiarized (or cribbed) from Obama’s ACA roll-out promise?
If Republicans had their way, there would be no public sector other than the police, jails/prisons, courts to protect, them and their assets, and the Pentagon. Can’t afford the cost of water? Tough. That’s why they’re Republicans.
As the ACA seems not to have boosted the fortunes of the DP, we’ll what whittling it down will do for the GOP. In general, Americans, at least those that vote, don’t seem to mind going from bad to worse. Don’t know how they’d respond to an offer of good because that hasn’t been on offer for a long time.
It won’t do anything good for the GOP. Why?
It occurs to me suddenly that this issue is a poison charm for anyone who touches it. There’s no constituency or mass movement for health care. ACA was put in place by people who wanted to do good and save the country money over time. The American public apparently couldn’t care less. They weren’t buying the Democrats’ covert contract.
If this GOP plan goes into effect, then they own it and all the troubles that come with it. It might even be a gift to the Democrats, who can then run on the misery stories. (But see above – it’s still a loser.)
The Republicans’ best strategy, if they have to do anything about ACA, would be to repeal it lock stock & barrel & then distract everyone from thinking about it with some other problem (a la the occupant of the White House).
That should have read:
You could be right that whittling it down is worse for the GOP than repealing it outright. The latter is what GOP voters believe they want. OTOH, the GOP leadership understands that voters are stupid. So, they’ve preserved the portions of it that they believe GOP voters have taken advantage of.
Seventy years of anti-socialized medicine propaganda is why there’s no constituency for it. That’s in addition to the general anti-socialist/anti-communist, pro-capitalist propaganda. Yet, people can’t see all the evidence of socialism that exists even in this country. That most of us would be illiterate if not for public schools. Couldn’t afford to drive if notfor public roads. Etc.
A minor accident of history created health insurance as something individuals earned and it was for employees that were special, giving it enhanced value. The AMA and unions then built on that accident because it benefited them. Truman was four years too late at the point in time when national healthcare would have been embraced. So, psychologically, Americans that receive employer paid health insurance (and Medicare beneficiaries as well) are invested in the belief that they personally earned their health insurance and they resent taxes to give/subsidize health insurance for those that haven’t earned it. They haven’t a clue as to how much their health insurance is government subsidized.
The only way I can see to teach those people the lesson they need is to do away completely with all the government subsidies and ban employer paid health insurance with the condition that employers put their net reduction into their employees paychecks (roughly between 90 to 92.35% of their current cost for employee health insurance). Let everybody purchase health insurance in the private market. (Keep Medicare Part A because retirees did pay into that.)
We could make it extra special by treating medical debt like we do student loan debt; IOW can’t be discharged in personal bankruptcy.
How soon until howls for a government fix become deafening. I’d guess three.
Or maybe someone could build an app (getting rich in the process) and people can experience what their health insurance fetish really costs.
Occurs to me also that there IS a constituency for “No Government Health Care!” & the GOP is currently answerable to them, having run on that issue.
How did the Democrats get themselves tied to this loser issue? My recollection is that is a combination of accident, & sunk cost fallacy.
The chronology’s a research project but my recollection is …
The Clintons tried to pull off a national health insurance system and failed in the 1st term. After that, it disappeared. I don’t remember it from earlier administrations.
It wasn’t a huge campaign issue for Obama in ’08. It may have been there (I don’t remember any details).
In 2009 Obama had a pretty good mandate, & the Congress, but a huge financial crisis to deal with. Part of the reason for health care was to solve the explosion in medical costs, & control costs long term in the federal budget. Since it looked like it could actually get passed, it absorbed more and more attention and eventually succeeded. But how it was done is making it possible to undo it or trash it.
Unless there is a loud, large constituency demanding a health care system (like there is, opposing it), I don’t think Democrats should touch it. It’s a great idea but the consensus is against it. And no more covert contracts!
In fact wasn’t ACA originally thought to be a bipartisan sorta thing, a Republican plan from the ’90’s that Romney updated and implemented in Massachusetts? That’s probably part of the explanation for why Obama and the Democrats stuck with it, hoping ….
Well, there has been only one D president between LBJ and Clinton, but Carter did propose a health care plan, structured around extending Medicaid/Medicare and employer mandates for catastrophic coverage. Ted Kennedy also worked on several health care plans in Congress, and universal health care was a major part of his primary campaign against Carter. I believe its also been part of every major D primary candidate since LBJ.
This is the opposite of what I am talking about.
There is no constituency – not politicians campaigning for health care … or is there? Where’s the mass movement?
Politicians decorate their platforms with all kinds of things. Somehow this got to be real important to Democrats, perhaps as a bipartisan sop in 2009. I’m glad they did it and succeeded, but I am afraid it is a bad issue without a mass movement behind it.
Maybe this repeal garbage will light that fuse. Without that, though, best forget about it.
Look. Here.. An entire blog with writers covering stuff in addition to the “Russian news.” Good writers, good blog. You should check it out.
I’ve kept it bookmarked for a reason.
Sad to read that Robert Osborne is dead.
What about the exemption of Union plans and FEHB from the Cadillac tax? I assume it’s gone. Since, in my case, my former employer pays two thirds of the premiums, would I only pay one third of the tax, or all of it?
Typical Republican “Screw you, prole!” attitude.
And they had such a good chance to have an overwhelming majority by just screwing us less than the Democrats.
No idea. I will find out.
Thank you very much! Because I will give you 3:1 odds that Democrats will sign on, or at least enough to make it bipartisan. Then they will scream about it in 2018. Our (proles) best chance is that the bill fails in some (R) internecine feud.
No Democrat will sign on to a bill to knock 4 years off Medicare’s funding, end the Medicaid expansion, and close the exchanges. None. It’s political death. This is particularly true because conservative rural areas where the wobblers are will be most brutally throttled by this plan.
This bill won’t get 45 Senate votes. I doubt it can get 40. Every constituency is against it. Libertarians (Cato and Reason), conservatives (it has tax credits!), Heritage Action/Foundation. No one wants it but Grover Norquist.
Isn’t he the one who counts?
The Kochs also oppose it.
It may be single most unpopular piece of major legislation I have ever seen.
It’s amazing.
I think plan B is for them to do nothing and let Obamacare collapse.
The republican “plan” is now, always and forever, nothing.
That strikes me as quite plausible. As someone elsewhere noted, this allows the GOP leadership to say “we tried, and would have got away with it too had it not been for those meddling Dems!” Then ramp up the hate machine some more ahead of the midterm elections. Could be wrong, but seems like a safer bet as time continues to pass.
Despite the preposterous secret-then-rushed-with-no-CBO-scoring machinations, I’m unsure the Senate will get a chance to vote on this Bill. If the Freedom Caucus votes No on this shit sandwich, the POS doesn’t pass the House.
Thanks for posting this summary of the Bill, fladem. It is indeed horrible.
There are Senators who want to see deliberations in the House slowed down considerably – I want to say Cotton (who is generally awful on just about everything, but apparently cautious on this issue) and Graham. Speed is of the essence in getting a bill rammed through the House.
Deficits? What do they care about deficits? Look at the deficits under Reagan and “W” (I forget GHWB’s record).
And Reagan sucked Social Security into the general budget and taxed it too and still had massive deficits! But without excusing RR, don’t forget Tip O’Neill’s part in this Grand Bargain (with the Devil).
P.S. Just looking over some old papers for filing this morning. My pension COLA for 2017 (none for 2016) is $4 a month, but because of insurance increases, the net dropped by $43 a month. SS held steady do to “hold harmless”. COLA’s are a cruel joke.
This plan immediately collapses the exchanges. Nobody below average income will be able to afford insurance under this plan, and they’re the large majority on the exchanges. With more than half the insurees gone the plans become much more costly because of overhead and have no promise for meaningful future profits, so the insurance companies will just quit. Only in relatively wealthy states under Democratic control could you see additional state subsidies to save the exchanges. At present that’s only California and Delaware, although maybe the Republican governors of Massachusetts and Maryland might let it through. Otherwise, sayonara.
This is really the question I have not seen addressed.
People get a subsidy, but where are they buying insurance?
From the fast buck artists on TV currently selling reverse mortgages and cut rate auto insurance.
ObamaCareFacts
12.6 million is roughly 4% of the population. It’s estimated that another 2+ million qualify but haven’t applied. Probably correct to conclude that almost all, if not all, of that 12.6 million receive a subsidy.
In other words, even if they’re all pissed off, they’re insufficient to do anything about Republicans in gerrymandered districts.
Another “strategy” being thrown about is that Ryan knows this third-a-loaf patchwork can’t pass and has thrown a pawn out there as a doomed sop, so that Repub extremists can vote against it, while those Repubs less certain of the level of braindeadness in their constituencies can vote for it, all with everyone knowing that FraudCare can’t pass without united Repub support.
So “We Tried!” (and failed), doggonnit, due to “lockstep” opposition from America-hatin’ obstructionist Dems!
Trumpites and Repubs then simply keep increasing the toxin levels within which the ACA must live, knowing that every new burden and obstacle Trumper places in its path reduces its functionality, until collapse occurs without repeal. The ground will then be ripe for a new (non)plan in response to the crisis, while Repubs can get busy NOW in mutilating the federal gub’mint into the “conservative”/Bannonite image.
The difficulty with this theory, of course, is that Trumper and Ryan look very bad/incompetent having “their” bill go down to defeat in Trumper’s “Hundred Dayz of Victory!” That may be a small price to pay for enacting the Repub Revolution, however…
No they won’t look bad because they will blame it on ‘Murca hating Socialist Libruls. Do you think the general public knows about or looks at vote counts? The MSM will be screaming RUSSIA! Meanwhile, Faux News addicts will be saying “look at the legs on that one!”
Sorry. I feel I’m getting as cynical as Davis X Machina.
It has been clear for quite some time that the only conceivable political course for the Repubs on this front is to simply repeal the ACA wholesale and assert that they are returning the nation to the halcyon pre-ObammyCare days when we lived contentedly under the Holy Free Market—a glorious capitalist approach which had given us the World’s Best Healthcare(tm) (leave aside that the ACA is about health care insurance, but whatever..)
This is a simple message that the Mighty Wurlitzer can trumpet competently and loudly, and the mass of rubes and braindead fools who call themselves “conservatives” and “independents” can fight the “merits” of the claim out amongst themselves. The left will know the truth by and large, but so what?
There isn’t going to be any accountability for whatever Repubs do on the insurance front, and it’s weird that they are hesitating. They have also gotten themselves into the unexplained situation of declaring they “have to” shit this issue out before they begin the rest of the pillage and rapine of the existing 20th century governmental order. If true, they need to get done with this “We Care!” healthcare charade immediately.
The details don’t matter. Declare victory and leave the mop up operations to the insurance industry talking heads and the “conservative” think tanks.
They do not declare victory because they have never known how to win.
Perhaps they are just as foolish as Democrats in their own way.
I don’t see how they escape ownership should the GOP congress pass this bill or something like it.
They don’t hate Obamacare on fiscal grounds or really even on ideological grounds.
They hate Obamacare because they think it’s FREE STUFF for people they despise.
They hate Obamacare because doing so pisses off liberals.
This is completely true.