Spitfire List Web site and blog of anti-fascist researcher and radio personality Dave Emory.

News & Supplemental  

Guess What? Grandma is Moving In. She’s Got Medical Bills. Maybe to Share. It’s Medicaid Brought to You by Kochcare.

Is kick­ing senior cit­i­zens out of nurs­ing homes good pol­i­tics? That’s a ques­tion GOP ask­ing itself these days. One of many ques­tions relat­ed to the pol­i­tics of health care. Although not many are ask­ing it since the pub­lic large­ly has no idea the ques­tion is being asked at all as recent polls show. With the Sen­ate’s ver­sion of ‘Trump­care’ final­ly released to the pub­lic, we’re now learn­ing that, yes, the GOP appears to think kick­ing seniors out their nurs­ing homes is good pol­i­tics. Because trans­fer­ring Med­ic­aid costs to states and indi­vid­u­als has been a key GOP goal of Trump­care’s con­gres­sion­al authors the entire time and nurs­ing homes are paid for by Med­ic­aid for the vast major­i­ty of peo­ple. So in addi­tion to the many pro­found moral ques­tions raised by the GOP’s health care ‘reform’ plans, a grow­ing num­ber of pro­found polit­i­cal ques­tions are being raised the more we learn about Trump­care as it takes form. Includ­ing whether or not putting nurs­ing home cov­er­age on a fis­cal death spi­ral makes for good pol­i­tics. Granny would prob­a­bly say ‘no’, but she’s got com­pe­ti­tion.

******

But despite the deep antipa­thy polls showed towards the House ver­sion of Trump­care, the Amer­i­can Health Care Act (AHCA), the ques­tion of how Amer­i­cans will respond to the GOP’s pro­pos­al to dis­man­tle Amer­i­can’s med­ical safe­ty-net is still an open ques­tion. Why? Because the vast major­i­ty of Amer­i­cans still don’t know that Med­ic­aid is on the chop­ping block:

Think Progress

New poll shows major­i­ty of Amer­i­cans are unaware Trump­care slash­es Med­ic­aid
Just 38 per­cent of peo­ple polled knew the Repub­li­can health care bill makes major cuts to Med­ic­aid.

Kiley Kroh
Jun 24, 2017

As Sen­ate Repub­li­cans aim to force a vote on their ver­sion of Trump­care—a bill that was writ­ten in secret, with­out pub­lic hear­ings, despite the fact that it will reshape one-sixth of the U.S. econ­o­my and impact the lives of mil­lions of Amer­i­cans—most peo­ple have been left in the dark.

Last month, the House passed their ver­sion of the bill, which would strip health care from 24 mil­lion peo­ple, accord­ing to the non­par­ti­san Con­gres­sion­al Bud­get Office. The bill also makes major cuts and struc­tur­al changes to Med­ic­aid, a health insur­ance pro­gram relied upon by near­ly 75 mil­lion Americans—primarily low-income, dis­abled, and elder­ly.

The Sen­ate ver­sion of Trump­care goes even fur­ther, accord­ing to the draft released by Sen. Major­i­ty Leader Mitch McConnell (R‑KY) on Thurs­day, effec­tive­ly phas­ing out Med­ic­aid entire­ly.

But accord­ing to a new poll released by the Kaiser Fam­i­ly Foun­da­tion on Fri­day, only 38 per­cent of Amer­i­cans are aware of the sig­nif­i­cant cuts to Med­ic­aid that would be deliv­ered by the House-passed bill (the poll was con­duct­ed before the details of the Sen­ate bill were made pub­lic). Sev­en­ty-four per­cent of those polled, mean­while, said they have a favor­able opin­ion of Med­ic­aid.

...

The Senate’s harsh­er Med­ic­aid cuts were imme­di­ate­ly met with fierce objec­tions, how­ev­er. Rough­ly 60 mem­bers of ADAPT, a U.S. dis­abil­i­ty rights orga­ni­za­tion that strong­ly oppos­es the Repub­li­can health care bill, staged a die-in out­side of McConnell’s office on Thurs­day. Wheel­chair users were arrest­ed and dragged from the Capi­tol by police.

Mod­er­ate Repub­li­cans have also expressed their dis­com­fort with the severe cuts to Med­ic­aid, with the strongest objec­tion thus far com­ing from Sen. Dean Heller (R‑NV) on Fri­day. “I can­not sup­port a piece of leg­is­la­tion that takes away insur­ance from tens of mil­lions of Amer­i­cans and hun­dreds of thou­sands of Nevadans,” the sen­a­tor said at a press con­fer­ence in Las Vegas.

Hours lat­er, Amer­i­ca First Policies—a pro-Trump group run by sev­er­al of the president’s top cam­paign advisers—announced it was launch­ing a sev­en-fig­ure adver­tis­ing cam­paign against Heller, Politi­co report­ed. Heller is wide­ly viewed as one of the most vul­ner­a­ble incum­bents up for reelec­tion in 2018.

Iron­i­cal­ly, Pres­i­dent Don­ald Trump made pro­tect­ing Med­ic­aid a key com­po­nent of his cam­paign, vow­ing to “save Medicare, Med­ic­aid, and Social Secu­ri­ty with­out cuts” in the speech announc­ing his can­di­da­cy.

Trump told the Wash­ing­ton Post’s Abby Phillip that the Sen­ate ver­sion of Trump­care need­ed “a lit­tle nego­ti­a­tion, but it’s going to be very good.” The pres­i­dent report­ed­ly made calls to Sen­ate Repub­li­cans on Fri­day to try to gin up sup­port for the mea­sure. Trump acknowl­edged there is a “very, very nar­row path” to pas­sage, but that “I think we’re going to get there,” Reuters report­ed.

———-

“New poll shows major­i­ty of Amer­i­cans are unaware Trump­care slash­es Med­ic­aid” by Kiley Kroh; Think Progress; 06/24/2017

“But accord­ing to a new poll released by the Kaiser Fam­i­ly Foun­da­tion on Fri­day, only 38 per­cent of Amer­i­cans are aware of the sig­nif­i­cant cuts to Med­ic­aid that would be deliv­ered by the House-passed bill (the poll was con­duct­ed before the details of the Sen­ate bill were made pub­lic). Sev­en­ty-four per­cent of those polled, mean­while, said they have a favor­able opin­ion of Med­ic­aid.”

Yep, even though only about 1 in 5 Amer­i­cans approved of the House ver­sion of the House ver­sion of Trump­care, only 38 per­cent of them even knew about the most extreme parts of pro­pos­al, the plan to severe­ly cut and fun­da­men­tal­ly change Med­ic­aid. So unless the pub­lic actu­al­ly wants Med­ic­aid to be gut­ted, it’s hard to see how grow­ing aware­ness of the planned Med­ical cuts are going to increase pub­lic sup­port, mak­ing the GOP’s ongo­ing push to pass Trump­care an remark­able polit­i­cal risk. Espe­cial­ly when you con­sid­er that, while Trump­care will have a pro­found (large­ly neg­a­tive) impact across the US health care sys­tem, it’s pri­mar­i­ly a Med­ic­aid phase out scheme and Med­ic­aid cov­ers even more peo­ple than Medicare:

The New York Times

G.O.P. Health Plan Is Real­ly a Roll­back of Med­ic­aid

Lim­it­ing the amount that the fed­er­al gov­ern­ment would pay for each per­son would leave states with dif­fi­cult choic­es, and would be a fun­da­men­tal shift of finan­cial risk.

By MARGOT SANGER-KATZ
JUNE 20, 2017

Tucked inside the Repub­li­can bill to replace Oba­macare is a plan to impose a rad­i­cal diet on a 52-year-old pro­gram that insures near­ly one in five Amer­i­cans.

The bill, of course, would mod­i­fy changes to the health sys­tem brought by the Afford­able Care Act. But it would also per­ma­nent­ly restruc­ture Med­ic­aid, which cov­ers tens of mil­lions of poor or dis­abled Amer­i­cans, includ­ing mil­lions who are liv­ing in nurs­ing homes with con­di­tions like Alzheimer’s or the after­ef­fects of a stroke.

“This is the most con­se­quen­tial change in 50 years for low-income people’s health care,” said Joan Alk­er, the exec­u­tive direc­tor of the Cen­ter for Chil­dren and Fam­i­lies at George­town Uni­ver­si­ty. “This is a mas­sive change that has hard­ly been dis­cussed.”

Since its found­ing, Med­ic­aid has oper­at­ed as a part­ner­ship between the fed­er­al gov­ern­ment and the states. Each pays a share of patients’ med­ical bills, with no over­all lim­it on spend­ing. The Amer­i­can Health Care Act would try to slim down the fed­er­al share of that spend­ing, by lim­it­ing how much the fed­er­al gov­ern­ment would pay for each per­son enrolled in the pro­gram. The Sen­ate ver­sion of the leg­is­la­tion, expect­ed this week, is like­ly to make the pay­ments still lean­er in lat­er years.

The results, accord­ing to inde­pen­dent analy­ses, would be major reduc­tions in fed­er­al spend­ing on Med­ic­aid over time. States would be left decid­ing whether to raise more mon­ey to make up the dif­fer­ence, or to cut back on med­ical cov­er­age for peo­ple using the pro­gram. The Con­gres­sion­al Bud­get Office esti­mates that the changes would lead to a reduc­tion in spend­ing on Med­ic­aid of more than $800 bil­lion over a decade. (That fig­ure also includes addi­tion­al cuts to the Oba­macare Med­ic­aid expan­sion.)

[see chart show­ing per­cent­age of Amer­i­cans cov­ered by Med­ic­aid in dif­fer­ent cat­e­gories]

Med­ic­aid is the country’s largest gov­ern­ment health care pro­gram, cov­er­ing more Amer­i­cans than its bet­ter-known sib­ling, Medicare.

Its reach is broad: About half of all births in the coun­try are cov­ered by Med­ic­aid, and near­ly 40 per­cent of chil­dren are cov­ered through the pro­gram. Med­ic­aid cov­ers the long-term care costs of two-thirds of Amer­i­cans liv­ing in nurs­ing homes, many of them mid­dle-class Amer­i­cans who spent all of their sav­ings on care before becom­ing eli­gi­ble.

It cov­ers chil­dren and adults with dis­abil­i­ties who require ser­vices that most com­mer­cial health insur­ance doesn’t include. It cov­ers poor women who are preg­nant or rais­ing young chil­dren. Those pop­u­la­tions were all includ­ed in the pro­gram before Oba­macare became law.

It also pro­vides insur­ance for poor adult Amer­i­cans, and recent evi­dence shows that its expan­sion under Oba­macare has giv­en more poor peo­ple access to health care ser­vices and reduced their expo­sure to finan­cial shocks.

The Repub­li­can approach would set a for­mu­la for deter­min­ing a max­i­mum pay­ment for each per­son in the pro­gram. Then that cap would grow by a set rate each year. Law­mak­ers are nego­ti­at­ing about the rate to use, but all of the options are intend­ed to grow more slow­ly than expect­ed under the cur­rent sys­tem. The gap would be left for states to fill — or cut.

“While details remain elu­sive, this is shap­ing up to be the largest inter­gov­ern­men­tal trans­fer of finan­cial risk in our country’s his­to­ry,” said Matt Salo, the exec­u­tive direc­tor of the Nation­al Asso­ci­a­tion of Med­ic­aid Direc­tors, in an email. Mr. Salo said that some of his direc­tors would wel­come caps if they came with more pro­gram flex­i­bil­i­ty, but said the cur­rent approach amount­ed to a fund­ing cut.

The growth in med­ical spend­ing tends to be uneven year over year, which means states might hit the caps in one year and fall under them in anoth­er, even with­out any pro­gram changes. Researchers at the Brook­ings Insti­tu­tion recent­ly looked back at his­tor­i­cal Med­ic­aid spend­ing to see what would have hap­pened under a cap. They found that ran­dom vari­a­tion was sub­stan­tial.

Med­ic­aid advo­cates wor­ry par­tic­u­lar­ly that a fixed growth rate doesn’t account for this vary­ing pat­tern of health expen­di­tures, which might shoot up in a year where there’s an epi­dem­ic or an impor­tant new treat­ment. Many Med­ic­aid bud­gets increased in recent years after the intro­duc­tion of expen­sive but effec­tivemed­ica­tions for hepati­tis C, for exam­ple. States had to pay more for the drug, but fed­er­al spend­ing also increased to match it.

...

Advo­cates for the struc­tur­al change point to inef­fi­cien­cies and waste in the cur­rent pro­gram. There is some evi­dence that Med­ic­aid pro­grams enroll some peo­ple who are not eli­gi­ble and some­times cov­er some ser­vices that are not med­ical­ly nec­es­sary. James Capret­ta, a fel­low at the con­ser­v­a­tive Amer­i­can Enter­prise Insti­tute, said that the cur­rent sys­tem, where the fed­er­al gov­ern­ment match­es all state spend­ing, dis­cour­ages effi­cien­cy.

But he and co-authors have also sug­gest­ed a dif­fer­ent, more gen­er­ous approach than the one in the Repub­li­can leg­is­la­tion.

Most researchers who study the pro­gram close­ly say that it is already quite lean. Major sav­ings, they say, will be hard to achieve with­out reduc­ing med­ical ben­e­fits or cut­ting high­er-cost patients from the pro­gram.

Trump admin­is­tra­tion offi­cials and Repub­li­can mem­bers of Con­gress have argued that the Med­ic­aid changes won’t cause any­one to lose insur­ance cov­er­age direct­ly. That state­ment is true in only the nar­row­est sense.

Because the fund­ing cuts would fall to states, it is state offi­cials who would decide whether to save mon­ey by rais­ing tax­es, reduc­ing pay­ments to nurs­ing homes or elim­i­nat­ing ben­e­fits like home-based care for dis­abled ben­e­fi­cia­ries, a few avail­able options under the law.

The Con­gres­sion­al Bud­get Office esti­mates that enroll­ment in Med­ic­aid would decline sub­stan­tial­ly over a decade, as states pur­sued a vari­ety of strate­gies to save mon­ey, some of which would push peo­ple out of the pro­gram.

Still, the Med­ic­aid caps have not drawn the same pub­lic out­cry as oth­er pro­vi­sions of the law that would cut back on cov­er­age more direct­ly. Sev­er­al Repub­li­can sen­a­tors have expressed con­cerns about changes to Obamacare’s Med­ic­aid expan­sion, which broad­ened the pro­gram to include more low-income adults in 31 states.

Oth­ers wor­ry about changes to pri­vate insur­ance sub­si­dies that would make insur­ance less afford­able to old­er, mid­dle-class Amer­i­cans. Few­er have spo­ken out about the cuts to Medicaid’s lega­cy ben­e­fi­cia­ries. That means that, as the Sen­ate works out final details, the forced diet for Med­ic­aid is like­ly to stay in the bill.

———-

“G.O.P. Health Plan Is Real­ly a Roll­back of Med­ic­aid”
by MARGOT SANGER-KATZ; The New York Times; 06/20/2017

The results, accord­ing to inde­pen­dent analy­ses, would be major reduc­tions in fed­er­al spend­ing on Med­ic­aid over time. States would be left decid­ing whether to raise more mon­ey to make up the dif­fer­ence, or to cut back on med­ical cov­er­age for peo­ple using the pro­gram. The Con­gres­sion­al Bud­get Office esti­mates that the changes would lead to a reduc­tion in spend­ing on Med­ic­aid of more than $800 bil­lion over a decade. (That fig­ure also includes addi­tion­al cuts to the Oba­macare Med­ic­aid expan­sion.)”

Is Amer­i­ca’s health care safe­ty-net going to be pri­mar­i­ly a state-by-state issue? That’s the plan. With large state-by-state cuts to Med­ic­aid expect­ed. At least expect­ed by health care experts who study these issues. But for the Amer­i­cans either on Med­ic­aid or with fam­i­ly mem­bers on Med­ic­aid it’s hard to see how they can expect these dra­mat­ic changes to the saftey-net if they don’t even know about them. It’s going to be a hor­ri­ble sur­prise. And that’s part of what makes Trump­care such a remark­able polit­i­cal risk for the GOP: it’s bound to be far worse than peo­ple expect because most peo­ple have no idea how bad it is.

Beyond that, note one of the pop­u­la­tions set to be direct­ly impact­ed by these pro­posed Med­ic­aid cuts: peo­ple in nurs­ing homes. Yep, Trump­care isn’t sim­ply plan­ning on metaphor­i­cal­ly ‘throw­ing granny off the cliff’. It’s a plan to lit­er­al­ly throw granny out of the nurs­ing home:

...
Med­ic­aid is the country’s largest gov­ern­ment health care pro­gram, cov­er­ing more Amer­i­cans than its bet­ter-known sib­ling, Medicare.

Its reach is broad: About half of all births in the coun­try are cov­ered by Med­ic­aid, and near­ly 40 per­cent of chil­dren are cov­ered through the pro­gram. Med­ic­aid cov­ers the long-term care costs of two-thirds of Amer­i­cans liv­ing in nurs­ing homes, many of them mid­dle-class Amer­i­cans who spent all of their sav­ings on care before becom­ing eli­gi­ble.

It cov­ers chil­dren and adults with dis­abil­i­ties who require ser­vices that most com­mer­cial health insur­ance doesn’t include. It cov­ers poor women who are preg­nant or rais­ing young chil­dren. Those pop­u­la­tions were all includ­ed in the pro­gram before Oba­macare became law.
...

“Its reach is broad: About half of all births in the coun­try are cov­ered by Med­ic­aid, and near­ly 40 per­cent of chil­dren are cov­ered through the pro­gram. Med­ic­aid cov­ers the long-term care costs of two-thirds of Amer­i­cans liv­ing in nurs­ing homes, many of them mid­dle-class Amer­i­cans who spent all of their sav­ings on care before becom­ing eli­gi­ble.”

Two-thirds of Amer­i­cans in nurs­ing homes are there because Med­ic­aid is cov­er­ing their expens­es. But under Trump­care there’s going to be less and less fed­er­al fund­ing avail­able for those costs every year.

Throw Granny Off the Cliff Out of the Nurs­ing Home

So while today’s nurs­ing home recip­i­ents may or may not live long enough to see an impact from these cuts, the grannies of tomor­row are set to be increas­ing­ly in per­il. The younger you are now the more Med­ic­aid will be gut­ted by the time you’re old enough for a nurs­ing home. Which, again, is part of what makes Trump­care such a remark­able polit­i­cal gam­ble: If Amer­i­cans actu­al­ly learn about these planned ever-grow­ing cuts to Med­ic­aid it might dawn on them that almost every­one is poten­tial­ly impact­ed. Includ­ing younger peo­ple finan­cial­ly well-off today. Even­tu­al­ly. Because even today’s afflu­ent can become tomor­row’s des­ti­tute elder­ly in need of Med­ic­aid just to live. That’s what hap­pens if you sim­ply live long enough and you’re not rich. And maybe if you are rich:

The New York Times

Cuts to Med­ic­aid May Lim­it Access to Nurs­ing Homes

By JORDAN RAU
JUNE 24, 2017

ORANGE, Va. — Alice Jacobs, 90, once owned a fac­to­ry and hors­es. She raised four chil­dren and buried two hus­bands.

But years in an assist­ed liv­ing cen­ter drained her sav­ings, and now she relies on Med­ic­aid to pay for her care at Dog­wood Vil­lage, a non­prof­it, coun­ty-owned nurs­ing home here.

“You think you’ve got enough mon­ey to last all your life, and here I am,” Ms. Jacobs said.

Med­ic­aid pays for most of the 1.4 mil­lion elder­ly peo­ple in nurs­ing homes, like Ms. Jacobs. It cov­ers 20 per­cent of all Amer­i­cans and 40 per­cent of poor adults.

On Thurs­day, Sen­ate Repub­li­cans joined their House col­leagues in propos­ing steep cuts to Med­ic­aid, part of the effort to repeal the Afford­able Care Act. Con­ser­v­a­tives hope to roll back what they see as an expand­ing and cost­ly health care enti­tle­ment. But lit­tle has been said about what would hap­pen to old­er Amer­i­cans in nurs­ing homes if these cuts took effect.

Under fed­er­al law, state Med­ic­aid pro­grams are required to cov­er nurs­ing home care. But state offi­cials decide how much to pay facil­i­ties, and states under bud­getary pres­sure could decrease the amount they are will­ing to pay or restrict eli­gi­bil­i­ty for cov­er­age.

The states are going to make it hard­er to qual­i­fy med­ical­ly for need­ing nurs­ing home care,” pre­dict­ed Toby S. Edel­man, a senior pol­i­cy attor­ney at the Cen­ter for Medicare Advo­ca­cy. “They’d have to be more dis­abled before they qual­i­fy for Med­ic­aid assis­tance.”

States might allow nurs­ing homes to require res­i­dents’ fam­i­lies to pay for a por­tion of their care, she added. Offi­cials could also lim­it the types of ser­vices and days of nurs­ing home care they pay for, as Medicare already does.

The 150 res­i­dents of Dog­wood Vil­lage include for­mer teach­ers, farm­ers, doc­tors, lawyers, stay-at-home par­ents and health aides — a cross sec­tion of this rur­al coun­ty a half-hour north­east of Char­lottesville. Many entered old age solid­ly mid­dle class but turned to Med­ic­aid, which was once thought of as a gov­ern­ment pro­gram exclu­sive­ly for the poor, after exhaust­ing their insur­ance and assets.

A com­bi­na­tion of longer life spans and spi­ral­ing health care costs has left an esti­mat­ed 64 per­cent of the Amer­i­cans in nurs­ing homes depen­dent on Med­ic­aid. In Alas­ka, Mis­sis­sip­pi and West Vir­ginia, Med­ic­aid was the pri­ma­ry pay­er for three-quar­ters or more of nurs­ing home res­i­dents in 2015, accord­ing to the Kaiser Fam­i­ly Foun­da­tion.

“Peo­ple are sim­ply out­liv­ing their rel­a­tives and their resources, and for­tu­nate­ly, Med­ic­aid has been there,” said Mark Parkin­son, the pres­i­dent of the Amer­i­can Health Care Asso­ci­a­tion, a nation­al nurs­ing home indus­try group.

With more than 70 mil­lion peo­ple enrolled in Med­ic­aid at an annu­al cost of more than $500 bil­lion, the pro­gram cer­tain­ly faces long-term finan­cial chal­lenges. Fed­er­al Med­ic­aid spend­ing is pro­ject­ed to grow 6 per­cent a year on aver­age, ris­ing to $650 bil­lion in 2027 from $389 bil­lion this year, accord­ing to the Con­gres­sion­al Bud­get Office.

Even if Con­gress does not repeal the Afford­able Care Act, Med­ic­aid will remain a tar­get for cuts, experts say.

“The Med­ic­aid pieces of the House bill could be incor­po­rat­ed into oth­er pieces of leg­is­la­tion that are mov­ing this year,” said Edwin Park, a vice pres­i­dent at the Cen­ter on Bud­get and Pol­i­cy Pri­or­i­ties, a Wash­ing­ton non­prof­it that focus­es on how gov­ern­ment bud­gets affect low-income peo­ple. “Cer­tain­ly, nurs­ing homes would be part of those cuts, not only in reim­burse­ment rates but in reduc­tions in eli­gi­bil­i­ty for nurs­ing home care.”

While most Med­ic­aid enrollees are chil­dren, preg­nant women and nonelder­ly adults, long-term ser­vices such as nurs­ing homes account for 42 per­cent of all Med­ic­aid spend­ing — even though only 6 per­cent of Med­ic­aid enrollees use them.

“Moms and kids aren’t where the mon­ey is,” said Damon Terza­ghi, a senior direc­tor at the Nation­al Asso­ci­a­tion of States Unit­ed for Aging and Dis­abil­i­ties, a group rep­re­sent­ing state agen­cies that man­age pro­grams for these pop­u­la­tions or advo­cate on their behalf. “If you’re going to cut that much mon­ey out, it’s going to be com­ing from old­er peo­ple and peo­ple with dis­abil­i­ties.”

The House health care bill tar­gets nurs­ing home cov­er­age direct­ly by requir­ing every state to count home equi­ty above $560,000 in deter­min­ing Med­ic­aid eli­gi­bil­i­ty. That would make eli­gi­bil­i­ty rules tougher in 10 states — most­ly ones with expen­sive real estate mar­kets, includ­ing Cal­i­for­nia, Mass­a­chu­setts and New York — as well as in the Dis­trict of Colum­bia, accord­ing to an analy­sis by the Cen­ter for Bud­get and Pol­i­cy Pri­or­i­ties.

Dog­wood Vil­lage receives about half of its $13 mil­lion annu­al oper­at­ing costs from Med­ic­aid, with rates from $168 to $170 a day. Some res­i­dents who come to the nurs­ing home after a hos­pi­tal stay are ini­tial­ly cov­ered by Medicare, but if they stay longer than 100 days, that ben­e­fit ends, and those with­out sav­ings move to Med­ic­aid.

...

Med­ic­aid helps pay for care for peo­ple with dis­abil­i­ties, like Nan­cy Huff­stick­ler, 65, who has been here for four years and regards her­self as “a med­ical dis­as­ter.”

She list­ed her ail­ments: spinal can­cer in remis­sion, rest­less leg syn­drome, high blood pres­sure and mul­ti­ple ulcers. She has had spinal recon­struc­tive surgery and a hip replace­ment. She is under­go­ing phys­i­cal ther­a­py with the hope that one day she will be able to leave her wheel­chair and use a walk­er.

Ms. Huff­stick­ler is fear­ful of Repub­li­cans’ health care changes. “It may save the fed­er­al gov­ern­ment mon­ey, but what about us?” she asked.

Major Med­ic­aid cuts would com­pel Dog­wood Vil­lage to cut staff, sup­plies and ameni­ties — changes that would affect the qual­i­ty of care for all res­i­dents, not just those on Med­ic­aid.

If that does not save enough mon­ey, the nurs­ing home might have to reduce the num­ber of Med­ic­aid res­i­dents, said Ver­non Bak­er, who resigned as admin­is­tra­tor in April. “It’s not like our toi­let paper or paper tow­els are like the Ritz-Carlton’s,” he said.

Some res­i­dents do not even know they are on gov­ern­ment insur­ance; admin­is­tra­tors often com­plete the paper­work to start Med­ic­aid once oth­er insur­ance expires. Oth­ers are embar­rassed that they are depen­dent on a pro­gram that still car­ries stig­ma.

They should not be, said Jen­nifer Harp­er, the assis­tant direc­tor of nurs­ing. Rely­ing on Med­ic­aid for nurs­ing home care has become the new nor­mal.

“These folks have worked their whole lives, some with pret­ty stren­u­ous jobs, and paid into the sys­tem,” she said. But with changes loom­ing, she said, “it may be a sys­tem that fails them.”

———-

“Cuts to Med­ic­aid May Lim­it Access to Nurs­ing Homes” by JORDAN RAU; The New York Times; 06/24/2017

“Peo­ple are sim­ply out­liv­ing their rel­a­tives and their resources, and for­tu­nate­ly, Med­ic­aid has been there,” said Mark Parkin­son, the pres­i­dent of the Amer­i­can Health Care Asso­ci­a­tion, a nation­al nurs­ing home indus­try group.”

For over half a cen­tu­ry now, when elder­ly Amer­i­cans in need of nurs­ing home ser­vices out­lived their sav­ings at least they weren’t com­plete­ly screwed. Med­ic­aid was there. But once Trump­care becomes law, the ques­tion of whether or not granny gets to stay in the nurs­ing home, or gets admit­ted in the first place, its going to become an increas­ing­ly expen­sive ques­tion for the states. And answer just might include things like forc­ing fam­i­ly mem­bers to start pay­ing to cov­er the costs the fed­er­al gov­ern­ment used to cov­er. So it’s going a state issue and a fam­i­ly issue...are you will­ing to pay the state to help give your par­ents or grand­par­ents nurs­ing home care? That’s the ques­tion the GOP would like you to start answer­ing soon:

...
Under fed­er­al law, state Med­ic­aid pro­grams are required to cov­er nurs­ing home care. But state offi­cials decide how much to pay facil­i­ties, and states under bud­getary pres­sure could decrease the amount they are will­ing to pay or restrict eli­gi­bil­i­ty for cov­er­age.

The states are going to make it hard­er to qual­i­fy med­ical­ly for need­ing nurs­ing home care,” pre­dict­ed Toby S. Edel­man, a senior pol­i­cy attor­ney at the Cen­ter for Medicare Advo­ca­cy. “They’d have to be more dis­abled before they qual­i­fy for Med­ic­aid assis­tance.”

States might allow nurs­ing homes to require res­i­dents’ fam­i­lies to pay for a por­tion of their care, she added. Offi­cials could also lim­it the types of ser­vices and days of nurs­ing home care they pay for, as Medicare already does.
...

States might allow nurs­ing homes to require res­i­dents’ fam­i­lies to pay for a por­tion of their care, she added. Offi­cials could also lim­it the types of ser­vices and days of nurs­ing home care they pay for, as Medicare already does.”

This is part of the new Trum­p­lan­di­an Amer­i­ca and the vast major­i­ty of Amer­i­cans have no idea this is about to become real­i­ty. Young par­ents won’t just have to start the col­lege fund for their chil­dren as ear­ly as pos­si­ble. They’re going to need a “mom and dad’s future nurs­ing home fund” too. Soon. Maybe. Sure, that’s just the opin­ion of a Medicare Advo­ca­cy group attor­ney, but claim­ing the assets of Med­ic­aid recip­i­ents after they die or charg­ing rel­a­tives month­ly fees is bound to get increas­ing­ly tempt­ing to states as the fed­er­al par­tic­i­pa­tion in Med­ic­aid erodes year after year. And in Trump­care, states are going to be giv­en lots of the “flex­i­bil­i­ty” to “exper­i­ment” with new ways to trans­fer the cost of med­ical ser­vices and oth­er safe­ty-net pro­grams back onto the pub­lic. Espe­cial­ly the poor. If slow­ly killing Med­ic­aid becomes a new nation­al pas­time, charg­ing fam­i­lies for Med­ic­aid nurs­ing home costs is just a mat­ter of time. And not just for nurs­ing home ser­vices but poten­tial­ly any­thing Med­ic­aid relat­ed. Why not? That’s anoth­er tax cut for the Koch broth­ers. It’s pos­si­ble. One state at a time.

And if you think, “well, since the elder­ly are such an impor­tant vot­ing block, espe­cial­ly for the GOP, there’s no way they’ll actu­al­ly imple­ment all these cuts for nurs­ing homes. Sure­ly there must be some sort of loop­hole they’ll add in at the last minute,” take a look at just how much of the total spend­ing on Med­ic­aid is spent on long-term ser­vices like nurs­ing homes: 42 per­cent. So unless the GOP is plan­ning on sig­nif­i­cant­ly cur­tail­ing the tax cuts for the rich in Trump­care — and don’t for­get that Trump­care is basi­cal­ly a tax cut for the rich paid for by cut­ting pri­mar­i­ly Med­ic­aid — there’s almost no way they’re going to give poor seniors any­thing oth­er than token help. Cut­ting seniors off Med­ic­aid is where the big mon­ey is at:

...
While most Med­ic­aid enrollees are chil­dren, preg­nant women and nonelder­ly adults, long-term ser­vices such as nurs­ing homes account for 42 per­cent of all Med­ic­aid spend­ing — even though only 6 per­cent of Med­ic­aid enrollees use them.

“Moms and kids aren’t where the mon­ey is,” said Damon Terza­ghi, a senior direc­tor at the Nation­al Asso­ci­a­tion of States Unit­ed for Aging and Dis­abil­i­ties, a group rep­re­sent­ing state agen­cies that man­age pro­grams for these pop­u­la­tions or advo­cate on their behalf. “If you’re going to cut that much mon­ey out, it’s going to be com­ing from old­er peo­ple and peo­ple with dis­abil­i­ties.”
...

Moms and kids aren’t where the mon­ey is. Grand­ma and grand­pa had bet­ter get their check­books.

Throw­ing Granny Out of the Nurs­ing Home Isn’t a New Idea. Or a Pop­u­lar One. for Obvi­ous Rea­sons

So what’s the pub­lic response to this going to be once they final­ly fig­ure Trump­care’s plans for elder­ly Amer­i­cans? Well, while we don’t have cur­rent polling data avail­able giv­en the pub­lic igno­rance on this mat­ter, we do have past polling data for sim­i­lar GOP pro­pos­als. After all, Trump­care is Ryan­care. And House Speak­er Paul Ryan has been try­ing to do this to Med­ic­aid for years. So while Amer­i­cans don’t know what’s in Trump­care today, the did learn about Ryan­car­e’s very sim­i­lar plans for Med­ic­aid in 2011. And boy oh boy did seniors hate Ryan­care. And what did they hate the most? The Med­ic­aid cuts to nurs­ing homes:

The Huff­in­g­ton Post

Amer­i­cans ‘Very Con­cerned’ GOP Bud­get Will Force Elder­ly From Nurs­ing Homes: Poll

By Michael McAu­li­ff
06/23/2011 10:39 am ET | Updat­ed Aug 23, 2011

WASHINGTON — Democ­rats are get­ting set to ramp up the bud­get cut rhetoric with a new mes­sage: Don’t throw grand­ma from the nurs­ing home.

The mes­sag­ing comes after new polling by a Demo­c­ra­t­ic-aligned polling firm found that mes­sages about the impacts of the House Repub­li­can bud­get plan on elder­ly Med­ic­aid recip­i­ents res­onate even more pow­er­ful­ly than crit­i­cism about its impact on Medicare.

The bud­get blue­print craft­ed by House Bud­get Com­mit­tee Chair­man Paul Ryan (R‑Wis.) turns the health­care sys­tem for the elder­ly into a pri­vate pro­gram, which will dou­ble the cost of health­care in 10 years for future seniors, accord­ing to the Con­gres­sion­al Bud­get Office.

The Ryan pri­va­ti­za­tion plan is deeply unpop­u­lar:: Fresh polling by Bloomberg released Thurs­day found that Amer­i­cans think they would be worse off if Ryan’s Medicare pro­pos­al is adopt­ed by a mar­gin of 57 per­cent to 34 per­cent — includ­ing 58 per­cent of elec­toral­ly key inde­pen­dents who dis­like the plan.

But the new polling by Anza­lone Liszt Research, the Demo­c­ra­t­ic-aligned polling firm, found an even more dra­mat­ic response on Med­ic­aid if respon­dents are told of the impacts seniors face.

Told that the Ryan bud­get “would cut $750 bil­lion from Med­ic­aid, includ­ing fund­ing for 80 per­cent of nurs­ing home res­i­dents, forc­ing many seniors to be kicked out of their nurs­ing homes,” 63 per­cent of respon­dents said they were “very” con­cerned. That fig­ure was 69 per­cent for seniors and 64 per­cent for inde­pen­dents.

About 64 per­cent of senior nurs­ing home res­i­dents depend on Med­ic­aid as the pri­ma­ry means of pay­ing for their hous­ing. Still more rely on Med­ic­aid for oth­er expens­es or to be able to stay in their own homes.

The polling firm con­clud­ed those num­bers make the issue a win­ner for Democ­rats, and they advise using sim­i­lar lan­guage to bring the mes­sage home to vot­ers.

Democ­rats, how­ev­er, are not about to drop the com­plaints about the impacts of Ryan’s plan on Medicare, which are wide­ly cred­it­ed with help­ing Democ­rats win the New York spe­cial elec­tion that pro­pelled Rep. Kathy Hochul into a seat long held by the GOP.

...

———-

“Amer­i­cans ‘Very Con­cerned’ GOP Bud­get Will Force Elder­ly From Nurs­ing Homes: Poll” by Michael McAu­li­ff; The Huff­in­g­ton Post; 06/23/2011

“Told that the Ryan bud­get “would cut $750 bil­lion from Med­ic­aid, includ­ing fund­ing for 80 per­cent of nurs­ing home res­i­dents, forc­ing many seniors to be kicked out of their nurs­ing homes,” 63 per­cent of respon­dents said they were “very” con­cerned. That fig­ure was 69 per­cent for seniors and 64 per­cent for inde­pen­dents.

69 per­cent of seniors were “very” con­cerned about the Med­ic­aid cuts. Even more con­cerned than they were about the Medicare cuts. And unless some­thing dra­mat­i­cal­ly changed in senior atti­tudes over the last 6 years it’s hard to see why we would­n’t see the same lev­el of con­cern today...at least among ~38 per­cent of seniors who are actu­al­ly aware today of what’s in Trump­care.

Don’t Wor­ry Granny. Here’s a Tax Cred­it (Granny Should Prob­a­bly Wor­ry).

So since the Sen­ate bill is hurtling towards pas­sage and Trump­care’s dire impli­ca­tions loom large on a large­ly unsus­pect­ing pop­u­lace how is the GOP plan­ning on explain­ing all this to a pub­lic that large­ly loathes the ideas of Trump­care? And in par­tic­u­lar, what is the GOP going to tell seniors, a crit­i­cal and reli­able vot­ing bloc, about how the 2/3 of nurs­ing home res­i­dents are either going to be increas­ing­ly at risk of get­ting kicked out or forced to beg their fam­i­lies for the mon­ey in com­ing years and decades? Peo­ple can end up in nurs­ing homes for decades if they live long enough and the way Trump­care works those fed­er­al funds avail­able for nurs­ing home care is going to keep shrink­ing every sin­gle year. And not just nurs­ing home care but any oth­er med­ical ser­vices too. There’s a pret­ty clear ‘hur­ry up and die’ ele­ment to it all. How is the GOP going to explain this? We’ll see, but it will prob­a­bly involve ask­ing poor seniors to cov­er the costs them­selves with the help of tax cred­its. Seri­ous­ly:

Think Progress

Repub­li­can Sen­a­tors pre­tend peo­ple who get kicked off of Med­ic­aid will just start buy­ing insur­ance
Sen­ate Repub­li­cans are try­ing (and fail­ing) to jus­ti­fy cuts to Med­ic­aid.

Aman­da Michelle Gomez
Jun 23, 2017

The day after the Senate’s draft health bill was released, sup­port­ers looked to defend a key com­po­nent of bill: cuts to Med­ic­aid. Repub­li­can law­mak­ers will need to answer to its ben­e­fi­cia­ries, who’ve grown depen­dent on this pro­gram for cov­er­age.

On Fri­day, Sen­a­tor Bill Cas­sidy (R‑LA) on Morn­ing Joe rec­on­ciled the Senate’s Med­ic­aid cuts the fol­low­ing way: “If Med­ic­aid expan­sion goes away and if there is no cov­er­age, that’s a bad thing, Willie. On the oth­er hand, if they move from Med­ic­aid to pri­vate insur­ance, that could be a good thing.”

Cas­sidy claimed that Med­ic­aid enrollees could join the indi­vid­ual mar­ket­places, which have been doing poor­ly because not enough peo­ple are opt­ed in. They’ll be able to afford such plans with tax cred­its, which he char­ac­ter­ized as “more gen­er­ous” than the House.

Sen­ate Rand Paul (R‑KY), who does not sup­port the bill as it cur­rent­ly stands, also appeared on the show and said he would like to “legal­ize inex­pen­sive insur­ance,” and ulti­mate­ly have Med­ic­aid patients go on “inex­pen­sive” plans—likely pri­vate plans.

Both sen­a­tors believe that Med­ic­aid enrollees could obtain cov­er­age else­where. But health experts say Med­ic­aid enrollees will like­ly for­go cov­er­age alto­geth­er under the Sen­ate Repub­li­cans’ health care bill, leav­ing them unin­sured.

The Sen­ate Repub­li­cans’ Bet­ter Care Rec­on­cil­i­a­tion Act (BCRA) ends Med­ic­aid expan­sion by 2024, and also makes addi­tion­al cuts to the over­all pro­gram start­ing in 2025. The entire Med­ic­aid pro­gram as Amer­i­cans know it could end, and for many Repub­li­cans, that’s the entire idea. Med­ic­aid over­haul has been a point of moti­va­tion for health care reform. House Speak­er Paul Ryan (R‑OH) had pre­vi­ous­ly told the Nation­al Review that he has been dream­ing about mak­ing cuts to the Med­ic­aid pro­gram since his keg-days in col­lege.

The Sen­ate bill, like the House bill, looks to under­cut the Med­ic­aid pro­gram in the fol­low­ing way: the cur­rent mod­el, which is an open-end­ed com­mit­ment to states to pay most Med­ic­aid enrollee’s bills, would become a per capi­ta cap sys­tem. Under this sys­tem, states can get a lump sum from the gov­ern­ment for each enrollee or request a block grant. The Sen­ate bill breaks away from the House ver­sion of the bill after 2025. At that point, the rates at which the fed­er­al gov­ern­ment assists states changes and becomes teth­ered to the con­sumer price index. The adjust­ed growth rate funds less than what Med­ic­aid requires and could lead to a non-func­tion­ing pro­gram, accord­ing to the Urban Insti­tute.

Tax cred­its under BCRA will not be help­ful to Med­ic­aid ben­e­fi­cia­ries, Tara Straw, senior health pol­i­cy ana­lyst at the Cen­ter on Bud­get and Pol­i­cy Pri­or­i­ties, told ThinkProgress.

Under the Sen­ate bill, pre­mi­ums tax cred­its are based on income, age, and geog­ra­phy. Cas­sidy is right in that cred­its under the Sen­ate are more gen­er­ous than the House, which is based sole­ly on age. How­ev­er, the Sen­ate bill changes the Oba­macare for­mu­la for cred­its, mak­ing them less gen­er­ous. The Sen­ate plans are set up like bronze plans under Oba­macare. Essen­tial­ly, plans would see low­er month­ly pre­mi­ums but rais­es costs when patients need care. And deductibles—the amount of med­ical costs patients pay them­selves before the insur­ance plan starts to pay—could become more expen­sive. A medi­an bronze plan deductible is $6,300, said Straw. Under the sen­ate bill, cost shar­ing reductions?—?that help pay for out-of-pock­et costs are repealed by 2020.

Straw says that even if Med­ic­aid patients agree to fun­nel 2 per­cent of their income to pay for these insur­ance plans, the plans cov­er less because states could waive cov­er­age require­ments.

When Cas­sidy says Med­ic­aid enrollees will see low­er pre­mi­ums under the Senate’s restruc­ture, that’s like­ly true. But what he neglects to men­tion is that patients will instead see expen­sive co-pay­ments and deductibles.

“Some­one could scrap to pay for pre­mi­ums. But could they ever use?” asked Straw, “No because deductibles.”

...

———-

“Repub­li­can Sen­a­tors pre­tend peo­ple who get kicked off of Med­ic­aid will just start buy­ing insur­ance” by Aman­da Michelle Gomez; Think Progress; 06/23/2017

Both sen­a­tors believe that Med­ic­aid enrollees could obtain cov­er­age else­where. But health experts say Med­ic­aid enrollees will like­ly for­go cov­er­age alto­geth­er under the Sen­ate Repub­li­cans’ health care bill, leav­ing them unin­sured.”

And how do Sen­a­tors Cas­sidy and Paul pro­pose Med­ic­aid recip­i­ents — peo­ple who make less than the pover­ty line — afford to buy their own pri­vate med­ical ser­vices? Tax cred­its. That’s seri­ous­ly their response:

...
On Fri­day, Sen­a­tor Bill Cas­sidy (R‑LA) on Morn­ing Joe rec­on­ciled the Senate’s Med­ic­aid cuts the fol­low­ing way: “If Med­ic­aid expan­sion goes away and if there is no cov­er­age, that’s a bad thing, Willie. On the oth­er hand, if they move from Med­ic­aid to pri­vate insur­ance, that could be a good thing.”

Cas­sidy claimed that Med­ic­aid enrollees could join the indi­vid­ual mar­ket­places, which have been doing poor­ly because not enough peo­ple are opt­ed in. They’ll be able to afford such plans with tax cred­its, which he char­ac­ter­ized as “more gen­er­ous” than the House.

Sen­ate Rand Paul (R‑KY), who does not sup­port the bill as it cur­rent­ly stands, also appeared on the show and said he would like to “legal­ize inex­pen­sive insur­ance,” and ulti­mate­ly have Med­ic­aid patients go on “inex­pen­sive” plans—likely pri­vate plans.
...

It’s kind of hard to see how that isn’t going to be per­ceived as a ghast­ly insult to elder­ly GOP vot­ers. But that ghast­ly insult, tax cred­its for the poor appears, real­ly does appears to be the like­ly GOP expla­na­tion for what peo­ple are sup­posed to do. And it’s the response that will pre­sum­ably not just apply to med­ical ser­vices but nurs­ing home ser­vices too.

The GOP’s Trumpian ‘New Coke’ Sure Tastes LIke ‘Old Koch’

Ok, so could tax cred­it’s for poor seniors seri­ous­ly be the GOP’s plan? Is that real­ly about to become the new safe­ty-net for elder­ly Amer­i­cans? Well, unless those plans change, and change very soon since Sen­ate Major­i­ty Leader Mitch McConnell is try­ing to pass it in the Sen­ate by July 4th, it looks like that’s the plan. And if the plan does change it’s prob­a­bly going to become a worse plan:

Bloomberg Pol­i­tics

Koch Group Says Repub­li­can Health Plan Does­n’t Go Far Enough

By John McCormick
June 24, 2017, 9:30 AM CDT June 24, 2017, 6:24 PM CDT

* Amer­i­cans for Pros­per­i­ty says it will work to improve mea­sure
* Bill faces per­il­ious path with five Repub­li­cans doubt­ful

Lead­ers from the influ­en­tial Koch polit­i­cal net­work expressed con­cern about the Sen­ate Repub­li­can plan to reshape the nation’s health sys­tem, say­ing as they met with donors at a Col­orado resort that the mea­sure isn’t suf­fi­cient­ly con­ser­v­a­tive.

<b>“We’ve been dis­ap­point­ed that move­ment has not been more dra­mat­ic toward a full repeal or a broad­er roll­back of this law, Oba­macare,” Tim Phillips, the pres­i­dent of the Koch-affil­i­at­ed polit­i­cal advo­ca­cy group, Amer­i­cans for Pros­per­i­ty, told reporters.

“We worked to make the House bill bet­ter and it did get bet­ter,” he said. “We’re doing the same thing on the Sen­ate front.”

Unveiled on Thurs­day as a dis­cus­sion draft after weeks of work done in secret by a small num­ber of law­mak­ers, the Sen­ate plan was imme­di­ate­ly crit­i­cized by Democ­rats and some Repub­li­cans. Five Sen­ate Repub­li­cans have said they oppose the bill in its cur­rent form.

Sen­ate Major­i­ty Leader Mitch McConnell can only afford two defec­tions from his par­ty to pass the bill in the 100-mem­ber cham­ber.

Oppo­si­tion from the Koch net­work, which has deliv­ered tens of mil­lions of dol­lars to Repub­li­can can­di­dates and caus­es in recent years, promis­es to fur­ther com­pli­cate the per­ilous path McConnell faces.

‘Can Get Done’

“We still think this can get done,” Phillips said. “It has to get bet­ter.”

Phillips spoke on the first day of a three-day donor retreat at a lux­u­ry Rocky Moun­tains resort. He was also among those who met Fri­day evening with Vice Pres­i­dent Mike Pence ahead of the event.

“It was a good, cor­dial dis­cus­sion of issues, includ­ing health care,” Phillips said of his talk with Pence.

...

———-

“Koch Group Says Repub­li­can Health Plan Does­n’t Go Far Enough” by John McCormick; Bloomberg Pol­i­tics; 06/24/2017

““We still think this can get done,” Phillips said. “It has to get bet­ter.”

It has to get bet­ter bet­ter. And by bet­ter, the pres­i­dent of the Koch net­work means much, much worse health care for Amer­i­cans. Any good parts of Oba­macare that were left in the Sen­ate GOP’s draft ver­sion of Trump­care have to go for things to “get bet­ter”:

...
“We’ve been dis­ap­point­ed that move­ment has not been more dra­mat­ic toward a full repeal or a broad­er roll­back of this law, Oba­macare,” Tim Phillips, the pres­i­dent of the Koch-affil­i­at­ed polit­i­cal advo­ca­cy group, Amer­i­cans for Pros­per­i­ty, told reporters.

“We worked to make the House bill bet­ter and it did get bet­ter,” he said. “We’re doing the same thing on the Sen­ate front.”
...

“We’ve been dis­ap­point­ed that move­ment has not been more dra­mat­ic toward a full repeal or a broad­er roll­back of this law, Oba­macare”

And don’t for­get, it’s not just that Trump­care is repeal­ing almost all the good parts of Obmaacare. It’s repeal­ing the good parts of the New Deal and Great Soci­ety that are still left. This is a deep gut­ting. Nurs­ing home vouch­ers are a seri­ous pos­si­bil­i­ty. Steadi­ly shrink­ing nurs­ing home vouch­ers.

Again, it’s tru­ly amaz­ing just how mas­sive a polit­i­cal gam­ble Trump­care is turn­ing out to be be for the GOP but it’s a gam­ble the par­ty is clear­ly intent on mak­ing because Trump­care is Ryan­care and Ryan­care is Kochcare. The GOP is in con­trol of every­thing so there’s almost no way the Kochcare isn’t going to become a real­i­ty. Unless GOP vot­ers sud­den­ly turn anti-Koch. Which could hap­pen. That’s sort of what the Trump phe­nom­e­na in the 2016 GOP pri­ma­ry was all about: the rise of the anti-Koch wing of the GOP. And here we are, with the Sen­ate on the verge of pass­ing TrumpRyanKochcare and the only real obsta­cle is the hand­ful of hold out GOP Sen­a­tors who are just doing a song and dance ‘nego­ti­a­tion’ — most­ly with demands that it be more Koch-ish. So unless being anti-Koch sud­den­ly gets bach in vogue in the GOP base giv­ing polit­i­cal cov­er to at least three GOP Sen­a­tors to vote against it, grand­ma is mov­ing into the base­ment room. With large med­ical bills. And the state might start charg­ing grand­ma’s rel­a­tives for her new awe­some Med­ic­aid ser­vices.

At this point one of the big ques­tions is whether or not the GOP will expand its exten­sive vot­er sup­pres­sion efforts to include seniors on Med­ic­aid now too? That seems like a real pos­si­bil­i­ty although con­sid­er­ing that the elder­ly peo­ple most neg­a­tive­ly impact­ed by Trump­care are also the most like­ly to die pre­ma­ture­ly as Med­ic­aid gets increas­ing­ly under­fund­ed maybe vot­er sup­pres­sion efforts won’t be nec­es­sary. Still, in terms of polit­i­cal risks, when you con­sid­er just how much TrumpRyanKochcare presents a mor­tal dan­ger to the most reli­able vot­ing demo­graph­ic in Amer­i­ca — a demo­graph­ic that most peo­ple will join some­day, although a lot few­er if this becomes law — and how that demo­graph­ic large­ly has no idea what’s in store for it, the TrumpRyanKochcare tax cut gam­bit is turn­ing out to be tru­ly breath­tak­ing.

Discussion

19 comments for “Guess What? Grandma is Moving In. She’s Got Medical Bills. Maybe to Share. It’s Medicaid Brought to You by Kochcare.”

  1. Con­necti­cut Sen­a­tor Chris Mur­phy, a Demo­c­ra­t­ic mem­ber of the Sen­ate Health, Edu­ca­tion, Labor & Pen­sions Com­mit­tee, recent­ly com­ment­ed on the poten­tial impact the Trump­care(Kochcare) health care ‘reform’ bill could have on nurs­ing home res­i­dents in Con­necti­cut, a state where over 70 per­cent of nurs­ing home res­i­dents are on Med­ic­aid, and he makes a crit­i­cal point to be made dur­ing the cur­rent health care ‘reform’ debate: Med­ic­aid isn’t just for poor peo­ple. By cov­er­ing the costs that would oth­er­wise fall on fam­i­ly mem­bers, like costs for nurs­ing home care, Med­ic­aid is effec­tive­ly a ben­e­fit pro­gram cur­rent­ly pro­tect­ing all Amer­i­cans. And it’s about to be shred­ded:

    New Haven Reg­is­ter

    Health bill could present chal­lenge to Con­necti­cut nurs­ing home care

    By Dan Freed­man

    Post­ed: 06/25/17, 12:20 PM EDT | Updat­ed

    WASHINGTON » Deep cuts to Med­ic­aid embod­ied in Sen­ate and House ver­sions of the GOP GOP health care bill could sharply reduce crit­i­cal pay­ments to nurs­ing homes, poten­tial­ly leav­ing many mid­dle-class fam­i­lies in Con­necti­cut to foot the bill for elder­ly rel­a­tives.

    Both bills envi­sion end­ing Med­ic­aid as an open-end­ed enti­tle­ment pro­vid­ing health insur­ance pri­mar­i­ly for low-income fam­i­lies. Instead, fed­er­al Med­ic­aid dis­tri­b­u­tions would be capped.

    The Con­gres­sion­al Bud­get Office esti­mat­ed the for­mu­la in the House bill would elim­i­nate more than $800 bil­lion over the next decade.

    Matthew Bar­rett, CEO of the Mid­dle­town-based Con­necti­cut Asso­ci­a­tion of Health Care Facil­i­ties, said the Repub­li­cans’ Oba­macare “repeal-and-replace’’ mea­sure would be a “cat­a­stro­phe’’ for the state’s nurs­ing home oper­a­tors, as well as res­i­dents and their fam­i­lies.

    “Med­ic­aid for nurs­ing homes is very much a mid­dle-class ben­e­fit,’’ he said, not­ing it is the only nation­al pro­gram that cov­ers long-term care in a nurs­ing home. “The com­mon per­cep­tion is that Med­ic­aid is for some­body else, but it’s actu­al­ly a pro­gram for all Amer­i­cans.’’

    Med­ic­aid also can cov­er home and com­mu­ni­ty health ser­vices.

    POSSIBLE CHANGE OF RULES

    In Con­necti­cut, there are more than 24,000 most­ly elder­ly nurs­ing home res­i­dents, accord­ing to fed­er­al data com­piled by the non-par­ti­san Kaiser Fam­i­ly Foun­da­tion. Close to 70 per­cent of them are sub­si­dized by Med­ic­aid, which is fund­ed through a com­bi­na­tion of state and fed­er­al mon­ey. The nation­al fig­ure is 62 per­cent. Total Med­ic­aid nurs­ing-home expen­di­ture in Con­necti­cut topped $1.2 bil­lion in 2016.

    Connecticut’s rate of Med­ic­aid-cov­ered nurs­ing-home res­i­dents is one of the high­er ones in the nation. Only Alas­ka and deep-South­ern states like Mis­sis­sip­pi, Louisiana and Geor­gia have high­er rates.

    Connecticut’s aging pop­u­la­tion is on the rise, with a 51 per­cent increase in those over 65 pro­ject­ed by 2025.

    Also on the rise is the inci­dence of dif­fi­cult-to-man­age con­di­tions such as dia­betes, Alzheimer’s and demen­tia, Bar­rett said.

    To qual­i­fy for Med­ic­aid, nurs­ing home res­i­dents must first exhaust all their sav­ings and assets, includ­ing the sale of homes. Once on the pro­gram, fam­i­ly mem­bers are not oblig­at­ed to pay. But if the Repub­li­can bills become law, that might change.

    U.S. Sen. Chris Mur­phy, D‑Conn., a mem­ber of the Sen­ate Health, Edu­ca­tion, Labor & Pen­sions Com­mit­tee and a bit­ter oppo­nent of the GOP leg­isla­tive effort, said the GOP mea­sure would mean states like Con­necti­cut ulti­mate­ly have to ration nurs­ing home care.

    Doing so might end up throw­ing the finan­cial bur­den onto fam­i­lies if they want loved ones to stay in these facil­i­ties, Mur­phy said.

    “Med­ic­aid is no longer a pro­gram for poor peo­ple; it prob­a­bly touch­es an equal num­ber of mid­dle-class fam­i­lies,’’ he said in an inter­view Fri­day. “You’re not guar­an­teed that if Mom runs through her bank account that Med­ic­aid will pick up the cost. That should freak out every son or daugh­ter in this coun­try.’’

    A STRUGGLING STATE

    The­o­ret­i­cal­ly, cuts to the fed­er­al side of Med­ic­aid financ­ing could be off­set by increased state spend­ing. But such mon­ey is unlike­ly to flow from Hart­ford, which faces a pro­ject­ed $5 bil­lion deficit over the next two years.

    Med­ic­aid pay­ments to nurs­ing homes are already insuf­fi­cient, said Bar­rett. He cal­cu­lat­ed the short­fall at about $25 a day, per res­i­dent.

    The GOP Sen­ate bill in many ways is more mod­er­ate than the House coun­ter­part. But it bends the down­ward cost curve of Med­ic­aid over 10 years more rad­i­cal­ly by peg­ging it to the reg­u­lar con­sumer price index, instead of more-gen­er­ous med­ical infla­tion.

    ...

    ———–

    “Health bill could present chal­lenge to Con­necti­cut nurs­ing home care” by Dan Freed­man; New Haven Reg­is­ter; 06/25/17

    ““Med­ic­aid is no longer a pro­gram for poor peo­ple; it prob­a­bly touch­es an equal num­ber of mid­dle-class fam­i­lies,’’ he said in an inter­view Fri­day. “You’re not guar­an­teed that if Mom runs through her bank account that Med­ic­aid will pick up the cost. That should freak out every son or daugh­ter in this coun­try.’’”

    And as Sen­a­tor Mur­phy warns us, if the GOP bill becomes law, the pro­vi­sions in Med­ic­aid that cov­er all the costs required for ser­vices like med­ical care and nurs­ing homes could fade away and pro­tect might effec­tive­ly be forced to cov­er the costs of their par­ents’ health care/nursing home costs:

    ...
    To qual­i­fy for Med­ic­aid, nurs­ing home res­i­dents must first exhaust all their sav­ings and assets, includ­ing the sale of homes. Once on the pro­gram, fam­i­ly mem­bers are not oblig­at­ed to pay. But if the Repub­li­can bills become law, that might change.

    U.S. Sen. Chris Mur­phy, D‑Conn., a mem­ber of the Sen­ate Health, Edu­ca­tion, Labor & Pen­sions Com­mit­tee and a bit­ter oppo­nent of the GOP leg­isla­tive effort, said the GOP mea­sure would mean states like Con­necti­cut ulti­mate­ly have to ration nurs­ing home care.

    Doing so might end up throw­ing the finan­cial bur­den onto fam­i­lies if they want loved ones to stay in these facil­i­ties, Mur­phy said.

    “Med­ic­aid is no longer a pro­gram for poor peo­ple; it prob­a­bly touch­es an equal num­ber of mid­dle-class fam­i­lies,’’ he said in an inter­view Fri­day. “You’re not guar­an­teed that if Mom runs through her bank account that Med­ic­aid will pick up the cost. That should freak out every son or daugh­ter in this coun­try.’’
    ...

    It’s a reminder that when TrumpRyanKochcare threat­ens to give granny a ‘one-way tick­et to the cliff’, it’s not just Paul Ryan or Mitch McConnell giv­ing granny the ride. By trans­fer­ring every­one costs pre­vi­ous­ly cov­ered by the fed­er­al gov­ern­ment to states and states like­ly to trans­fer them to fam­i­lies, it’s going to be fam­i­ly mem­bers who are going to be fac­ing the ques­tion of how much they can afford to cov­er for their rel­a­tive’s costs to sim­ply live. And that’s going to effec­tive­ly be a ‘cliff’-like deci­sion in many cir­cum­stances. And it’s going to be vot­ers in state elec­tions who are going to be fac­ing ques­tions of how much of the cost bur­den to push onto fam­i­lies. So as we enter an era of more or less per­ma­nent fed­er­al annu­al Med­ic­aid cuts, we’re cre­at­ing a sit­u­a­tion where all vot­ers are pushed into a posi­tion to push every­one off ‘the cliff’. The ‘feel free to die’ cliff. That’s what hap­pens when states and fam­i­lies sud­den­ly have to decide if they’re going to cov­er those lost fed­er­al funds. That ‘cliff push­ing’ deci­sion might be at the bal­lot box, or it could be your fam­i­ly mem­ber, but cliff push­ing is sched­uled to become Amer­i­can’s most pop­u­lar new extreme sport. It’s not actu­al­ly going to be very pop­u­lar but lots of peo­ple will do it. Try not to get too pushy. But that’s where we are. Col­lec­tive­ly set­ting up res­i­dence next to the ‘feel free to die’ cliff. Some­where a lem­ming is shak­ing its head.

    A lot of lem­mings are prob­a­bly shak­ing their heads.

    Posted by Pterrafractyl | June 25, 2017, 4:14 pm
  2. You can stop clean­ing the spare bed­room. For now. At least until Trump­care is back on track after get­ting derailed today. No, this does­n’t mean Med­ic­aid isn’t going to be gut­ted and nurs­ing home res­i­dents aren’t going to be forced to move in with their rel­a­tives. That could still def­i­nite­ly hap­pen. But now that Sen­ate Major­i­ty Leader Mitch McConnell sud­den­ly with­drew the Trump­care leg­is­la­tion from con­sid­er­a­tion after con­clud­ing he did­n’t have the 50 votes he need­ed today, it’s unclear when that’s going to hap­pen. Or even if it will ever hap­pen. Grand­ma’s extend­ed vis­it is tem­porar­i­ly on hold.

    And while you might be cel­e­brat­ing, and grand­ma might be cel­e­brat­ing, the GOP in DC cer­tain­ly isn’t going to be cel­e­brat­ing and that leads us to one of the more inter­est­ing dynam­ics emerg­ing from Trump­care’s trou­bles: the leg­isla­tive fail­ures of Trump and the GOP appear to be cre­at­ing the impres­sion with­in the par­ty that their leader, Don­ald Trump, is a “paper tiger”. A fig­ure to be denied and not feared. And GOP elect­ed offi­cials are now appar­ent­ly so unscared of Trump that they’re talk­ing about it to reporters, cit­ing fail­ures like today’s Trump­care melt­down as an exam­ple why they no longer fear their dear leader.

    It’s a pret­ty amaz­ing diss to come from the GOP, both in terms of sub­stance and tim­ing. But per­haps the most amaz­ing part is that, if you look back at who is doing who a favor with the attempt­ed pas­sage of Trump­care, it was Don­ald Trump who was going back on his cam­paign promis­es in order to push for a health care bill that embraced establishment/Koch GOP goals at the cost of Trump’s ‘pop­ulist’ image. Trump is being mocked by his fel­low GOP Sen­a­tors for not being able to cajole the GOP into sup­port­ing a bill that was based on long-held GOP goals. Gut­ting Med­ic­aid was­n’t a long-held goal of Trump’s. Allow­ing states to waive all the part of Oba­macare the pub­lic likes isn’t part of Trump’s polit­i­cal brand. That’s the establishment/Koch broth­er agen­da and Trump is just going along for the ride. Trump is the one doing the favor by cater­ing to the establishment/Koch wing’s agen­da. And yet when Mitch McConnell fails to keep his own cau­cus togeth­er to make law some­thing the GOP has been try­ing to do for years we get reports about how this fail­ure is mak­ing the GOP lose respect for Trump. So much that they open­ly diss him in the wake of this humil­i­at­ing defeat.

    So beyond all the ques­tions that this sig­nif­i­cant leg­isla­tive set­back rais­es about the prospects of the GOP actu­al­ly repeal­ing Oba­macare and ful­fill­ing their decades-long desire to shred Med­ic­aid, there are now some seri­ous ques­tions about what Trump is going to do now that the GOP is open­ly dis­re­spect­ing him after the GOP fails to pass its own bill. Is Trump real­ly going to just accept this?

    The Wash­ing­ton Post

    Who’s afraid of Trump? Not enough Repub­li­cans — at least for now.

    By Philip Ruck­er, Robert Cos­ta and Ash­ley Park­er
    June 27, 2017 at 7:37 PM

    Scram­bling to line up sup­port for the Repub­li­can health-care bill, Pres­i­dent Trump got on the phone Mon­day with Sen. Mike Lee (R‑Utah) and urged him to back the mea­sure.

    The president’s per­son­al plea was not enough. On Tues­day, Lee said he would vote against the bill. Sen­ate GOP lead­ers lat­er post­poned the planned health-care vote because too many oth­er Repub­li­can sen­a­tors also opposed — for now, at least — leg­is­la­tion that would deliv­er on Trump’s cam­paign promise to scale back the law known as Oba­macare.

    Trump had hoped for a swift and easy win on health care this week. Instead he got a delay and a return to the nego­ti­at­ing table — the lat­est reminder of the lim­its of his pow­er to shape out­comes at the oppo­site end of Penn­syl­va­nia Avenue.

    His­to­ry sug­gests that pres­i­dents who have gov­erned suc­cess­ful­ly have been both revered and feared. But Repub­li­can fix­tures in Wash­ing­ton are begin­ning to con­clude that Trump may be nei­ther, despite his mix of brava­do, threats and efforts to schmooze with GOP law­mak­ers.

    The pres­i­dent is the leader of his par­ty, yet Trump has strug­gled to get Repub­li­can law­mak­ers mov­ing in lock­step on health care and oth­er major issues, leav­ing no sig­na­ture leg­is­la­tion in his first five months in office. The con­fir­ma­tion of Supreme Court Jus­tice Neil M. Gor­such is his most-cit­ed achieve­ment to date.

    “This pres­i­dent is the first pres­i­dent in our his­to­ry who has nei­ther polit­i­cal nor mil­i­tary expe­ri­ence, and thus it has been a chal­lenge to him to learn how to inter­act with Con­gress and learn how to push his agen­da bet­ter,” said Sen. Susan Collins (R‑Maine), who oppos­es the cur­rent health-care bill.

    The Sen­ate could pass a revised ver­sion of the bill once law­mak­ers return from their July 4 recess and pick up delib­er­a­tions. Still, some Repub­li­cans are will­ing to defy their president’s wish­es — a dynam­ic that can be attrib­uted in part to Trump’s sin­gu­lar sta­tus as a dis­rupter with­in his par­ty.

    “The pres­i­dent remains an enti­ty in and of itself, not a part of the tra­di­tion­al Repub­li­can Par­ty,” said Rep. Car­los Curbe­lo (R‑Fla.), a mod­er­ate who rep­re­sents a dis­trict Trump lost by 16 per­cent­age points. “I han­dle the Trump admin­is­tra­tion the same way I han­dled the Oba­ma admin­is­tra­tion. When I agree, I work with them. When I oppose, I don’t.”

    In pri­vate con­ver­sa­tions on Capi­tol Hill, Trump is often not tak­en seri­ous­ly. Some Repub­li­can law­mak­ers con­sid­er some of his promis­es — such as mak­ing Mex­i­co pay for a new bor­der wall — fan­tas­ti­cal. They are exhaust­ed and at times exas­per­at­ed by his hop­scotch­ing from one sub­ject to the next, chron­i­cled in his pithy and provoca­tive tweets. They are quick to point out how lit­tle com­mand he demon­strates of pol­i­cy. And they have come to regard some of his threats as emp­ty, con­clud­ing that cross­ing the pres­i­dent pos­es lit­tle dan­ger.

    “The House health-care vote shows he does have juice, par­tic­u­lar­ly with peo­ple on the right,” Sen. Lind­sey O. Gra­ham (R‑S.C.) said. “The Sen­ate health-care vote shows that peo­ple feel that health care is a defin­ing issue and that it’d be pret­ty hard for any politi­cian to push a sen­a­tor into tak­ing a vote that’s going to have con­se­quences for the rest of their life.”

    Asked if he per­son­al­ly fears Trump, Gra­ham chuck­led before say­ing, “No.”

    Rep. Dar­rell Issa (R‑Calif.), who has dis­tanced him­self from Trump on var­i­ous issues, said few mem­bers of Con­gress fear per­ma­nent retal­i­a­tion from the pres­i­dent.

    “He comes from the pri­vate sec­tor, where your busi­ness part­ner today isn’t always your busi­ness part­ner tomor­row,” Issa said. “Just because you’re one way today doesn’t mean you’re writ­ten off. That’s the ‘Art of the Deal’ side.”

    One senior Repub­li­can close to both the White House and many sen­a­tors called Trump and his polit­i­cal oper­a­tion “a paper tiger,” not­ing how many GOP law­mak­ers feel free “to go their own way.”

    “Mem­bers are polit­i­cal entre­pre­neurs, and they react to what they see in the polit­i­cal mar­ket­place,” said the Repub­li­can, who spoke on the con­di­tion of anonymi­ty to avoid alien­at­ing the White House.

    John Weaver, a GOP con­sul­tant and fre­quent Trump crit­ic, was more blunt in explain­ing why Trump has been unable to rule with a ham­mer. “When you have a 35 per­cent approval rat­ing and you’re under FBI inves­ti­ga­tion, you don’t have a ham­mer,” he said, refer­ring to the probe of pos­si­ble con­nec­tions between the Trump cam­paign and Rus­sia.

    Trump’s approval rat­ing in Gallup’s dai­ly track­ing poll stood Tues­day at 39 per­cent, with 57 per­cent of Amer­i­cans dis­ap­prov­ing of his per­for­mance. But a sig­nif­i­cant por­tion of those sup­port­ers, par­tic­u­lar­ly in red states and dis­tricts, still strong­ly back Trump.

    White House offi­cials con­test the sug­ges­tion that Trump does not instill fear among fel­low Repub­li­cans in Con­gress. The president’s polit­i­cal shop, mean­while, is labor­ing to force more Repub­li­cans to bend to his wish­es.

    Amer­i­ca First Poli­cies, a Trump-allied super PAC staffed by for­mer aides, launched a neg­a­tive adver­tis­ing effort against Sen. Dean Heller (R‑Nev.) after he spoke out against the bill Fri­day. Sen­ate Major­i­ty Leader Mitch McConnell (R‑Ky.) com­plained about the ads to White House chief of staff Reince Priebus, and the super PAC said Tues­day that it would pull the spots after Heller said he was open to fur­ther nego­ti­a­tions, accord­ing to two peo­ple famil­iar with the deci­sion.

    Amer­i­ca First Poli­cies has been mulling sim­i­lar ads against oth­er Repub­li­cans who have bro­ken ranks, hop­ing to make law­mak­ers believe they will pay a price for betray­ing Trump and imper­il­ing his agen­da. The super PAC also is con­sid­er­ing grass-roots cam­paigns across the coun­try to mobi­lize Trump sup­port­ers in key states dur­ing the July 4 recess, as a way to ratch­et up pres­sure on waver­ing law­mak­ers.

    Trump allies have encour­aged major GOP donors to reach out to sen­a­tors who oppose the bill. Las Vegas casi­no moguls Shel­don Adel­son and Steve Wynn have both spo­ken by phone with Heller to prod him along, accord­ing to peo­ple famil­iar with the dis­cus­sions.

    Trump has been hun­gry for a leg­isla­tive pol­i­cy vic­to­ry on Capi­tol Hill, and he and his advis­ers see health care as the best chance for one this sum­mer. The pres­i­dent is play­ing a less pub­lic role advo­cat­ing for the leg­is­la­tion than he did lead­ing up to this spring’s vote on a House bill, when he used his rela­tion­ship with con­ser­v­a­tive mem­bers of the House Free­dom Cau­cus to even­tu­al­ly bring them to the table.

    In the Sen­ate talks, Trump has been work­ing large­ly behind the scenes to lob­by sen­a­tors, with per­son­al phone calls and oth­er entreaties. Unlike the House, where rank-and-file Repub­li­cans may be like­ly to fol­low Trump’s lead, the Sen­ate nat­u­ral­ly is a more inde­pen­dent insti­tu­tion.

    Many sen­a­tors fash­ion their own polit­i­cal brands and have out­size egos, and some Repub­li­cans ran away from Trump in their reelec­tion races last year.

    Chris Whip­ple, author of “The Gate­keep­ers,” a new his­to­ry of White House chiefs of staff, said the tumult inside Trump’s White House — and the president’s lack of a coher­ent mes­sage or vision for his pol­i­cy agen­da — inhibits his abil­i­ty to enforce par­ty dis­ci­pline in Con­gress.

    “Noth­ing instills fear on Capi­tol Hill like suc­cess, and all this White House has been able to do is one fail­ure after anoth­er,” Whip­ple said. “There are just zero points on the board so far. Who’s going to be afraid of that?”

    ...

    Ear­ly in Pres­i­dent George W. Bush’s tenure, fel­low Repub­li­cans in Con­gress saw his White House as a fine­ly tuned machine that could not be crossed.

    “You nev­er want­ed to get on the wrong side of the Bush White House because the staff was dis­ci­plined, ded­i­cat­ed and extreme­ly loy­al to the pres­i­dent,” said Ryan Williams, a Repub­li­can oper­a­tive. “If you crossed or under­mined the pres­i­dent or his admin­is­tra­tion, the Bush die-hards would remem­ber it for­ev­er.”

    Trump’s lieu­tenants, by con­trast, have strug­gled to force Repub­li­cans into line. In March, when House Repub­li­cans were slow to ral­ly behind the health-care bill, White House chief strate­gist Stephen K. Ban­non told Free­dom Cau­cus mem­bers that they must stop waf­fling and vote for the leg­is­la­tion.

    Ban­non was imme­di­ate­ly rebuffed by Rep. Joe Bar­ton (R‑Tex.), who has been in the House for more than three decades. Bar­ton ici­ly told Ban­non that the only per­son who ordered him around was “my dad­dy” — and that his father was unsuc­cess­ful in doing so, accord­ing to sev­er­al Repub­li­cans with knowl­edge of the meet­ing.

    In an inter­view Tues­day, Bar­ton smiled wry­ly when asked about the inci­dent.

    “I will admit on the record that I took excep­tion to a com­ment that he made,” Bar­ton said. “There is a sep­a­ra­tion of pow­ers, and the pres­i­dent has a role and the Con­gress has a role. That’s all I’ll say.”

    ———-

    “Who’s afraid of Trump? Not enough Repub­li­cans — at least for now.” by Philip Ruck­er, Robert Cos­ta and Ash­ley Park­er; The Wash­ing­ton Post; 06/27/2017

    “One senior Repub­li­can close to both the White House and many sen­a­tors called Trump and his polit­i­cal oper­a­tion “a paper tiger,” not­ing how many GOP law­mak­ers feel free “to go their own way.””

    A paper tiger. Them’s fight­in’ words. Issued right after the GOP major­i­ty in the Sen­ate failed to pass it’s own bill. And yet Trump is some­how the per­son “often not tak­en seri­ous­ly” as opposed to not tak­ing seri­ous­ly the estab­lish­ment GOP/Koch agen­da that Trump and the GOP and try­ing, and fail­ing, to pass because it’s it’s so unpop­u­lar:

    ...
    In pri­vate con­ver­sa­tions on Capi­tol Hill, Trump is often not tak­en seri­ous­ly. Some Repub­li­can law­mak­ers con­sid­er some of his promis­es — such as mak­ing Mex­i­co pay for a new bor­der wall — fan­tas­ti­cal. They are exhaust­ed and at times exas­per­at­ed by his hop­scotch­ing from one sub­ject to the next, chron­i­cled in his pithy and provoca­tive tweets. They are quick to point out how lit­tle com­mand he demon­strates of pol­i­cy. And they have come to regard some of his threats as emp­ty, con­clud­ing that cross­ing the pres­i­dent pos­es lit­tle dan­ger.

    “The House health-care vote shows he does have juice, par­tic­u­lar­ly with peo­ple on the right,” Sen. Lind­sey O. Gra­ham (R‑S.C.) said. “The Sen­ate health-care vote shows that peo­ple feel that health care is a defin­ing issue and that it’d be pret­ty hard for any politi­cian to push a sen­a­tor into tak­ing a vote that’s going to have con­se­quences for the rest of their life.”

    Asked if he per­son­al­ly fears Trump, Gra­ham chuck­led before say­ing, “No.”

    Rep. Dar­rell Issa (R‑Calif.), who has dis­tanced him­self from Trump on var­i­ous issues, said few mem­bers of Con­gress fear per­ma­nent retal­i­a­tion from the pres­i­dent.

    “He comes from the pri­vate sec­tor, where your busi­ness part­ner today isn’t always your busi­ness part­ner tomor­row,” Issa said. “Just because you’re one way today doesn’t mean you’re writ­ten off. That’s the ‘Art of the Deal’ side.”
    ...

    ““The House health-care vote shows he does have juice, par­tic­u­lar­ly with peo­ple on the right,” Sen. Lind­sey O. Gra­ham (R‑S.C.) said. “The Sen­ate health-care vote shows that peo­ple feel that health care is a defin­ing issue and that it’d be pret­ty hard for any politi­cian to push a sen­a­tor into tak­ing a vote that’s going to have con­se­quences for the rest of their life.”

    LInd­sey Gra­ham is cor­rect, it’s “pret­ty hard for any politi­cian to push a sen­a­tor into tak­ing a vote that’s going to have con­se­quences for the rest of their life.” And in this case that would have been a vote for a health care bill writ­ten by Mitch McConnell and designed to appease GOP mega-donors, not the GOP base that ral­lied to Trump last year due, in part, to have much his cam­paign agen­da con­flict­ed with that tra­di­tion­al GOP mega-donor agen­da of tax cuts for the rich and spend­ing cuts to every­thing else. That was the agen­da that was going to be threat­en the polit­i­cal futures of all those GOP sen­a­tors and it was writ­ten a long time before Trump ever ran for office. And Trump sure­ly rec­og­nizes this, which rais­es the ques­tion of just how livid is he right now with the rest of his par­ty? It’s got to hurt. Nor­mal­ly Trump is the one throw­ing peo­ple under the bus.

    But here’s part of what must be enrag­ing Trump and what rais­es real ques­tions about how well the GOP is going to hold itself togeth­er: While Neva­da Sen­a­tors Dean Heller — who was oppos­ing the Trump­care bill from the left based on its gen­er­al cru­el­ty — was at the receiv­ing end of a round of TV attack ads by the pro-Trump super-PAC “Amer­i­ca First Poli­cies” as some sort of gam­bit designed to pres­sure him and strike fear in oth­ers who might be think­ing about oppos­ing the bill, don’t for­get that the there were four Sen­a­tors who came out in oppo­si­tion to the bill from the right, say­ing it was­n’t con­ser­v­a­tive enough and did­n’t repeal Oba­macare (the remain­ing good parts) enough (Sen­a­tor’s Cruz, Paul, John­son, and Lee).

    So four sen­a­tors attack Trump­care from the right, one from the left, and the one from the left gets attack ads run against him. It cer­taint­ly gives us a hint about when the next ver­sion of Trump­care will look like.

    But a much big­ger hint comes from the Koch net­work, which had a big gath­er­ing over the week­end where they declared that they were going to make a big push to ensure Trump­care ends up much more con­ser­v­a­tive. And Koch net­work rep­re­sen­ta­tives were say­ing over the week­end that this unique win­dow of oppor­tu­ni­ty to real­ize their long-term agen­da is open for the 10–12 months. So trash­ing Trump­care, and then trash­ing Trump, may have been a Koch net­work nego­ti­at­ing tac­tic. A tac­tic based on the expec­ta­tion that there’s time for anoth­er attempt to pass health care ‘reform’ lat­er:

    Politi­co

    Koch net­work donors eye Trump and Con­gress war­i­ly on health care, tax­es

    A com­bi­na­tion of hope and con­cern infused the sum­mer sem­i­nar meet­ing of the Koch broth­ers’ net­work of con­ser­v­a­tive groups.

    By Kevin Robil­lard

    06/26/2017 01:13 PM EDT

    COLORADO SPRINGS, Colo. — Con­ser­v­a­tive donors see a major oppor­tu­ni­ty this year to achieve years-old Repub­li­can goals of reform­ing the tax code and pass­ing a new health care law. But they are also con­sumed with wor­ry that the GOP will some­how blow the chance it has been wait­ing for — whether because of an unfo­cused Pres­i­dent Don­ald Trump or fret­ful con­gres­sion­al Repub­li­cans.

    That com­bi­na­tion of hope and con­cern infused the sum­mer sem­i­nar meet­ing of the Koch broth­ers’ net­work of con­ser­v­a­tive groups. Before a gath­er­ing of over 400 donors at the lux­u­ry Broad­moor Resort, Koch offi­cials spoke of an entic­ing but nar­row win­dow to pass major tax and health care leg­is­la­tion, even though Repub­li­cans con­trol the pres­i­den­cy and both cham­bers of Con­gress.

    We have a win­dow of about 12 months until the 2018 elec­tion grinds pol­i­cy to a halt,” said Tim Phillips, the pres­i­dent of Amer­i­cans for Pros­per­i­ty, the network’s grass­roots orga­niz­ing group.

    After wait­ing eight years for anoth­er Repub­li­can pres­i­dent, some Koch net­work donors now wor­ry that the cur­rent one could end up being an obsta­cle.

    Trump “doesn’t have a core phi­los­o­phy that we have,” said Col­orado ener­gy exec­u­tive Chris Wright. Wright, who said he vot­ed for Lib­er­tar­i­an pres­i­den­tial nom­i­nee Gary John­son in 2016, added: “We don’t have a clear, con­sis­tent direc­tion from the top.”

    “I think we have 10 months and a rare oppor­tu­ni­ty to shrink the influ­ence of the gov­ern­ment on the econ­o­my,” Wright said. “The one we have now who can sell the pub­lic is Paul Ryan, but he doesn’t have the bul­ly pul­pit. The per­son with bul­ly pul­pit is not a great sell­er of ideas and progress.”

    The Koch net­work, orga­nized by broth­ers Charles and David Koch, is a col­lec­tion of con­ser­v­a­tive donors who have donat­ed bil­lions over the decades to every­thing from Repub­li­can politi­cians to school choice efforts to uni­ver­si­ty think tanks in an effort to move the coun­try in their ide­o­log­i­cal direc­tion. The group’s allies and for­mer staffers hold key posi­tions through­out the Trump admin­is­tra­tion, and the net­work announced plans ear­li­er this week­end to spend near­ly $400 mil­lion on pol­i­tics and pol­i­cy over the next two years.

    The Koch net­work declined to direct­ly back Trump’s can­di­da­cy in the elec­tion last year. Top net­work offi­cials have been pleased with his administration’s court appoint­ments and work on tax reform, and were ecsta­t­ic about leg­is­la­tion he signed last week reform­ing the Depart­ment of Vet­er­ans Affairs. But they were sharply crit­i­cal of Attor­ney Gen­er­al Jeff Ses­sions’ stance on crim­i­nal jus­tice reform and the GOP efforts to repeal Oba­macare, argu­ing the Sen­ate bill doesn’t do enough to low­er pre­mi­ums and total­ly repeal the law. (The net­work isn’t offi­cial­ly oppos­ing the Sen­ate pro­pos­al, but is work­ing to make it more con­ser­v­a­tive.)

    But indi­vid­ual donors in the net­work have donat­ed sig­nif­i­cant sums to Trump and super PACs back­ing him, includ­ing Doug Dea­son, a Texas-based donor who is the son of IT bil­lion­aire Dar­win Dea­son.

    Dea­son was more bull­ish on Trump, par­tic­u­lar­ly prais­ing his pick of Supreme Court Jus­tice Neil Gor­such. “Any­thing oth­er than Gor­such is gravy,” Dea­son said. “Even if he just tweet­ed and pissed peo­ple off now, I’d be hap­py.”

    But he also said he and a group of about ten oth­er Dal­las-area donors planned to with­hold checks from out-of-state Sen­ate and House GOP incum­bents until Trump’s agen­da, includ­ing Oba­macare repeal and tax reform, made it through.

    Dea­son said Sen­ate Major­i­ty Leader Mitch McConnell need­ed to “grow a pair.” “We want to send a mes­sage about how impor­tant this is,” he said.

    At the same time, Dea­son said he had recent­ly met with lead­ers from Amer­i­ca First Poli­cies, a non­prof­it back­ing Trump’s agen­da that launched attacks on Neva­da Sen. Dean Heller for oppos­ing the Sen­ate health care bill, argu­ing it cut Med­ic­aid too harsh­ly and did too lit­tle to low­er pre­mi­ums.

    Dea­son wasn’t the only donor who wor­ried about whether con­gres­sion­al Repub­li­cans will ulti­mate­ly pass major leg­is­la­tion.

    ...

    Despite the appre­hen­sion, none indi­cat­ed they were ready to shut off the mon­ey faucet into GOP cam­paign wal­lets. Even Dea­son, who said he had orga­nized Texas donors to deny Repub­li­cans cam­paign cash until Trump’s agen­da is passed, admit­ted he might not be able to fol­low through.

    When a reporter asked if he would donate to Repub­li­can sen­a­tors next sum­mer when McConnell called even if the president’s agen­da flopped, he respond­ed with a shrug: “Yeah.”

    ———-

    “Koch net­work donors eye Trump and Con­gress war­i­ly on health care, tax­es” by Kevin Robil­lard; Politi­co; 06/26/2017

    ““We have a win­dow of about 12 months until the 2018 elec­tion grinds pol­i­cy to a halt,” said Tim Phillips, the pres­i­dent of Amer­i­cans for Pros­per­i­ty, the network’s grass­roots orga­niz­ing group.”

    12 months. That’s the Koch net­work’s win­dow to strike accord­ing to Amer­i­cans for Pros­per­i­ty pres­i­dent Tim Phillips. And as the arti­cle also made clear, a lot of these Koch net­work mega-donors are get­ting impa­tient. And, more impor­tant­ly, skep­ti­cal. Skep­ti­cal specif­i­cal­ly of Trump:

    ...
    Trump “doesn’t have a core phi­los­o­phy that we have,” said Col­orado ener­gy exec­u­tive Chris Wright. Wright, who said he vot­ed for Lib­er­tar­i­an pres­i­den­tial nom­i­nee Gary John­son in 2016, added: “We don’t have a clear, con­sis­tent direc­tion from the top.”

    “I think we have 10 months and a rare oppor­tu­ni­ty to shrink the influ­ence of the gov­ern­ment on the econ­o­my,” Wright said. “The one we have now who can sell the pub­lic is Paul Ryan, but he doesn’t have the bul­ly pul­pit. The per­son with bul­ly pul­pit is not a great sell­er of ideas and progress.”
    ...

    ““I think we have 10 months and a rare oppor­tu­ni­ty to shrink the influ­ence of the gov­ern­ment on the econ­o­my,” Wright said. “The one we have now who can sell the pub­lic is Paul Ryan, but he doesn’t have the bul­ly pul­pit. The per­son with bul­ly pul­pit is not a great sell­er of ideas and progress.””

    Trump is not a great sell­er of ideas and progress. Only Paul Ryan can save their agen­da. that’s the kind of chat­ter report­ed from the Koch net­work meet­ing. Ouch. And that arti­cle is from Mon­day, a day before the sud­den pulling of of the Sen­ate Trump­care bill.

    So there appears to be a gen­er­al feel­ing of con­cern about the abil­i­ty of the GOP to push through a Koch-approved leg­isla­tive agen­da. And Trump is the fig­ure the Koch net­work is blam­ing. Not their hor­ri­ble agen­da that the pub­lic loathes. Trump was sup­posed to sell it. And he did­n’t (and appar­ent­ly Paul Ryan could sell it?!). And don’t for­get that the Kochs were already in oppo­si­tion to the Sen­ate Trump­care bill over the week­end because it was­n’t “con­ser­v­a­tive” enough and pledged to ensure it would be. And don’t for­get that Don­ald Trump rep­re­sents the oppor­tu­ni­ty of a life­time to put Trump’s brand of ‘pop­ulism’ on the long-held Koch-led pro-oli­garch agen­da that the far-right has been dream­ing of mak­ing law for decades. And Trump has to rec­og­nize the sit­u­a­tion he’s in. It’s his his­toric rep­u­ta­tion on the line. Those pleas for the Sen­ate to make sure the bill has “heart” prob­a­bly were sin­cere. But it’s hard to see the oli­garchy pass­ing on this oppor­tu­ni­ty to make their night­mare agen­da a real­i­ty pin it all on Trump. To the Koch net­work, Trump is just tame a sac­ri­fi­cial paper tiger.

    Giv­en all that, you real­ly have to won­der if wide­spread mega-donor oppo­si­tion was, in fact, the pri­mar­i­ly source of the sud­den deci­sion to delay the Trump­care vote. Sure, wide­spread pub­lic oppo­si­tion to the details in Trump­care was also undoubt­ed­ly a sig­nif­i­cant fac­tor. But the Koch net­work of mega-donors have made it pret­ty clear they want a more con­ser­v­a­tive ver­sion of Trump­care and they don’t appear to be will­ing to take ‘no’ for an answer. And when the Kochs say “No”, the GOP is going to obey. Espe­cial­ly since they just pledged to spend $400 mil­lion dol­lars on the 2018 mid-term elec­tions dur­ing their con­fer­ence over the week­end:

    Politi­co

    Koch net­work ramps up polit­i­cal spend­ing while try­ing to push Trump team

    Vice Pres­i­dent Mike Pence met with Charles Koch the day before a Koch net­work sum­mit.

    By Kevin Robil­lard
    06/24/2017 07:11 PM EDT

    COLORADO SPRINGS, Colo. — The lead­er­ship of the Koch broth­ers’ net­work is brush­ing off its occa­sion­al­ly chilly atti­tude toward Pres­i­dent Don­ald Trump, try­ing to nudge the admin­is­tra­tion in its direc­tion as the group’s annu­al sum­mit began Sat­ur­day just after Charles Koch met with Vice Pres­i­dent Mike Pence.

    The net­work of con­ser­v­a­tive donors announced Sat­ur­day it plans to spend between $300 mil­lion and $400 mil­lion on pol­i­tics and pol­i­cy dur­ing the 2018 cycle.

    “When we look at our bud­get for pol­i­tics and pol­i­cy, it’s our largest we’ve ever had,” said Tim Phillips, the pres­i­dent of Amer­i­cans for Pros­per­i­ty, the net­work’s grass­roots orga­niz­ing arm with chap­ters in dozens of states.

    The Koch net­work, led by bil­lion­aire broth­ers Charles and David Koch, rivals the Repub­li­can Nation­al Com­mit­tee in size, scope and bud­get. The alliance of con­ser­v­a­tive donors has worked for decades to move both elec­toral pol­i­tics and the coun­try at large in a lib­er­tar­i­an direc­tion with every­thing from polit­i­cal ad buys to dona­tions to uni­ver­si­ties.

    The mil­lions from the Koch net­work and its wealthy allies will boost the Trump admin­is­tra­tion on some key pri­or­i­ties, espe­cial­ly tax reform and rolling back reg­u­la­tions. It also will help push back against oth­ers — espe­cial­ly Attor­ney Gen­er­al Jeff Ses­sions’ desire to imple­ment tough-on-crime poli­cies — and work­ing to make Oba­macare repeal efforts more con­ser­v­a­tive. And they could prove crit­i­cal to Repub­li­can efforts to retain the House and expand a major­i­ty in the Sen­ate.

    “We’ve made tremen­dous progress on the fed­er­al lev­el that we haven’t been able to make in the last ten years,” said James Davis, a top net­work offi­cial.

    Pence has long­stand­ing ties to the Koch net­work, while Charles Koch has been open­ly crit­i­cal of the vice president’s boss since the ear­ly days of the Repub­li­can pri­ma­ry cam­paign. Through Pence, the group’s allies have estab­lished a beach­head in the admin­is­tra­tion. Pence and Koch spoke Fri­day night for about 45 min­utes about tax reform, leg­is­la­tion Trump signed on Fri­day to over­haul the Depart­ment of Vet­er­ans Affairs and oth­er top­ics.

    The meet­ing includ­ed Marc Short, Trump’s direc­tor of leg­isla­tive affairs and a for­mer Koch net­work offi­cial, Pence staffer Mar­ty Obst and sev­er­al cur­rent top Koch offi­cials, includ­ing Mark Hold­en and Phillips, the Amer­i­cans for Pros­per­i­ty pres­i­dent.

    The Koch network’s annu­al sem­i­nar, as the group dubbed it, began Sat­ur­day at the Broad­moor Resort here and con­tin­ues until Mon­day. Offi­cials said the sem­i­nar includ­ed more donors than ever, and more new donors than ever.

    Ken­tucky Gov. Matt Bevin, Texas Gov. Greg Abbott and Mis­souri Gov. Eric Gre­it­ens were set to speak to donors Sat­ur­day night, with Nebras­ka Sen. Ben Sasse, a fre­quent Trump crit­ic, sched­uled to deliv­er a speech Sun­day. Ari­zona Gov. Doug Ducey will dis­cuss edu­ca­tion pol­i­cy on Mon­day, and anoth­er group of law­mak­ers is set to dis­cuss tax reform.

    Tax reform is arguably the area where the net­work seems most pleased with the Trump admin­is­tra­tion. Phillips said AFP plans to hold grass­roots ral­lies in 36 states around the coun­try to push for a tax over­haul. Offi­cials also gave ster­ling reviews to Trump’s judi­cial appoint­ments and efforts to roll back reg­u­la­tions.

    But they were open­ly dis­ap­point­ed with GOP efforts to repeal Oba­macare. “At the end of the day, this bill is not going to fix health care,” Davis said.

    Phillips added: “We’ve been dis­ap­point­ed that this has not been more dra­mat­ic. We’re seek­ing to make it bet­ter. We’re not walk­ing away. This is too impor­tant an issue for too many Amer­i­cans.”

    The offi­cials said the pro­pos­al needs to do more roll back Med­ic­aid expan­sion, argu­ing the pro­gram didn’t do enough to make health care more afford­able for poor peo­ple or improve health out­comes. The Sen­ate could vote on its Oba­macare repeal before the July 4 recess, and it’s unclear whether Sen­ate Major­i­ty Leader Mitch McConnell will be able to round up the required 50 votes for the plan.

    Phillips acknowl­edged they dis­cussed the pro­pos­al with Pence. “It was a cor­dial dis­cus­sion of issues,” he said. “But there was not any kind of ask by either side.”

    Of the four con­ser­v­a­tive sen­a­tors who announced their oppo­si­tion to the health care plan, two — Texas’ Ted Cruz and Utah’s Mike Lee — are attend­ing the sem­i­nar, as is NRSC Chair Cory Gard­ner of Col­orado, vul­ner­a­ble Ari­zona Sen. Jeff Flake and Texas Sen. John Cornyn, the GOP’s num­ber two in the Sen­ate.

    ...

    ———-

    “Koch net­work ramps up polit­i­cal spend­ing while try­ing to push Trump team” by Kevin Robil­lard; Politi­co; 06/24/2017 07:11 PM EDT

    The Koch net­work, led by bil­lion­aire broth­ers Charles and David Koch, rivals the Repub­li­can Nation­al Com­mit­tee in size, scope and bud­get. The alliance of con­ser­v­a­tive donors has worked for decades to move both elec­toral pol­i­tics and the coun­try at large in a lib­er­tar­i­an direc­tion with every­thing from polit­i­cal ad buys to dona­tions to uni­ver­si­ties.”

    Yep, the Koch net­work rivals the RNC. And it just announced the largest planned round of polit­i­cal expen­di­tures in his­to­ry for the upcom­ing 2018 elec­tions:

    ...
    The net­work of con­ser­v­a­tive donors announced Sat­ur­day it plans to spend between $300 mil­lion and $400 mil­lion on pol­i­tics and pol­i­cy dur­ing the 2018 cycle.

    “When we look at our bud­get for pol­i­tics and pol­i­cy, it’s our largest we’ve ever had,” said Tim Phillips, the pres­i­dent of Amer­i­cans for Pros­per­i­ty, the net­work’s grass­roots orga­niz­ing arm with chap­ters in dozens of states.
    ...

    And the Koch net­work wants a much more con­ser­v­a­tive Oba­macare repeal:

    ...
    But they were open­ly dis­ap­point­ed with GOP efforts to repeal Oba­macare. “At the end of the day, this bill is not going to fix health care,” Davis said.

    Phillips added: “We’ve been dis­ap­point­ed that this has not been more dra­mat­ic. We’re seek­ing to make it bet­ter. We’re not walk­ing away. This is too impor­tant an issue for too many Amer­i­cans.”

    The offi­cials said the pro­pos­al needs to do more roll back Med­ic­aid expan­sion, argu­ing the pro­gram didn’t do enough to make health care more afford­able for poor peo­ple or improve health out­comes. The Sen­ate could vote on its Oba­macare repeal before the July 4 recess, and it’s unclear whether Sen­ate Major­i­ty Leader Mitch McConnell will be able to round up the required 50 votes for the plan.
    ...

    So the Koch net­work meets days after the Sen­ate reveals its hor­ri­ble Trump­care bill, express­es its dis­ap­point­ment with it not being mean enough. Then announces $300–400 mil­lion in 2018 polit­i­cal spend. And days lat­er the bill sud­den­ly col­laps­es. Did it pure­ly col­lapse under the weight of its own unpop­u­lar­i­ty? Or were the Kochs also putting pres­sure on Mitch McConnell to call a time­out, regroup, and plan to fight for an even more con­ser­v­a­tive ver­sion of Trump­care at a lat­er date? A more con­ser­v­a­tive ver­sion that will be pinned in Trump. Don’t for­get that an announce­ment of $300–400 mil­lion on spend­ing in next year’s elec­tions is basi­cal­ly code for “don’t wor­ry about vot­ing for a hor­ri­bly unpop­u­lar bill, you’ll have lots of sup­port­ing ads to fool the rablle.” And that announce­ment came dur­ing a meet­ing when the Kochs were declar­ing their intent on ensur­ing a more con­ser­v­a­tive ver­sion of Trump­care is what final­ly pass­es.

    All in all, the Koch net­work has made it pret­ty clear that, despite the sud­den col­lapse of the Trump­care push, fear of Trump­care should not be reced­ing any time soon. Intra-GOP fear of Trump’s wrath should Trump­care not become law, on the oth­er hand, is more an open ques­tion.

    Posted by Pterrafractyl | June 27, 2017, 10:35 pm
  3. White House senior advi­sor Kellyanne Con­way recent­ly echoed an argu­ment that’s becom­ing a grow­ing right-wing meme as the GOP’s push to ‘reform’ health care and gut Med­ic­aid creeps along: that when Oba­macare expand­ed Med­ic­aid to include some peo­ple above the pover­ty line, all these new­ly cov­ered peo­ple were lazy able-bod­ied adults who were unjust­ly suck­ing away resources from a pro­gram intend­ed for oth­er groups like the dis­abled, chil­dren, and the elder­ly. And when Trumpcare/Kochcare kicks all those new­ly cov­ered peo­ple off of Med­ic­aid, if they want health care they can go get a job. Yes, the vast major­i­ty of able-bod­ied adults on Med­ic­aid already have a job, and yes, one of the big rea­sons the peo­ple above the pover­ty line who are now cov­ered by the Med­ic­aid expan­sion (in the states that actu­al­ly did the expan­sion) are the work­ing poor, and yes, many low-pay jobs don’t actu­al­ly offer employ­er-spon­sored health care cov­er­age. And yes, Kellyanne Con­way almost cer­tain­ly knows all of this, but she said it any­way because that’s her job:

    The Huff­in­g­ton Post

    Kellyanne Con­way Defends Med­ic­aid Cuts, Says Adults Can Always Find Jobs
    Real­i­ty check: Most of them have jobs already.

    By Jonathan Cohn
    06/25/2017 12:29 pm ET | Updat­ed

    White House coun­selor Kellyanne Con­way on Sun­day came right out and said what so many Repub­li­cans are prob­a­bly think­ing — that tak­ing Med­ic­aid away from able-bod­ied adults is no big deal, because they can go out and find jobs that pro­vide health insur­ance.

    Appar­ent­ly nobody has told Con­way that the major­i­ty of able-bod­ied adults on Med­ic­aid already have jobs. The prob­lem is that they work as park­ing lot atten­dants and child care work­ers, man­i­curists and dish­wash­ers — in oth­er words, low-pay­ing jobs that typ­i­cal­ly don’t offer insur­ance. Take away their Med­ic­aid and they won’t be cov­ered.

    Appear­ing on ABC “This Week” pro­gram, Con­way faced tough ques­tions about steep cuts to Med­ic­aid in the Bet­ter Health Care Act — the bill to repeal the Afford­able Care Act that Sen­ate Repub­li­can lead­ers released on Thurs­day and hope to bring to a vote this week.

    The Afford­able Care Act — Oba­macare — offered states extra fed­er­al match­ing funds to expand Med­ic­aid eli­gi­bil­i­ty, so that any­body with income below or just above the pover­ty line would qual­i­fy. Under the Sen­ate bill, like its House coun­ter­part, the fed­er­al gov­ern­ment would with­draw those extra funds, forc­ing most of the 31 states (plus the Dis­trict of Colum­bia) that accept­ed the mon­ey to roll back their expan­sions part­ly or entire­ly.

    When ABC’s George Stephanopou­los asked Con­way about this pos­si­bil­i­ty, she offered an increas­ing­ly famil­iar argu­ment — that Oba­macare had over-extend­ed Med­ic­aid by tak­ing the pro­gram away from its his­toric mis­sion of cov­er­ing chil­dren, preg­nant women, the elder­ly and the dis­abled.

    .@KellyannePolls: Oba­macare opened up Med­ic­aid to “many able-bod­ied Amer­i­cans who should at least see if there are oth­ers options for them.” pic.twitter.com/fzqvuwXrXB— ABC News Pol­i­tics (@ABCPolitics) June 25, 2017

    “Oba­macare took Med­ic­aid, which was designed to help the poor, the needy, the sick, dis­abled, also chil­dren and preg­nant women, it took it and went way above the pover­ty line to many able-bod­ied Amer­i­cans who ... should at least see if there are oth­er options for them.”

    She added: “If they are able-bod­ied and they want to work, then they’ll have employ­er-spon­sored ben­e­fits like you and I do.”

    If only it were that easy.

    Among the able-bod­ied adults that Con­way and con­gres­sion­al Repub­li­cans have in mind — that is, non-elder­ly adults on Med­ic­aid who don’t qual­i­fy for dis­abil­i­ty ben­e­fits — 79 per­cent are in fam­i­lies where some­one works and 59 per­cent have jobs them­selves, accord­ing to the Hen­ry J. Kaiser Fam­i­ly Foun­da­tion.

    The prob­lem is that many work in low-pay­ing, tem­po­rary, or part-time jobs that don’t offer cov­er­age. In 2014, just 30 per­cent of work­ing adults with incomes at or below the pover­ty line had employ­er-spon­sored cov­er­age avail­able to them.

    As for the idea that the House and Sen­ate GOP bills would strength­en Med­ic­aid by focus­ing on its more tra­di­tion­al pop­u­la­tions, that claim would appear to be incon­sis­tent with the oth­er big change they would make.

    Both pro­pos­als would fun­da­men­tal­ly change Med­ic­aid by end­ing the fed­er­al government’s open-end­ed com­mit­ment to pro­vid­ing its share of fund­ing for the pro­gram, no mat­ter how many peo­ple become eli­gi­ble and no mat­ter how much their care ends up cost­ing.

    Fed­er­al pay­ments would like­ly fail to keep up with costs, forc­ing states to make cut­backs that would inevitably affect all groups that depend on the pro­gram — very much includ­ing the dis­abled and elder­ly, whose pre­dictably high med­ical needs mean their bills account for rough­ly half of all Med­ic­aid expen­di­tures, even though they rep­re­sent a minor­i­ty of enrollees.

    When Stephanopou­los asked Con­way about this, she said, “These are not cuts to Med­ic­aid, George. This slows the rate for the future and it allows gov­er­nors more flex­i­bil­i­ty, with Med­ic­aid dol­lars, because they’re clos­est to the peo­ple in need.”

    After @KellyannePolls says Sen­ate GOP bill does­n’t pro­pose Med­ic­aid cuts, @SenatorCollins says “I respect­ful­ly dis­agree with her analy­sis.” pic.twitter.com/QeS8lEWk66— ABC News Pol­i­tics (@ABCPolitics) June 25, 2017

    That claim, which the Trump admin­is­tra­tion and its allies in GOP lead­er­ship have made repeat­ed­ly in recent weeks, has drawn rebukes from Repub­li­can sen­a­tors — includ­ing Susan Collins of Maine, who appeared on “This Week” short­ly after Con­way.

    “I respect­ful­ly dis­agree with her analy­sis,” Collins said.

    ...

    ———-

    “Kellyanne Con­way Defends Med­ic­aid Cuts, Says Adults Can Always Find Jobs” by Jonathan Cohn; The Huff­in­g­ton Post; 06/25/2017

    “Among the able-bod­ied adults that Con­way and con­gres­sion­al Repub­li­cans have in mind — that is, non-elder­ly adults on Med­ic­aid who don’t qual­i­fy for dis­abil­i­ty ben­e­fits — 79 per­cent are in fam­i­lies where some­one works and 59 per­cent have jobs them­selves, accord­ing to the Hen­ry J. Kaiser Fam­i­ly Foun­da­tion.”

    Why can’t all those peo­ple with a job just go get jobs? That’s the how peo­ple about to get kicked off Med­ic­aid should respond, accord­ing to Kellyanne Con­way and the rest of the GOP:

    ...
    “Oba­macare took Med­ic­aid, which was designed to help the poor, the needy, the sick, dis­abled, also chil­dren and preg­nant women, it took it and went way above the pover­ty line to many able-bod­ied Amer­i­cans who ... should at least see if there are oth­er options for them.”

    She added: “If they are able-bod­ied and they want to work, then they’ll have employ­er-spon­sored ben­e­fits like you and I do.”
    ...

    Since “get a job, you [already employed] bums!” is appar­ent­ly going to be the GOP response once the GOP final­ly guts Med­ic­aid, it’s worth not­ing one of the more twist­ed ways Med­ic­aid actu­al­ly encour­ages some peo­ple get jobs: Some states, like Wis­con­sin, allow the rel­a­tives of Med­ic­aid recip­i­ents waiv­er where they can get a fixed amount of funds for home-care ser­vices and hire who­ev­er they want. Includ­ing rel­a­tives who can become the paid ser­vice provider, pay­ing $11,50/hour in Wis­con­sin’s case. And while that’s a lot less mon­ey that many peo­ple could get in oth­er jobs, it’s still poten­tial­ly a mon­ey saver for some­one to quit a high­er-pay­er career and become a home-care provider for their rel­a­tive sim­ply to avoid pay­ing the high-cost of hav­ing a pro­fes­sion home-care providers do those ser­vices.

    So while it’s absurd and just cru­el to tell peo­ple about to lose the Med­ic­aid cov­er­age to just go get it job, as the fol­low­ing arti­cle describes, there are sit­u­a­tions where the Med­ic­aid recip­i­ents’ rel­a­tives might get a job...a very low pay­ing job being the in-home Med­ic­aid ser­vice provider for their rel­a­tives. And yes, they might have to quit their career to do it. And even that option is threat­ened by the pro­posed Med­ic­aid cuts:

    Nation­al Pub­lic Radio

    Wis­con­sin Fam­i­ly Stays Togeth­er With Help From Med­ic­aid

    June 5, 2017 2:09 PM ET

    Nan­cy and Dan Gap­in­s­ki of Glen­dale, Wis., remem­ber a time when they could­n’t real­ly com­mu­ni­cate with their own son.

    “He used to not real­ly have any kinds of con­ver­sa­tions with us. He did a lot of echo­ing things that we said, and script­ing from movies,” Nan­cy Gap­in­s­ki says as she and her hus­band wait for their son Ben’s school bus to arrive. “A lot of times kids did­n’t know how to respond to him then, and did­n’t know what he was try­ing to say and con­ver­sa­tions would­n’t real­ly go any­where.”

    But that’s all changed. On a recent Fri­day after­noon, 10-year-old Ben hops off the bus, greets both his par­ents and starts chat­ting about his day.

    “So what I did today was I had an extra recess today, and also I had to do two star math tests,” he reports. He says he did pret­ty well on those tests.

    When Ben was a tod­dler he was diag­nosed with an autism spec­trum dis­or­der. He bare­ly com­mu­ni­cat­ed with his par­ents and need­ed con­stant mon­i­tor­ing to stay safe.

    The Gap­in­skis need­ed help. They found a ther­a­pist to work with Ben for 24 hours a week, which cost more $50,000 a year. Dan’s work­place insur­ance paid for some of the costs, but not all.

    So they turned to Med­ic­aid.

    Ben’s dis­abil­i­ty was severe enough – he was deemed by the state to require “an insti­tu­tion­al lev­el of care” — that he was eli­gi­ble for Wis­con­sin’s chil­dren’s long-term care pro­gram, fund­ed by Med­ic­aid.

    “They work with the child on basic lan­guage skills, try­ing to learn words, try­ing to do some intel­lec­tu­al exer­cis­es,” Ben’s father Dan recalls. “It even­tu­al­ly grad­u­ates into some back and forth con­ver­sa­tion, and doing home­work and doing things that are more like what nor­mal kids do.”

    While Med­ic­aid is best known as a health care pro­gram for poor peo­ple, more than 80 per­cent of its bud­get goes to care for the elder­ly, the dis­abled and chil­dren, accord­ing to the Kaiser Fam­i­ly Foun­da­tion. Only 15 per­cent goes to health care for able-bod­ied adults.

    The pro­gram has been grow­ing in recent years and it now makes up almost 10 per­cent of fed­er­al spend­ing. That’s why it’s the num­ber one tar­get in Pres­i­dent Trump’s pro­posed bud­get, and fig­ures promi­nent­ly in the Repub­li­can pro­pos­al to replace the Afford­able Care Act. Some esti­mates sug­gest the pro­gram could be cut by more than 1 tril­lion dol­lars over 10 years.

    After three years of intense ther­a­py, Ben now goes to his local pub­lic school and works on grade lev­el in math and Eng­lish. He no longer works with his pri­vate ther­a­pist or uses Med­ic­aid ben­e­fits.

    “We just decid­ed not to reap­ply,” Nan­cy says. “The need had been met.”

    Pres­i­dent Trump and Repub­li­cans in Con­gress have pro­posed mas­sive cuts to Med­ic­aid’s bud­get over the next decade, and Nan­cy and Dan Gap­in­s­ki wor­ry that the ser­vices they used for Ben won’t be there if he needs them in the future, or be there for oth­er fam­i­lies.

    “I don’t know what Ben will need in his life­time,” Nan­cy Gap­in­s­ki says. “Our goals for him are very much like our goals for our daugh­ter Zoe. We real­ly want for them to be active, engaged cit­i­zens.”

    Ben’s not the only one in the Gap­in­s­ki home who has used Med­ic­aid ser­vices. His grand­moth­er Eve­lyn Ben­jamin is also a ben­e­fi­cia­ry.

    Eve­lyn is 84. She’s had a few falls and depends on a walk­er to get around. She also has heart dis­ease and uses three dif­fer­ent inhalers.

    “They take very good care of me,” Eve­lyn says, sip­ping tea in the liv­ing room sur­round­ed by her fam­i­ly. “I’m very lucky to be one that can stay in my home, and know that I’m cared for.”

    Eve­lyn has health insur­ance through Medicare. But after her hus­band suf­fered a stroke and need­ed con­stant care, she deplet­ed her sav­ings and now qual­i­fies for Med­ic­aid as well. It helps pay for her 12 pre­scrip­tion med­ica­tions and, through a Med­ic­aid-fund­ed pro­gram called IRIS, she gets in-home help.

    Wis­con­sin’s IRIS pro­gram is an exam­ple of how states tai­lor Med­ic­aid to their own needs. It gives ben­e­fi­cia­ries a bud­get to use for the ser­vices they need, and it allows peo­ple to hire who­ev­er they want.

    So Eve­lyn hired her daugh­ter, Nan­cy, who gave up her full-time career to care for her moth­er and son. She works part-time from home, and sup­ple­ments that income with $11.50 an hour for 20 hours a week car­ing for her moth­er. She says it’s helped keep them out of bank­rupt­cy. And her hourly rate is a frac­tion of the going rate for such ser­vices from an agency. Accord­ing to a 2015 study by Gen­worth, home health aides and home­mak­er ser­vices in Mil­wau­kee cost an aver­age of about $22 an hour.

    “It’s just a big, big help for not only me, but for my daugh­ter who wor­ries about me con­stant­ly,” Eve­lyn says.

    Nan­cy Gap­in­s­ki wor­ries that help may dis­ap­pear under the pro­posed bud­get cuts. That’s because the ser­vices her fam­i­ly uses are con­sid­ered option­al under the Med­ic­aid law. The pro­gram is required to pay for doc­tor vis­its, hos­pi­tal care and even nurs­ing home care. But in-home sup­port ser­vices that Eve­lyn uses and ther­a­pies like those Ben received aren’t.

    Dan Gap­in­s­ki says his chil­dren love hav­ing their grand­moth­er around. When they have night­mares they climb into her bed and they gig­gle with her in the liv­ing room.

    “I don’t think we, as a soci­ety, appre­ci­ate the val­ue of that,” he says. “There’s a lot of talk about enti­tle­ments and how that’s become a bit of dirty word. We don’t take the sat­is­fac­tion in hav­ing made a greater soci­ety by mak­ing these kinds of sit­u­a­tions pos­si­ble.”

    ...

    ———-

    “Wis­con­sin Fam­i­ly Stays Togeth­er With Help From Med­ic­aid” by Ali­son Kod­jak; Nation­al Pub­lic Radio; 06/05/2017

    “Eve­lyn has health insur­ance through Medicare. But after her hus­band suf­fered a stroke and need­ed con­stant care, she deplet­ed her sav­ings and now qual­i­fies for Med­ic­aid as well. It helps pay for her 12 pre­scrip­tion med­ica­tions and, through a Med­ic­aid-fund­ed pro­gram called IRIS, she gets in-home help.

    84 year old Eve­lyn gets to stay liv­ing at home with her fam­i­ly, with the help of Wis­con­sin’s IRIS pro­gram. But also with the help of her daugh­ter who gets paid by IRIS to be Eve­lyn’s care provider. Until the GOP’s Med­ic­aid cuts force such “option­al” pro­grams to go away:

    ...
    Wis­con­sin’s IRIS pro­gram is an exam­ple of how states tai­lor Med­ic­aid to their own needs. It gives ben­e­fi­cia­ries a bud­get to use for the ser­vices they need, and it allows peo­ple to hire who­ev­er they want.

    So Eve­lyn hired her daugh­ter, Nan­cy, who gave up her full-time career to care for her moth­er and son. She works part-time from home, and sup­ple­ments that income with $11.50 an hour for 20 hours a week car­ing for her moth­er. She says it’s helped keep them out of bank­rupt­cy. And her hourly rate is a frac­tion of the going rate for such ser­vices from an agency. Accord­ing to a 2015 study by Gen­worth, home health aides and home­mak­er ser­vices in Mil­wau­kee cost an aver­age of about $22 an hour.

    “It’s just a big, big help for not only me, but for my daugh­ter who wor­ries about me con­stant­ly,” Eve­lyn says.

    Nan­cy Gap­in­s­ki wor­ries that help may dis­ap­pear under the pro­posed bud­get cuts. That’s because the ser­vices her fam­i­ly uses are con­sid­ered option­al under the Med­ic­aid law. The pro­gram is required to pay for doc­tor vis­its, hos­pi­tal care and even nurs­ing home care. But in-home sup­port ser­vices that Eve­lyn uses and ther­a­pies like those Ben received aren’t.
    ...

    And just to be clear, the fears of the Gapinksi fam­i­ly that the Med­ic­aid cuts will results in cuts to pro­grams that cov­er home-care aren’t just fears. Home-care ser­vices real­ly are con­sid­ered “option­al” under Med­ic­aid and as such are far more like­ly to be cut than ser­vices con­sid­ered “manda­to­ry”. And as the fol­low­ing arti­cle points out, one of the ser­vices con­sid­ered “manda­to­ry” is nurs­ing home ser­vices, so one effect of the com­ing Med­ic­aid cuts might actu­al­ly be to push peo­ple into nurs­ing homes. Of course, nurs­ing homes ser­vices are them­selves going to be under pres­sure since all Med­ic­aid ser­vices are going to be under pres­sure giv­en the scale of the pro­posed cuts, option­al and manda­to­ry. But the option­al ser­vices are obvi­ous­ly going to be cut a lot more so we could be effec­tive­ly push­ing peo­ple out of their home and into a shrink­ing num­ber of nurs­ing home beds. You real­ly don’t want play this ver­sion of musi­cal chairs:

    Time

    What Would Hap­pen to Seniors in Nurs­ing Homes Under the Repub­li­can Health Care Bill?

    Eliz­a­beth O’Brien
    Jun 29, 2017

    Dawn Burnfin’s 94-year-old grand­moth­er recent­ly had a mas­sive stroke in a Mis­souri nurs­ing home. She quick­ly recov­ered well enough to tell the end-of-life hos­pice work­ers car­ing for her to go home, since she had no plans to die.

    But the Med­ic­aid funds that help pay for her care are now up in the air.

    “I don’t know where she would go,” Burn­fin, 43, says of her grand­moth­er, if she los­es her bed in the nurs­ing home. “It’s real­ly scary.”

    Includ­ed in the Bet­ter Care Rec­on­cil­i­a­tion Act, the bill Sen­ate Repub­li­cans have pro­posed to replace the Afford­able Care Act, are an esti­mat­ed $772 bil­lion in fed­er­al cuts to Med­ic­aid through 2026, plus a reduc­tion in the fund­ing for­mu­la that would sharply decrease spend­ing beyond that. The non­par­ti­san Con­gres­sion­al Bud­get Office pro­ject­ed on Thurs­day that fed­er­al Med­ic­aid spend­ing in 2036 would be 35% less than under cur­rent law.

    Pro­po­nents of the bill say the new Med­ic­aid struc­ture would increase states’ flex­i­bil­i­ty to design their Med­ic­aid pro­grams around the unique needs of their pop­u­la­tions. But the pro­posed cuts have many like Burn­fin won­der­ing who will pay to keep her grand­moth­er cared for?

    While Med­ic­aid is best known for insur­ing low-income Amer­i­cans, the gov­ern­ment pro­gram also pro­vides a vital safe­ty net to elder­ly Amer­i­cans who need long-term care, either at home or in a facil­i­ty. Med­ic­aid cov­ers about 60% of nurs­ing home res­i­dents, and accord­ing to a 2015 study by Tru­ven Health Ana­lyt­ics, rough­ly 2.2 mil­lion elder­ly Amer­i­cans received Med­ic­aid-financed long-term care in 2011. As more baby boomers reach old­er age, these num­bers will only grow.

    Burn­fin lives in Chisholm, Minn., not close enough to pro­vide hands-on care to her grand­moth­er, although though she has plen­ty of exper­tise: Burn­fin her­self works as a home care work­er, pro­vid­ing in-home assis­tance to an elder­ly woman on Med­ic­aid. Her own liveli­hood depends on the program’s health.

    Med­ic­aid is such an impor­tant safe­ty net because Medicare, the fed­er­al health insur­ance pro­gram for those ages 65-plus, does not cov­er the kind of rou­tine assis­tance that most elder­ly need: help with dress­ing, bathing, eat­ing and oth­er activ­i­ties of dai­ly liv­ing. Accord­ing to gov­ern­ment esti­mates, 70% of peo­ple turn­ing 65 will even­tu­al­ly need such assis­tance in old­er age.

    When it comes to finding—and financing—long-term care for old­er loved ones, most fam­i­lies are on their own. And many end up turn­ing to Med­ic­aid when their mon­ey runs out. It’s not hard to drain your life sav­ings on nurs­ing home care that runs around $82,000 per year but can go much high­er in cost­lier areas of the coun­try. To qual­i­fy for Med­ic­aid for long-term care, appli­cants need to have deplet­ed most of their resources. Cri­te­ria vary by state; in New York, for exam­ple, the asset lim­it is about $14,000, not includ­ing a cer­tain amount of home equi­ty.

    Eli­gi­bil­i­ty cri­te­ria would like­ly get even stricter under the Bet­ter Care Rec­on­cil­i­a­tion Act, experts say. That’s because the bill would fun­da­men­tal­ly change the entire Med­ic­aid pro­gram, not just the parts affect­ed by the ACA: it would switch Med­ic­aid financ­ing from an open-end­ed ben­e­fit to one that’s capped.

    Instead of receiv­ing increased fed­er­al fund­ing to meet mount­ing needs—say, to fund opi­oid addic­tion treat­ment or to pay for a new break­through drug—beginning in 2020 states would receive a capped amount. This would rep­re­sent “a trans­fer of risk, respon­si­bil­i­ty, and cost to the states of his­toric pro­por­tions,” accord­ing to a state­ment by the Nation­al Asso­ci­a­tion of Med­ic­aid Direc­tors, a bipar­ti­san orga­ni­za­tion rep­re­sent­ing lead­ers of state Med­ic­aid agen­cies nation­wide.

    Spend­ing caps would become even more harsh in 2025, when Med­ic­aid spend­ing could only rise each year with gen­er­al infla­tion, which tends to lag med­ical infla­tion by sev­er­al per­cent­age points. “The bill’s Med­ic­aid cuts are real­ly about starv­ing the pro­gram, and states won’t think about the long-term, they’ll think about sur­viv­ing until the next year,” says Edwin Park, vice pres­i­dent for health pol­i­cy at the Cen­ter on Bud­get and Pol­i­cy Pri­or­i­ties.

    Med­ic­aid finances are already stretched, and there’s not that much fat to cut in the sys­tem. “It’s not like Med­ic­aid sys­tems have been rolling in cash under the cur­rent sys­tem, due to the need,” says Eric Carl­son, a direct­ing attor­ney in Jus­tice in Aging, a non­prof­it legal advo­ca­cy orga­ni­za­tion.

    Nobody knows yet how states would respond to the cuts, but experts say all long-term care sup­ports and ser­vices are vulnerable–that includes qual­i­ty care in nurs­ing homes for patients whose needs are best met in such facil­i­ties, and also in-home care for patients who can stay at home with assis­tance.

    Among the lim­it­ed choic­es states would have to cope with the cuts: they could restrict Med­ic­aid eli­gi­bil­i­ty, reduce the already-low pay­ments Med­ic­aid makes to med­ical providers, and reduce the num­ber of ser­vices that Med­ic­aid cov­ers. In-home care is gen­er­al­ly con­sid­ered an option­al ben­e­fit in state Med­ic­aid pro­grams, so it would like­ly be on the chop­ping block if the Sen­ate bill becomes law. Nurs­ing home care, by con­trast, is con­sid­ered manda­to­ry. “What’s hor­ri­ble about the bill is it will force insti­tu­tion­al­iza­tion,” says Michael J. Amoru­so, pres­i­dent-elect of the Nation­al Acad­e­my of Elder Law Attor­neys and a prac­tic­ing attor­ney in Rye Brook, N.Y. In oth­er words, the bill would force old­er, vul­ner­a­ble cit­i­zens out of their homes and into nurs­ing facil­i­ties.

    ...

    ———-

    “What Would Hap­pen to Seniors in Nurs­ing Homes Under the Repub­li­can Health Care Bill?” by Eliz­a­beth O’Brien; Time; 06/29/2017

    “Among the lim­it­ed choic­es states would have to cope with the cuts: they could restrict Med­ic­aid eli­gi­bil­i­ty, reduce the already-low pay­ments Med­ic­aid makes to med­ical providers, and reduce the num­ber of ser­vices that Med­ic­aid cov­ers. In-home care is gen­er­al­ly con­sid­ered an option­al ben­e­fit in state Med­ic­aid pro­grams, so it would like­ly be on the chop­ping block if the Sen­ate bill becomes law. Nurs­ing home care, by con­trast, is con­sid­ered manda­to­ry. “What’s hor­ri­ble about the bill is it will force insti­tu­tion­al­iza­tion,” says Michael J. Amoru­so, pres­i­dent-elect of the Nation­al Acad­e­my of Elder Law Attor­neys and a prac­tic­ing attor­ney in Rye Brook, N.Y. In oth­er words, the bill would force old­er, vul­ner­a­ble cit­i­zens out of their homes and into nurs­ing facil­i­ties.

    So if you were hop­ing that you might be able to get paid by Med­ic­aid (very lit­tle) to take care of your par­ents after they get kicked out of the nurs­ing home, sor­ry, your home-care pro­grams is prob­a­bly going to get cut first. It all rais­es the ques­tion of where grand­ma and grand­pa are going to go after the nurs­ing home funds run out and there’s no pos­si­ble way all these fam­i­lies will be able to cov­er it. Oh, that’s right...grandma and grand­pa move back with their rel­a­tives any­way. And the fam­i­ly takes care of them any­way, includ­ing by quit­ting careers to do it. But with­out any­one get­ting paid by Med­ic­aid to do it. So, yes, peo­ple with “get a job” after these Med­ic­aid cuts. It’ll just be the rel­a­tives get­ting the jobs. Unpaid jobs.

    And for peo­ple with­out a strong famil­iar net­work to pro­vide for them? Where do they go? Oh, that’s right...

    Posted by Pterrafractyl | July 1, 2017, 7:42 pm
  4. Under a nor­mal White House admin­is­tra­tion, it would be real­ly, real­ly, real­ly big news when Wal­ter Schaub, the wide­ly respect­ed head of the Office of Gov­ern­ment Ethics — an agency set up in the post-Water­gate era with the pur­pose of help­ing gov­ern­ment employ­ees avoid eth­i­cal con­flicts — resigned sud­den­ly last week, six months before his term was set to end, as a form of protest over the Trump admin­is­tra­tion’s open­ly flaunt­ing con­flicts of inter­ests. But this the Trump admin­is­tra­tion, so it’s not actu­al­ly big news. In part because the news of active ongo­ing cor­rup­tion inves­ti­ga­tion is drown­ing out Schaub’s sym­bol­ic res­ig­na­tion, but also because, hey, it’s Trump. He’s sup­posed to be kind of mob-ish. That’s his brand. And some­how that brand got him into the White House. So who cares about things like the head of the agency in charge of polic­ing con­flicts of inter­est resigns in protest, right? At this point we’re just count­ing down the days until Trump either Trump implodes his pres­i­den­cy or blows up the world.

    But here’s a reminder that Schaub’s sym­bol­ic res­ig­na­tion does­n’t just need to be seen as a protest against Don­ald Trump. The GOP as a par­ty is plen­ty wor­thy of a sym­bol­ic protest res­ig­na­tion Schaub:

    New York Mag­a­zine

    GOP Law­mak­ers Bought Health-Insur­ance Stocks While Advanc­ing Trump­care

    By Eric Levitz
    July 7, 2017 5:26 pm

    It’s hard to imag­ine how the GOP could have set about reform­ing the health-care sys­tem in a more polit­i­cal­ly tox­ic fash­ion. The Amer­i­can Health Care Act is the most unpop­u­lar piece of leg­is­la­tion that either par­ty has pur­sued in the past three decades. And it isn’t hard to see why: The bill would throw mil­lions of poor peo­ple off of Med­ic­aid, so as to finance a cap­i­tal-gains tax cut for mil­lion­aire investors; it would under­mine reg­u­la­to­ry pro­tec­tions for peo­ple with pre­ex­ist­ing con­di­tions; and it would mas­sive­ly increase pre­mi­ums for old­er, low­er-mid­dle-class peo­ple, espe­cial­ly those in rur­al areas — which is to say, a sig­nif­i­cant chunk of the GOP base.

    In oth­er words, GOP leg­is­la­tors vot­ed to increase their own pas­sive income by con­demn­ing thou­sands of their own vot­ers to pre­ventable deaths. What more could Repub­li­cans have done to val­i­date Demo­c­ra­t­ic nar­ra­tives about who they real­ly stand for?

    The Intercept’s Lee Fang pro­vides one answer:

    Just as the House Repub­li­can bill to slash much of the Afford­able Care Act moved for­ward, Rep. Mike Conaway, a Texas Repub­li­can and mem­ber of Speak­er Paul Ryan’s lead­er­ship team, added a health insur­ance com­pa­ny to his port­fo­lio.

    An account owned by Conaway’s wife made two pur­chas­es of Unit­ed­Health stock, worth as much as $30,000, on March 24th, the day the leg­is­la­tion advanced in the House Rules Com­mit­tee, accord­ing to dis­clo­sures. The exact val­ue of Conaway’s invest­ment isn’t clear, giv­en that con­gres­sion­al ethics forms only show a range of amounts, and Conaway’s office did not respond to a request for com­ment.

    It was a savvy move. Health indus­try stocks, includ­ing insur­ance giants like Unit­ed­Health, have surged as Repub­li­cans move for­ward with their repeal effort, which rolls back broad tax­es on health care firms while loos­en­ing con­sumer reg­u­la­tions which pre­vent insur­ance com­pa­nies from deny­ing cov­er­age for med­ical treat­ment. Unit­ed­Health has gained near­ly 7 per­cent in val­ue since March 24.

    Three months lat­er, as Mitch McConnell and com­pa­ny were rewrit­ing the bill in Congress’s upper cham­ber, Okla­homa sen­a­tor James Inhofe pur­chased between $50,000 and $100,000 worth of Unit­ed­Health shares. Inhofe’s spokesper­son told the Inter­cept that the trans­ac­tion was made by the senator’s finan­cial advis­er with­out his con­sul­ta­tion.

    It’s worth not­ing that, for the ordi­nary investor, it’s rarely wise to buy and sell indi­vid­ual stocks — as opposed to invest­ing in mutu­al funds — unless one has access to spe­cial infor­ma­tion. And giv­en that the mere appear­ance of cor­rup­tion has a cor­ro­sive effect on our repub­lic, it’s dif­fi­cult to under­stand why mem­bers of Con­gress don’t restrict their invest­ments to such instru­ments.

    But then, the Trump-era Repub­li­can Par­ty has grown quite com­fort­able with com­plic­i­ty in man­i­fest cor­rup­tion — let alone with giv­ing the appear­ance of it.

    New York con­gress­man Chris Collins has, at best, a sin­gu­lar enthu­si­asm for the lat­ter. Collins owns 17 per­cent of the Aus­tralian biotech firm Innate Immunother­a­peu­tic, mak­ing him the company’s largest share­hold­er. He is also a mem­ber of the House sub­com­mit­tee that over­sees the FDA.

    In his role as a con­gress­man, Collins authored leg­is­la­tion designed to expe­dite FDA approval of exper­i­men­tal drugs like those Innate spe­cial­izes in. In his capac­i­ty as a big mon­ey Innate investors, Collins (report­ed­ly) sold sev­er­al of his fel­low Repub­li­can con­gress­men on the virtues of invest­ing in the com­pa­ny. Among those who took him up on that offer was cur­rent Health and Human Ser­vices sec­re­tary Tom Price.

    In Feb­ru­ary, Collins mocked the idea that his invest­ment in the com­pa­ny ren­dered him unfit to rewrite phar­ma­ceu­ti­cal reg­u­la­tions or over­see the FDA. In an inter­view with the Rochester Demo­c­rat and Chron­i­cle, Collins argued that the com­pa­ny was for­eign, and not yet seek­ing FDA approval — and he promised that he would not own any stock in Innate by the time it sought entry into the U.S. mar­ket.

    Last month, the FDA approved one of Innate’s mul­ti­ple scle­ro­sis drugs for clin­i­cal tri­als in the U.S. As the Dai­ly Beast notes, Collins said last week that he remains an investor in the com­pa­ny.

    ...

    ———-

    “GOP Law­mak­ers Bought Health-Insur­ance Stocks While Advanc­ing Trump­care” by Eric Levitz; New York Mag­a­zine; 07/07/2017

    “It was a savvy move. Health indus­try stocks, includ­ing insur­ance giants like Unit­ed­Health, have surged as Repub­li­cans move for­ward with their repeal effort, which rolls back broad tax­es on health care firms while loos­en­ing con­sumer reg­u­la­tions which pre­vent insur­ance com­pa­nies from deny­ing cov­er­age for med­ical treat­ment. Unit­ed­Health has gained near­ly 7 per­cent in val­ue since March 24.”

    As we can see, gut­ting health care pro­tec­tions like pre-exist­ing con­di­tions cre­ates a lot of savvy invest­ment oppor­tu­ni­ties in the pri­vate health insur­ance sec­tor. Oppor­tu­ni­ties that some in Con­gress appear to be tak­ing.

    Although it’s worth not­ing that the savvy invest­ment made by cur­rent HHS sec­re­tary Tom Price and oth­ers in Con­gress­man Collins’ biotech com­pa­ny Innate Immunother­a­peu­tic is of a some­what dif­fer­ent nature than invest­ing in Unit­ed­Health or some­thing since this was lit­er­al­ly a case of a Con­gress­man ped­dling shares in his own com­pa­ny to oth­er Con­gress­men. Quite aggres­sive ped­dling accord­ing to numer­ous accounts. And while Con­gress­man Collins appears to have a real con­flict of inter­est over his past leg­is­la­tion involv­ing the drug approval process and a key drug Innate was work­ing on, it’s unclear he or Sec­re­tary Price or the rest of Innate’s Con­gres­sion­al investors are going to see the bil­lions in poten­tial prof­its Collins was promis­ing was pos­si­ble after Innate’s stock just dropped over 90 per­cent. Although it still earned him an inves­ti­ga­tion from the Office of Gov­ern­ment Ethics for insid­er trad­ing:

    New York Mag­a­zine

    GOP Con­gress­man Los­es $17 Mil­lion on Biotech Stock

    By Eric Levitz
    June 27, 2017 5:30 pm

    It’s been a good few months for brazen­ly uneth­i­cal politi­cians. Pres­i­dent Trump has spent his first months in the White House chan­nel­ing pub­lic funds into his per­son­al prop­er­ties — and putting hilar­i­ous­ly unqual­i­fied friends and fam­i­ly mem­bers into top gov­ern­ment posi­tions — with impuni­ty. The administration’s Health sec­re­tary won con­fir­ma­tion despite evi­dence that he may have engaged in insid­er trad­ing while in Con­gress, and lied dur­ing his appear­ance before the Sen­ate. And an Okla­homa attor­ney gen­er­al who allowed a nat­ur­al-gas com­pa­ny to lit­er­al­ly dic­tate his office’s posi­tion on new envi­ron­men­tal reg­u­la­tions is now the head of the EPA.

    Still, even in Trump’s Amer­i­ca, (osten­si­ble) acts of soft cor­rup­tion don’t always pay. As Politi­co reports:

    The stock val­ue of the Aus­tralian biotech firm Rep. Chris Collins cham­pi­oned to fel­low law­mak­ers plum­met­ed on Tues­day, cost­ing the New York Repub­li­can $17 mil­lion as inves­ti­ga­tors con­tin­ue prob­ing his rela­tion­ship with the firm.

    Innate Immunother­a­peu­tic shares dropped more than 90 per­cent on Tues­day to 5 cents when mar­kets closed in Aus­tralia. The tumul­tuous fall of the company’s stock fol­lowed an announce­ment that the firm’s star phar­ma­ceu­ti­cal drug for mul­ti­ple scle­ro­sis failed to pass clin­i­cal tri­als.

    Collins is a mem­ber of the House’s sub­com­mit­tee on health care and Innate’s biggest share­hold­er. The con­gress­man report­ed­ly encour­aged a num­ber of his fel­low Repub­li­can law­mak­ers to invest in the com­pa­ny, and secured them access to dis­count­ed shares (this was the point that Tom Price mis­led the Sen­ate about dur­ing his con­fir­ma­tion hear­ings). Then, Collins helped craft leg­is­la­tion that expe­dit­ed the FDA’s approval process — a reform that direct­ly ben­e­fit­ed Innate, which was work­ing to get its wares onto the U.S. mar­ket.

    Those activ­i­ties have now earned Collins the scruti­ny of the Office of Gov­ern­ment Ethics (which is inves­ti­gat­ing him on sus­pi­cions of insid­er trad­ing); a $17 mil­lion paper loss; and, pre­sum­ably, the irri­ta­tion of sev­er­al of his (sud­den­ly less wealthy) col­leagues.

    ...

    Finan­cial­ly speak­ing, Collins will be just fine — the con­gress­man is worth upwards of $40 mil­lion, while his actu­al loss­es are report­ed­ly clos­er to $5 mil­lion, the amount he orig­i­nal­ly invest­ed in the com­pa­ny 15 years ago.

    Those activ­i­ties have now earned Collins the scruti­ny of the Office of Gov­ern­ment Ethics (which is inves­ti­gat­ing him on sus­pi­cions of insid­er trad­ing); a $17 mil­lion paper loss; and, pre­sum­ably, the irri­ta­tion of sev­er­al of his (sud­den­ly less wealthy) col­leagues.”

    It’s a reminder that Trump’s many scan­dals aren’t just a dis­trac­tions from his many scan­dals. They’re also dis­trac­tions from Con­gress’s many scan­dals.

    And at least Con­gress­man Collins is still real­ly, real­ly rich even after los­ing mil­lions on his biotech invest­ment. He’s not bank­rupt, like all the peo­ple that are going to become bank­rupt from med­ical bills after Trump­care becomes real­i­ty. But don’t for­get, should any GOP­ers invest in any­thing that some­how prof­its from from a rise in per­son­al bank­rupt­cies, that’s a con­flict of inter­est. Or invest­ments that some­how prof­its from fam­i­lies sud­den­ly being forced to pro­vide med­ical ser­vices for their rel­a­tives, includ­ing dis­abled chil­dren. That’s def­i­nite­ly a con­flict of inter­est.

    Coffins and cre­ma­tion ser­vice invest­ments? You almost can’t get more con­flict­ed.

    Posted by Pterrafractyl | July 9, 2017, 7:11 pm
  5. Is Ted Cruz going to save Trump­care? It’s pos­si­ble. A lot of peo­ple might die as a result, but Trump­care could be save. All thanks to Ted Cruz. Or rather, all thanks to Ted Cruz’s amend­ment to the Sen­ate Trump­care bill that would allow insur­ance com­pa­nies to sell ‘bare bones’ health care plans as long as they also offer plans include the var­i­ous fea­tures and pro­tec­tions, for things like pre-exist­ing con­di­tions, that are the among the most pop­u­lar fea­tures in Oba­macare. And the Cruz amend­ment under­mines those pro­tec­tions in a par­tic­u­lar­ly under­hand­ed way. By allow­ing bare bones plans again, the healthy peo­ple who help bal­ance out the costs when pooled with old­er, sick­er, and more expen­sive peo­ple cre­ate a ‘healthy (not yet sick)’ vs ‘sick-ish or worse’ two-tiered mar­ket. Like it was before Oba­macare. So health care is going to be priced out of the hands of even more peo­ple. Specif­i­cal­ly the poor­est and sick­est.

    Don’t for­get that one of the key ways Oba­macare was designed to pro­vide afford­able insur­ance even to peo­ple with poten­tial­ly expen­sive pre-exis­ing con­di­tions is by man­dat­ing that all health insur­ance pack­ages have the “essen­tial ben­e­fits” that pro­vide afford­able access even to the sick. Pro­vid­ing essen­tial ben­e­fits to every­one pools the you and healthy in with every­one else, while also ensur­ing pre­ven­ta­tive care is avail­able. And by mak­ing peo­ple health­i­er with pre­ven­ta­tive care and pool­ing every­one into a large pools of sick and healthy, afford­able health care with mean­ing­ful cov­er­age was going to be extend­ed to every­one with­out going to a gov­ern­ment run sin­gle-pay­er sys­tem. That’s how Oba­macare was sup­posed to work before the GOP repeat­ed­ly sab­o­taged it. This is a very Ted Cruz-ish amend­ment but it’s also a very GOP-ish amend­ment. Although in the fol­low­ing arti­cle from a week and a half ago it sounds like most of the Sen­ate GOP­ers don’t even want this amend­ment because it’s that bad to the con­stituents. But about 15 do. So it’s a rel­a­tive­ly Ted Cruz-ish amend­ment even by GOP stan­dards.

    But that amend­ment appears to be the secret sauce required to get the far-right “Free­dom Cau­cus” fac­tion of the GOP on baord. And not just in the Sen­ate but House Free­dom Cau­cus leader has already hint­ed that the Cruz Amend­ment is going to be a House Freed­com Cau­cus demand too. And there’s no way Trump­care is becom­ing a real­i­ty with the Free­dom Cau­cus’s sup­port. Plus, the Koch broth­ers’ net­work is back­ing it too, so it’s going to be pret­ty hard to amend away the Cruz amend­ment from the final ver­sion of Trumpcare/Kochcare:

    New York Mag­a­zine

    Cruz Amend­ment to Sen­ate Health-Care Bill Now Divid­ing GOP

    By Ed Kil­go­re
    July 6, 2017 11:02 am

    When Ted Cruz first aired his pro­pos­al to let insur­ance com­pa­nies that sell one Oba­macare-com­pli­ant health-care plan to sell cheap­ie bare-bones plans as well, he got lot of praise for per­haps find­ing a way out of the ide­o­log­i­cal grid­lock that was keep­ing Sen­ate Repub­li­cans short of the votes they need­ed to pass their ver­sion of Trump­care. The idea was that this approach would give con­ser­v­a­tives the avenue for low­er indi­vid­ual insur­ance pre­mi­ums they were demand­ing with­out a frontal attack on pro­tec­tions for peo­ple with pre­ex­ist­ing con­di­tions.

    As my col­league Eric Levitz not­ed at the time, how­ev­er, the Cruz pro­pos­al rep­re­sent­ed a sneaky col­lat­er­al attack on the risk pools that make insur­ance afford­able for sick folks:

    Under Cruz’s mod­el, many healthy con­sumers would avoid shelling out for high-cost, com­pre­hen­sive plans. This would then make the pool of peo­ple will­ing to pay for such cov­er­age dis­pro­por­tion­ate­ly sick, which would cause the price of such plans to rise, which would make the pool even sick­er, which cause prices to pre­mi­ums to rise fur­ther, which would make the pool sick­er still, on and on, in a death spi­ral, until the sick were priced out of the mar­ket com­plete­ly.

    This real­iza­tion is now spread­ing among Sen­ate Repub­li­cans, along with oppo­si­tion to the Cruz amend­ment, as the Hill reports:

    “I would say that if we vot­ed on the Cruz pro­pos­al, it would be in the neigh­bor­hood of 37 to 15 against, 37 no votes and 15 yeses, and that’s prob­a­bly gen­er­ous,” said a GOP aide famil­iar with the Sen­ate nego­ti­a­tions. “Nobody wants to go home and say to a 45-year-old steel­work­er with dia­betes that you should have to pay a lot more for your health insur­ance.”

    Frus­tra­tions are mount­ing with Cruz among Sen­ate nego­tia­tors because lead­ers have felt blind­sided by his demand that the leg­is­la­tion essen­tial­ly elim­i­nate the pro­tec­tion for peo­ple with pre-exist­ing con­di­tions.

    But it may be too late now to put the genie back in the bot­tle: Con­ser­v­a­tive groups like Free­dom­Works and the Club for Growth are pro­mot­ing the Cruz amend­ment avid­ly. And per­haps more sig­nif­i­cant­ly, House Free­dom Cau­cus chair­man Mark Mead­ows, who has gen­er­al­ly been qui­et about Sen­ate devel­op­ments, is sud­den­ly act­ing as though adop­tion of Cruz’s idea may be a con­di­tion for his own sup­port

    ...

    As a prac­ti­cal mat­ter, this debate could be in the hands of the Con­gres­sion­al Bud­get Office, which Mitch McConnell has asked to pro­vide a “score” for amend­ed ver­sions of the Sen­ate bill with and with­out Cruz’s pro­pos­al. It’s unclear which set of assump­tions about the Texan’s hand­i­work the green eye­shades will adopt:

    Repub­li­can aides who say Cruz’s amend­ment is polit­i­cal­ly unten­able acknowl­edge that the CBO could report some good news, like that the pro­pos­al would send down pre­mi­ums with­out sig­nif­i­cant­ly affect­ing cov­er­age.

    But they think it’s more like­ly that the CBO analy­sis will be damn­ing.

    “Or CBO will come back and say the mar­ket will be destroyed and 45 mil­lion peo­ple will be left with­out insur­ance,” said one staffer.

    How­ev­er it all turns out, the Cruz pro­pos­al has cast a spot­light on one of the under­ly­ing prob­lems the GOP has faced through­out its cru­sade to repeal Oba­macare. Giv­ing peo­ple with pre­ex­ist­ing health con­di­tions access to afford­able health insur­ance has always been one of the most pop­u­lar fea­tures of the Afford­able Care Act. To the extent that accom­plish­ing this goal requires broad­er risk pools that shift some costs to younger and health­i­er peo­ple (with the poor­er among them receiv­ing com­pen­sato­ry fed­er­al sub­si­dies), it’s “social­ist” in the eyes of many con­ser­v­a­tives. And so they keep com­ing up with ways around it, from state “opt outs” of pro­vi­sions ban­ning price dis­crim­i­na­tion against sick peo­ple (the “solu­tion” in the House-passed Amer­i­can Health Care Act) to the kind of indi­rect approach Cruz is pro­mot­ing.

    Con­ser­v­a­tives are being hon­est about one thing: A full repeal of Oba­macare would send the health-care sys­tem back to the pre-ACA sta­tus quo ante. In those days peo­ple with pre­ex­ist­ing con­di­tions were most­ly out of luck (aside from what­ev­er suc­cor they are offered via the health-insur­ance ghet­tos states cre­ate under the rubric of “high-risk pools”), while healthy peo­ple had a wide range of afford­able options — includ­ing the option of going with­out insur­ance. To the extent con­ser­v­a­tives pre­fer that sit­u­a­tion to the “tyran­ny” and “big gov­ern­ment” of Oba­macare, they will just have to accept the polit­i­cal dam­age asso­ci­at­ed with the dra­mat­ic unpop­u­lar­i­ty of their ideas.

    ———-

    “Cruz Amend­ment to Sen­ate Health-Care Bill Now Divid­ing GOP” by Ed Kil­go­re; New York Mag­a­zine; 07/06/2017

    “How­ev­er it all turns out, the Cruz pro­pos­al has cast a spot­light on one of the under­ly­ing prob­lems the GOP has faced through­out its cru­sade to repeal Oba­macare. Giv­ing peo­ple with pre­ex­ist­ing health con­di­tions access to afford­able health insur­ance has always been one of the most pop­u­lar fea­tures of the Afford­able Care Act. To the extent that accom­plish­ing this goal requires broad­er risk pools that shift some costs to younger and health­i­er peo­ple (with the poor­er among them receiv­ing com­pen­sato­ry fed­er­al sub­si­dies), it’s “social­ist” in the eyes of many con­ser­v­a­tives. And so they keep com­ing up with ways around it, from state “opt outs” of pro­vi­sions ban­ning price dis­crim­i­na­tion against sick peo­ple (the “solu­tion” in the House-passed Amer­i­can Health Care Act) to the kind of indi­rect approach Cruz is pro­mot­ing

    An amend­ment to make sure the health insur­ance mar­kets have a sick vs healthy dynam­ic that makes it a lot more expen­sive for the sick pools. And it also gets rid of Oba­macare pro­tec­tions by allow com­pa­nies to offer plans with­out them that will no doubt be mar­ket­ed heav­i­ly. That’s the Cruz amend­ment. It’s designed to cre­ate a pric­ing and lit­er­al death spi­ral for the sick­est:

    ...
    Under Cruz’s mod­el, many healthy con­sumers would avoid shelling out for high-cost, com­pre­hen­sive plans. This would then make the pool of peo­ple will­ing to pay for such cov­er­age dis­pro­por­tion­ate­ly sick, which would cause the price of such plans to rise, which would make the pool even sick­er, which cause prices to pre­mi­ums to rise fur­ther, which would make the pool sick­er still, on and on, in a death spi­ral, until the sick were priced out of the mar­ket com­plete­ly.
    ...

    And the worst part is, the Kochs love. And their Free­dom Cau­cus pets:

    ...
    But it may be too late now to put the genie back in the bot­tle: Con­ser­v­a­tive groups like Free­dom­Works and the Club for Growth are pro­mot­ing the Cruz amend­ment avid­ly. And per­haps more sig­nif­i­cant­ly, House Free­dom Cau­cus chair­man Mark Mead­ows, who has gen­er­al­ly been qui­et about Sen­ate devel­op­ments, is sud­den­ly act­ing as though adop­tion of Cruz’s idea may be a con­di­tion for his own sup­port.
    ...

    And it even sounds like most GOP Sen­a­tors would rather amend it all away (and prob­a­bly amend Ted Cruz away if they could):

    ...
    “I would say that if we vot­ed on the Cruz pro­pos­al, it would be in the neigh­bor­hood of 37 to 15 against, 37 no votes and 15 yeses, and that’s prob­a­bly gen­er­ous,” said a GOP aide famil­iar with the Sen­ate nego­ti­a­tions. “Nobody wants to go home and say to a 45-year-old steel­work­er with dia­betes that you should have to pay a lot more for your health insur­ance.”

    Frus­tra­tions are mount­ing with Cruz among Sen­ate nego­tia­tors because lead­ers have felt blind­sided by his demand that the leg­is­la­tion essen­tial­ly elim­i­nate the pro­tec­tion for peo­ple with pre-exist­ing con­di­tions.
    ...

    Accord­ing to one esti­mate only 15 fel­low GOP­ers are like­ly back­ers of Ted Cruz’s amend­ment. At least that was the case as the the time of the arti­cle which was about a week and a half ago.

    But that amend­ment was part of the recent­ly issued new Sen­ate GOP plan so it sounds like Ted Cruz/Freedom Caucus/Koch fac­tion won. So now the health insur­ance indus­try is try­ing to make it clear what this is a bad idea that will result in few­er peo­ple being insured:

    Talk­ing Points Memo
    DC

    Insur­ers Torch New Cruz Pro­vi­sion In Trump­Care: ‘Sim­ply Unwork­able’

    By Tier­ney Sneed
    Pub­lished July 15, 2017 9:49 am

    Big play­ers in the insur­ance indus­try, which has most­ly held back pub­lic crit­i­cism of the GOP’s Oba­macare repeal push, evis­cer­at­ed a Sen. Ted Cruz (R‑TX)-sponsored pro­vi­sion that was includ­ed in the lat­est ver­sion of the Sen­ate leg­is­la­tion.

    “It is sim­ply unwork­able in any form and would under­mine pro­tec­tions for those with pre-exist­ing med­ical con­di­tions, increase pre­mi­ums and lead to wide­spread ter­mi­na­tions of cov­er­age for peo­ple cur­rent­ly enrolled in the indi­vid­ual mar­ket,” Blue Cross Blue Shield and America’s Health Insur­ance Plans said Fri­day in a rare joint let­ter to Sen­ate lead­ers.

    The Cruz pro­pos­al, known as the “Con­sumer Free­dom Option,” would allow insur­ers to sell plans that would be free of many Afford­able Care Act man­dates if they were also sell­ing Oba­macare-com­pli­ant plans.

    Insur­ers and out­side health experts had already been rais­ing their con­cerns with the idea when it was being dis­cussed in the abstract, warn­ing the it seg­ment the mar­ket between healthy peo­ple choos­ing the non-com­pli­ant plans and sick peo­ple the com­pre­hen­sive ACA ones. The insur­ers upped their com­plaints in the let­ter Fri­day.

    “This would allow the new plans to ‘cher­ry pick’ only healthy peo­ple from the exist­ing mar­ket mak­ing cov­er­age unaf­ford­able for the mil­lions of peo­ple who need or want com­pre­hen­sive cov­er­age, includ­ing, for exam­ple, cov­er­age for pre­scrip­tion drugs and men­tal health ser­vices,” the insur­ers said.

    It had been an open ques­tion whether Sen­ate GOP lead­ers would include the amend­ment in the base leg­is­la­tion they unveiled Thurs­day, with Cruz promis­ing he would vote against it if it was not.

    The Cruz lan­guage in the lat­est bill was placed in brack­ets to sig­ni­fy that it was still a work in progress, Sen­ate aides said.

    The insur­ers also bashed the details of the pro­pos­al that became clear after it was unveiled, includ­ing an appar­ent attempt of have the non-com­pli­ant plans and the ACA plans share a sin­gle risk pool.

    “That is not the case. The Con­sumer Free­dom Option estab­lish­es a ‘sin­gle risk pool’ in name only. In fact, it cre­ates two sys­tems of insur­ance for healthy and sick peo­ple,” the insur­ers said.

    They said that the $70 bil­lion added to the new draft to off­set pre­mi­um increas­es for the sick “is insuf­fi­cient and addi­tion­al fund­ing will not make the pro­vi­sion work­able for con­sumers or tax­pay­ers.”

    They went on to pre­dict that the pro­pos­al “will lead to far few­er, if any, cov­er­age options for con­sumers who pur­chase their plan in the indi­vid­ual mar­ket.”

    “As a result, mil­lions of more indi­vid­u­als will become unin­sured,” the let­ter said.

    One more GOP defec­tion from the leg­is­la­tion, which already has two Sen­ate Repub­li­can oppo­nents, would kill it even before the Sen­ate could advance it pro­ce­du­ral­ly, in a vote slat­ed for this com­ing week.

    After the ini­tial vote is tak­en to advance leg­is­la­tion, there will be an amend­ments process where the Cruz pro­pos­al could be struck, as insur­ers are urg­ing. The par­lia­men­tar­i­an may also find it vio­lates Sen­ate rules con­cern­ing the process the GOP is using to push the leg­is­la­tion.

    ...

    ————

    “Insur­ers Torch New Cruz Pro­vi­sion In Trump­Care: ‘Sim­ply Unwork­able’” by Tier­ney Sneed; Talk­ing Points Memo; 07/15/2017

    ““This would allow the new plans to ‘cher­ry pick’ only healthy peo­ple from the exist­ing mar­ket mak­ing cov­er­age unaf­ford­able for the mil­lions of peo­ple who need or want com­pre­hen­sive cov­er­age, includ­ing, for exam­ple, cov­er­age for pre­scrip­tion drugs and men­tal health ser­vices,” the insur­ers said.”

    Mil­lions of peo­ple will lose cov­er­age. So says the health insur­ance lob­by. And it’s going to be the peo­ple who aren’t going to be helped by Ted Cruz’s bare bones plans because they’ll need actu­al med­ical care. To live and stuff:

    ...
    The insur­ers also bashed the details of the pro­pos­al that became clear after it was unveiled, includ­ing an appar­ent attempt of have the non-com­pli­ant plans and the ACA plans share a sin­gle risk pool.

    “That is not the case. The Con­sumer Free­dom Option estab­lish­es a ‘sin­gle risk pool’ in name only. In fact, it cre­ates two sys­tems of insur­ance for healthy and sick peo­ple,” the insur­ers said.

    They said that the $70 bil­lion added to the new draft to off­set pre­mi­um increas­es for the sick “is insuf­fi­cient and addi­tion­al fund­ing will not make the pro­vi­sion work­able for con­sumers or tax­pay­ers.”

    They went on to pre­dict that the pro­pos­al “will lead to far few­er, if any, cov­er­age options for con­sumers who pur­chase their plan in the indi­vid­ual mar­ket.”

    “As a result, mil­lions of more indi­vid­u­als will become unin­sured,” the let­ter said.
    ...

    “As a result, mil­lions of more indi­vid­u­als will become unin­sured,” the let­ter said.

    Again, that same amend­ment was in the recent­ly released new GOP Sen­ate Trump­care bill. And it’s not just the Free­dom Cau­cus and the Koch net­work back­ing Cruz up. The Trump admin­is­tra­tion’s Health and Human Ser­vices Sec­re­tary Tom Price wants to know what all the health insur­ance indus­try oppo­si­tion is com­ing from since, as Price puts it, Ted Cruz’s amend­ment sim­ply allows things to go back to how they were before Oba­macare. In oth­er words, its undoes the pro­tec­tions in Oba­macare that are so pop­u­lar most of the GOP Sen­a­tors are too scared to vote for some­thing that repeals them. Because it’s that harm­ful to their con­stituents. Ted Cruz’s amend­ment is a poi­son pill designed to kill Oba­macare:

    Think Progress

    Tom Price admits that the new Trump­care is only repeal, no replace
    Trump’s sec­re­tary of health and human ser­vices says all insur­ers have to do “is dust off how they did busi­ness before Oba­macare.”

    Josh Israel
    Jul 16, 2017

    Dur­ing his pres­i­den­tial cam­paign, Don­ald Trump promised, over and over again, that he would replace Oba­macare with “some­thing ter­rif­ic,” that would “take care of every­body” and be “a lot less expen­sive” for con­sumers and the gov­ern­ment.

    But despite claims by Sen­ate Repub­li­can Leader Mitch McConnell (R‑KY) that his lat­est ver­sion of Trump­care would pro­vide “sta­bil­i­ty” while “improv­ing afford­abil­i­ty,” Sec­re­tary of Health and Human Ser­vices Tom Price made a major admis­sion about the bill Sun­day: that the leg­is­la­tion to repeal and replace Oba­macare would sim­ply per­mit insur­ers return to the ways they used to oper­ate.

    On ABC’s This Week, the long­time Oba­macare crit­ic was pressed by Jon Karl about a pro­vi­sion in the bill pushed by Sen. Ted Cruz (R‑TX), which would allow insur­ance com­pa­nies to offer sub-stan­dard plans. Karl not­ed that not only do more than 10 med­ical groups and 32 can­cer orga­ni­za­tions oppose the Trump­care bill, “a rare joint state­ment by the biggest insur­ance com­pa­nies in the coun­try called the Cruz amend­ment ‘unwork­able in any form’ [as] ‘it would lead to, ‘wide­spread ter­mi­na­tions of cov­er­age.”

    Price respond­ed that he found that wall of oppo­si­tion “real­ly per­plex­ing, espe­cial­ly from the insur­ance com­pa­nies, cause all they have to do is dust off how they did busi­ness before Oba­macare.”

    ...

    But while much of this bill would return things to the bad old days, it would also hurt con­sumers in a nov­el way. Under the Trump­care bill, cus­tomers who pur­chase a cheapo Cruz sub­stan­dard plans would not be con­sid­ered to have had “con­tin­u­ous cov­er­age.” And a pro­vi­sion of the bill states that any­one with­out con­tin­u­ous cov­er­age would be sub­ject to a six-month wait­ing peri­od before they could buy any real plan. In oth­er words, it could be even worse than the pre-Oba­macare sys­tem for peo­ple who sud­den­ly become sick.

    ———-

    “Tom Price admits that the new Trump­care is only repeal, no replace” by Josh Israel; Think Progress; 07/16/2017

    “Price respond­ed that he found that wall of oppo­si­tion “real­ly per­plex­ing, espe­cial­ly from the insur­ance com­pa­nies, cause all they have to do is dust off how they did busi­ness before Oba­macare.””

    Sec­re­tary Price just can’t fig­ure out why the health insur­ance indus­try can’t keep its yap shut about how mil­lions are going to lose cov­er­age thanks to the Cruz Amend­ment since, hey, it will be like before! The Trump Admin­is­tra­tion and GOP have turned pri­vate health insur­ers into the ‘good guys’ dur­ing a major health reform debate. That’s where we are.

    Except the Cruz amend­ment isn’t just going to return things to the pre-Oba­macare era. It’ll make things worse. For the young and healthy who bought those Cruz plans and are sud­den­ly sick:

    ...
    But while much of this bill would return things to the bad old days, it would also hurt con­sumers in a nov­el way. Under the Trump­care bill, cus­tomers who pur­chase a cheapo Cruz sub­stan­dard plans would not be con­sid­ered to have had “con­tin­u­ous cov­er­age.” And a pro­vi­sion of the bill states that any­one with­out con­tin­u­ous cov­er­age would be sub­ject to a six-month wait­ing peri­od before they could buy any real plan. In oth­er words, it could be even worse than the pre-Oba­macare sys­tem for peo­ple who sud­den­ly become sick.

    Yep, thanks to the fact that Cruz’s bare bones plans are so inad­e­quate that they don’t even qual­i­fy as being ‘cov­ered’ under the pre-exist­ing con­di­tion pro­tec­tion rule. So peo­ple with the Cruz­care plans won’t be allowed to buy insur­ance fore six months if they get ill and sud­den­ly need more com­pre­hen­sive cov­er­age. It’s the six-month win­dow-of-manda­to­ry-uncare Ted Cruz got intro­duced into Trump­care:

    Think Progress

    The Trump­care pro­vi­sion that could be a death sen­tence for peo­ple who get sick sud­den­ly
    Trump­care keeps get­ting worse.

    Lind­say Gibbs
    Jul 15, 2017

    Repub­li­can sen­a­tors are hop­ing to pass the Bet­ter Care Rec­on­cil­i­a­tion Act—a.k.a. Trumpcare—next week, so in the past few days, there has been a flur­ry of amend­ments and alter­ca­tions to the bill in hopes of secur­ing enough votes.

    ...

    Per­haps the most egre­gious change this week was the amend­ment pro­posed by Sen. Ted Cruz (R‑TX), which will allow insur­ers to offer bare-bones plans as long as they offer at least one plan that ful­ly com­plies with exist­ing Afford­able Care Act reg­u­la­tions on pre­ex­ist­ing con­di­tions and com­pre­hen­sive cov­er­age. On Fri­day, insur­ers said the amend­ment was “unwork­able in any form.”

    But, some­how, it gets even worse. Not only are the bare-bones plans under the Cruz amend­ment so cheap that they would cause the cost for com­pre­hen­sive, ACA-com­pli­ant insur­ance plans to sky­rock­et, but the Cruz-spon­sored plans are so stripped down that they don’t even count as “con­tin­u­ous cov­er­age” in the BCRA.

    In oth­er words, if you are a healthy per­son who pur­chas­es the cheap Cruz plan because it’s more finan­cial­ly fea­si­ble, but then you become sick and need to upgrade to a bet­ter plan, you would be locked out of the insur­ance mar­ket­place for six full months until you were able to buy a more robust insur­ance plan.

    The Cruz amend­ment *could* basi­cal­ly destroy the entire indi­vid­ual health mar­ket in Amer­i­ca. And they’re gonna vote in 5 days.— Christo­pher Hayes (@chrislhayes) July 15, 2017

    That’s absurd, con­sid­er­ing the six-month ban is in place so that peo­ple won’t go with­out insur­ance until they become sick, and the entire point of the Cruz amend­ment seems to be to keep healthy peo­ple in the insur­ance mar­ket­place in the first place.

    For­mer Demo­c­ra­t­ic con­gress­woman Don­na Edwards put a face to this prob­lem on MSNBC’s AM Joy on Sat­ur­day morn­ing.

    Last week, Edwards penned a mov­ing op-ed in the Wash­ing­ton Post dis­cussing her bat­tle with mul­ti­ple scle­ro­sis. She was diag­nosed with the dis­ease last sum­mer, and was plan­ning on pur­chas­ing insur­ance through the ACA when her cur­rent $800-a-month cobra plan expires next June. How­ev­er, if the BCRA pass­es, she may be unable to get insur­ance due to her pre­ex­ist­ing con­di­tion.

    On AM Joy, Edwards stressed that if she had pur­chased one of the cheap Cruz plans last year when she was diag­nosed with M.S., she would have had to go six months before being allowed to pur­chase the (expen­sive) insur­ance that would cov­er her con­di­tion.

    “If I had one of these sim­ple bare-bones plans in May of 2016, by the time I was diag­nosed with mul­ti­ple scle­ro­sis in June of 2016, I would not have health care,” she said.

    Cruz plans don’t cov­er pre­scrip­tion drugs, chemother­a­py, hos­pi­tal­iza­tion, or preg­nan­cy.

    ———-

    “The Trump­care pro­vi­sion that could be a death sen­tence for peo­ple who get sick sud­den­ly” by Lind­say Gibbs; Think Progress; 07/15/2017

    “In oth­er words, if you are a healthy per­son who pur­chas­es the cheap Cruz plan because it’s more finan­cial­ly fea­si­ble, but then you become sick and need to upgrade to a bet­ter plan, you would be locked out of the insur­ance mar­ket­place for six full months until you were able to buy a more robust insur­ance plan.”

    Don’t for­get that one of the key ideas in Oba­macare for how to ‘bend the cost curb’ and slow down the growth in health care spend­ing is to ensure that peo­ple have ade­quate health care cov­er­age to address med­ical issues ear­ly, when they are far cheap­er to address. And now we have the Cruz Amend­ment that cre­ates “sick vs healthy” pools, makes the sick pools too expen­sive to afford, and allows for Cruz-style ‘afford­able’ plans that cov­er almost noth­ing and come with a six month “good luck!” clause if you need to buy one of the expen­sive plans that actu­al­ly have mean­ing­ful cov­er­age.

    Good luck young and healthy peo­ple who can’t afford any­thing bet­ter than a Cruz plan! Try not get sick. Or preg­nant. And def­i­nite­ly not can­cer:

    ...

    Cruz plans don’t cov­er pre­scrip­tion drugs, chemother­a­py, hos­pi­tal­iza­tion, or preg­nan­cy.

    Yep, if you sud­den­ly have a fetus, or tumor, grow­ing inside you, Ted Cruz and the GOP have a fun 6 month win­dow of won­der, fol­lowed by some extra expen­sive pric­ing options for the “essen­tial ben­e­fits” plan you need, planned for you and your new grow­ing thing. Same for all the rest of the stuff not cov­ered by the Cruz plans.

    So that’s all one more rea­son peo­ple hate Ted Cruz. Although obvi­ous­ly not every­one. There are excep­tions.

    Posted by Pterrafractyl | July 16, 2017, 5:25 pm
  6. Is Trump­care once again on life sup­port? It’s look­ing that way after Eliz­a­beth Mac­Do­nough, the Sen­ate Par­lia­men­tar­i­an whose respon­si­bil­i­ties include decid­ing which pro­vi­sions in Trump­care are allow­able under the ‘Byrd Rule’ that allows a bill to pass the Sen­ate with a straight 51 vote major­i­ty but only if it does­n’t involve a net change in spend­ing, maybe have just struck down some pro­vi­sions that could be a deal break­er for a large chunk of the GOP cau­cus. Espe­cial­ly a deal break­er for the ‘Free­dom Cau­cus’: The defund­ing of Planned Par­ent­hood was just ruled to be a vio­la­tion of the ‘Byrd Rule’. And if there’s one thing that would give waiv­er GOP­ers a good excuse to explain to their con­stituents why they vot­ed against Trump­care, it’s a ver­sion of Trump­care where Planned Par­ent­hood still gets fund­ing:

    The Atlantic

    The GOP Health-Care Bil­l’s Byrd Rule Dilem­ma

    The Sen­ate parliamentarian’s rejec­tion of impor­tant pro­vi­sions of the GOP’s Oba­macare repeal bill puts its sta­tus in fur­ther jeop­ardy.

    Vann R. Newkirk II
    7/22/2017 12:07 PM ET

    On Fri­day, Sen­ate Democ­rats released a list of pro­vi­sions in the Repub­li­can health-care bill that the Sen­ate par­lia­men­tar­i­an holds can pass via a sim­ple, fil­i­buster-proof major­i­ty vote. Among those pro­vi­sions that didn’t meet her scruti­ny are the bill’s plans to defund Planned Par­ent­hood, restrict tax-cred­it fund­ing for insur­ance plans that pro­vide abor­tions, and a six-month “lock­out” peri­od from pur­chas­ing insur­ance for peo­ple who don’t main­tain con­tin­u­ous cov­er­age.

    If this pre­lim­i­nary guid­ance holds, the Bet­ter Care Rec­on­cil­i­a­tion Act—which is already in dire straits—seems like­ly to fail.

    The final assess­ment of the par­lia­men­tar­i­an, Eliz­a­beth Mac­Do­nough, is a crit­i­cal step in the GOP’s strat­e­gy for pass­ing their bill to repeal and replace Oba­macare. Repub­li­cans have opt­ed to pass their health-care leg­is­la­tion via the spe­cial rec­on­cil­i­a­tion process, under which they can cut debate short in the Sen­ate and thus elim­i­nate indef­i­nite fil­i­busters, which Democ­rats would cer­tain­ly use in order to block any attempt to repeal Oba­macare. But bills have to fol­low a cer­tain procedure—called the Byrd Rule—in order to pass by rec­on­cil­i­a­tion.

    Broad­ly, the Byrd rule states that rec­on­cil­i­a­tion leg­is­la­tion can only include changes to laws that direct­ly affect the fed­er­al bud­get, and can be scored by the Con­gres­sion­al Bud­get Office. So for exam­ple, Repub­li­cans could “repeal” Oba­macare pre­mi­um tax cred­its via rec­on­cil­i­a­tion by mak­ing the cred­it $0 for every­one, but couldn’t in the­o­ry use the same bill to elim­i­nate the require­ment for insur­ers that take pre­mi­um tax cred­its to also take peo­ple with pre-exist­ing con­di­tions.

    In prac­tice, the par­lia­men­tar­i­an reviews every pro­vi­sion of a rec­on­cil­i­a­tion bill and out­lines which ones pass muster under the Byrd rule by her own judg­ment. In this instance, accord­ing to the Demo­c­ra­t­ic out­line, MacDonough’s office ruled that “abor­tion restric­tions on the pre­mi­um tax cred­it and the small busi­ness tax cred­it, and the lan­guage defund­ing Planned Par­ent­hood, vio­late the Byrd Rule.” Addi­tion­al­ly, oth­er pro­vi­sions on the chop­ping block include the BCRA’s six-month con­tin­u­ous-cov­er­age lock­out, and its sun­set of min­i­mum require­ments for alter­na­tive pri­vate-admin­is­tered Med­ic­aid plans.

    Still under review are the BCRA’s pro­vi­sions that allow states to waive cer­tain essen­tial health ben­e­fits for exchange plans, increase the age-rat­ing scheme for old­er adults, and allow Med­ic­aid fund­ing to go to states in lump sum “block grants.”

    Notably, all of these pro­vi­sions that have either been chal­lenged by the parliamentarian’s office or still await a final deter­mi­na­tion are those that were includ­ed in the BCRA to gain the sup­port of hard-core con­ser­v­a­tives, who, like their coun­ter­part mod­er­ate fac­tion have often crit­i­cized the bill and could har­poon any leg­isla­tive action. It’s hard to see how a bill that retains Planned Par­ent­hood fund­ing and the use of pre­mi­um tax-cred­its for plans that cov­er abor­tion would pro­ceed to debate through con­ser­v­a­tive objec­tions.

    ...

    Some Repub­li­cans are hint­ing at more rad­i­cal steps to get past MacDonough’s review. Sen­a­tor Ted Cruz of Texas has been float­ing the idea of sim­ply ignor­ing the parliamentarian’s review for months now. The pre­sid­ing offi­cer of the Senate—Vice Pres­i­dent Mike Pence—technically makes the final call on par­lia­men­tary pro­ce­dures, and could over­rule the parliamentarian’s objec­tions, although this would be a high­ly con­tro­ver­sial break of Sen­ate norms that hasn’t been attempt­ed for over 40 years.

    But this seems to be the era of flout­ing norms, as evi­denced by the increas­ing will­ing­ness of Sen­ate Repub­li­cans to chal­lenge the CBO scor­ing process, and per­haps even con­sid­er the fil­i­buster “nuclear option.” It’s hard to rule any­thing out at this stage.

    ———-

    “The GOP Health-Care Bil­l’s Byrd Rule Dilem­ma” by Vann R. Newkirk II; The Atlantic; 07/22/2017

    “If this pre­lim­i­nary guid­ance holds, the Bet­ter Care Rec­on­cil­i­a­tion Act—which is already in dire straits—seems like­ly to fail.”

    Yeah, it’s hard to see the GOP pass­ing a any health care bill that includes fund­ing for Planned Par­ent­hood. After all, tak­ing a moral grey zone issue peo­ple feel very pas­sion­ate­ly about but with no clear ‘right/wrong’ divid­ing line like abor­tion and ele­vat­ing it to a black and white issue of divine impor­tance is one of the core ele­ments of how the GOP main­tains some sem­blance of moral pos­tur­ing while imple­ment­ing its heart­less pro-oli­garch agen­da. The GOP needs very high pro­file and adamant oppo­si­tion to abor­tion as polit­i­cal cov­er. Which is part of why it’s going to be very inter­est­ing to see if the ‘Byrd rule’ becomes the ex-Byrd rule:

    ...
    Some Repub­li­cans are hint­ing at more rad­i­cal steps to get past MacDonough’s review. Sen­a­tor Ted Cruz of Texas has been float­ing the idea of sim­ply ignor­ing the parliamentarian’s review for months now. The pre­sid­ing offi­cer of the Senate—Vice Pres­i­dent Mike Pence—technically makes the final call on par­lia­men­tary pro­ce­dures, and could over­rule the parliamentarian’s objec­tions, although this would be a high­ly con­tro­ver­sial break of Sen­ate norms that hasn’t been attempt­ed for over 40 years
    ...

    At the same time, if the only thing stand­ing in the way of Trump­care is some­thing like Planned Par­ent­hood fund­ing, it’s hard to see how key oli­garch deci­sion-mak­ers like the Koch broth­ers are going to let that stand in the way of a bill that would slash their tax­es and gut Med­ic­aid. And that’s part of what what’s going to make the push to pass Trump­care so fas­ci­nat­ing now that the defund­ing of Planned Par­ent­hood was struck down by the Sen­ate Par­lia­men­tar­i­an: the GOP might need to ditch the issue that gives ig moral cov­er in the eyes of its base in order to pass a deeply immoral bill that the par­ty’s real lead­ers, the Koch broth­ers and oth­er wealthy patrons, real­ly, real­ly want to see become law.

    And it’s going to be even more inter­est­ing if the one pro­vi­sion that is crit­i­cal for the gut­ting a Med­ic­aid and destruc­tion of the Med­ical safe­ty-net, the block-grant­i­ng of Med­ic­aid to the states that ensures the pro­gram with­er and dies over time, gets struck down by the Sen­ate’s Par­lia­men­tar­i­an too. And that might still hap­pen:

    ...
    Still under review are the BCRA’s pro­vi­sions that allow states to waive cer­tain essen­tial health ben­e­fits for exchange plans, increase the age-rat­ing scheme for old­er adults, and allow Med­ic­aid fund­ing to go to states in lump sum “block grants.”
    ...

    Yep, the Med­ic­aid block-grant­i­ng is still an open ques­tion. That’s a very big ‘uh oh’.

    So at that point it’s very pos­si­ble the GOP seri­ous­ly isn’t going to pass Trump­care through the Sen­ate. Of course, it’s also seri­ous­ly pos­si­ble that Ted Cruz’s pro­pos­al to just ignore the par­lia­men­tar­i­an will hap­pen too, and if that hap­pens the Sen­ate effec­tive­ly killed the fil­i­buster when it comes to pass­ing spend­ing bills. And that could lead to quite of bit of cut­ting. Into quite a bit of bone.

    Could that hap­pen? Well, the GOP has to pass Trump­care some­how. And if that means break­ing the rules, well, so? This is the GOP we’re talk­ing about. The par­ty has but one rule: fol­low the mon­ey. And as ‘the mon­ey’ informed the GOP last month, if the GOP does­n’t pass Trump­care, soon, ‘the mon­ey’ might not give it more mon­ey:

    Asso­ci­at­ed Press

    Koch net­work ‘pig­gy banks’ closed until Repub­li­cans pass health and tax reform

    Koch offi­cials said that the network’s midterm bud­get for pol­i­cy and pol­i­tics is between $300m and $400m, but donors are demand­ing leg­isla­tive progress

    Asso­ci­at­ed Press in Col­orado Springs
    Mon­day 26 June 2017 07.49 EDT

    At a week­end donor retreat attend­ed by at least 18 elect­ed offi­cials, the Koch broth­ers warned that time is run­ning out to push their agen­da, most notably health­care and tax reform, through Con­gress.

    One Texas-based donor warned Repub­li­can law­mak­ers that his “Dal­las pig­gy bank” was now closed, until he saw leg­isla­tive progress.

    “Get Oba­macare repealed and replaced, get tax reform passed,” said Doug Dea­son. “Get it done and we’ll open it back up.”

    Nonethe­less, Koch offi­cials said that the network’s midterm bud­get for pol­i­cy and pol­i­tics is between $300m and $400m.

    The Sen­ate will this week seek to pass its ver­sion of health­care reform – at present it does not have enough Repub­li­can sup­port to over­come blan­ket Demo­c­ra­t­ic oppo­si­tion.

    “There is urgency,” said Tim Phillips, who leads Koch network’s polit­i­cal arm, Amer­i­cans for Pros­per­i­ty, at the indus­tri­al­ist broth­ers’ retreat in Col­orado Springs. “We believe we have a win­dow of about 12 months to get as much of it accom­plished as pos­si­ble before the 2018 elec­tions grind pol­i­cy to a halt.”

    The win­dow for action may be even small­er, some Koch allies warned at the week­end retreat that drew rough­ly 400 par­tic­i­pants to the heart of the Rocky Moun­tains. The price for admis­sion for most was a pledge to give at least $100,000 this year to the Kochs’ broad pol­i­cy and polit­i­cal net­work.

    ...

    In between meet­ings, Dave Brat, a Vir­ginia Repub­li­can rep­re­sen­ta­tive, pre­dict­ed dire con­se­quences in next year’s midterm elec­tions should his par­ty fail to deliv­er on its repeat­ed promis­es.

    “If we don’t get health­care, none of us are com­ing back,” he said in a brief inter­view. “We said for sev­en years you’re gonna repeal Oba­macare. It’s nowhere near repealed.”

    It’s the same for tax reform, Brat said: “We don’t get tax­es through, we’re all going home. Pack the bags.”

    There was a sense of deep frus­tra­tion from con­ser­v­a­tive offi­cials and donors alike, decry­ing the pace of progress in Wash­ing­ton with Repub­li­cans con­trol­ling both cham­bers of Con­gress and the White House for the first time in a decade.

    Dea­son has already informed a hand­ful of con­gres­sion­al Repub­li­cans that the “Dal­las pig­gy bank” is closed until he sees more action. He said he was recent­ly approached by con­gress­men Mark Mead­ows of North Car­oli­na and Jim Jor­dan of Ohio about host­ing a fundrais­er.

    “I said, ‘No I’m not going to because we’re clos­ing the check­book until you get some things done,’” Dea­son said, not­ing he’s encour­aged near­ly two dozen major Texas donors to fol­low his lead.

    While some donors threat­ened to with­hold cam­paign cash, Koch’s team out­lined a broad­er strat­e­gy to help shape the debate. Already, Amer­i­cans For Pros­per­i­ty claims a paid staff of more than 400 full-time activists in 36 states.

    The group is active­ly lob­by­ing Sen­ate Repub­li­cans to change their cur­rent health­care pro­pos­al, which it views as insuf­fi­cient­ly con­ser­v­a­tive.

    “We are not com­mit­ted to the Sen­ate bill in its cur­rent form, but there is still time to make changes and we’re active­ly work­ing to improve it,” Phillips said.

    At the same time, Koch’s allies are aggres­sive­ly push­ing for­ward on the tax­es. The net­work is run­ning what it describes as “a first wave” of dig­i­tal ads call­ing on more than 50 House and Sen­ate Repub­li­cans in both par­ties to over­haul the nation’s tax code.

    Lat­er in the sum­mer, Philips said, Amer­i­cans for Pros­per­i­ty will begin host­ing ral­lies and oth­er events to gen­er­ate momen­tum for a tax over­haul in all 36 states where they have full-time oper­a­tions.

    Sean Lans­ing, AFP’s chief oper­at­ing offi­cer, warned that the Repub­li­can party’s House major­i­ty could be in jeop­ardy if the Repub­li­can-led Con­gress doesn’t fol­low through.

    “If they don’t make good on these promis­es … there are going to be con­se­quences, and quite frankly there should be,” Lans­ing said.

    Repub­li­cans would have to lose 24 seats to lose the House major­i­ty. In a hand­ful of recent spe­cial elec­tions, the GOP has pre­vailed, despite Don­ald Trump’s low approval rat­ings.

    Anoth­er Koch donor, Chris Wright, of Col­orado, says Repub­li­cans like­ly have a 10-month win­dow before any chance of major pol­i­cy action is suf­fo­cat­ed by next year’s midterms.

    “If we don’t get any­thing done by then, the elec­tions prob­a­bly don’t go very well,” Wright said. “They may not go well any­way.”

    ———-

    “Koch net­work ‘pig­gy banks’ closed until Repub­li­cans pass health and tax reform”; Asso­ci­at­ed Press; 06/27/2017

    “One Texas-based donor warned Repub­li­can law­mak­ers that his “Dal­las pig­gy bank” was now closed, until he saw leg­isla­tive progress.”

    The natives are get­ting rest­less. And they want results soon. And that warn­ing from the Koch net­work was issued last month, before all the more recent Trump­care fail­ures. It’s a key fac­tor to keep in mind now that we learned that the defund­ing of Planned Par­ent­hood is poten­tial­ly tak­en off the table: the Koch net­work of super-wealthy donors wants results. Yes­ter­day.

    At the same time, while no results poten­tial­ly means a GOP wipe­out in 2018 from a demor­al­ized vot­er base and a demor­al­ized donor base, as one Koch donor acknowl­edge, even if they do get results, it’s not like the mid-terms are nec­es­sar­i­ly going to go well:

    ...
    Sean Lans­ing, AFP’s chief oper­at­ing offi­cer, warned that the Repub­li­can party’s House major­i­ty could be in jeop­ardy if the Repub­li­can-led Con­gress doesn’t fol­low through.

    “If they don’t make good on these promis­es … there are going to be con­se­quences, and quite frankly there should be,” Lans­ing said.

    Repub­li­cans would have to lose 24 seats to lose the House major­i­ty. In a hand­ful of recent spe­cial elec­tions, the GOP has pre­vailed, despite Don­ald Trump’s low approval rat­ings.

    Anoth­er Koch donor, Chris Wright, of Col­orado, says Repub­li­cans like­ly have a 10-month win­dow before any chance of major pol­i­cy action is suf­fo­cat­ed by next year’s midterms.

    “If we don’t get any­thing done by then, the elec­tions prob­a­bly don’t go very well,” Wright said. “They may not go well any­way.”

    Yeah, it’s kind of hard to see how the GOP does­n’t well in 2018 if it does­n’t pass an Oba­macare replace­ment since that’s what it’s been promis­ing the GOP base for years. But it’s also hard to see how they do well in 2018 if they do pass it since it’s such an incred­i­bly unpop­u­lar pro­posed law.

    Still, the Koch’s want to see Trump­care become a real­i­ty and they aren’t going to accept defeat casu­al­ly. If Trump­care is defeat­ed this year, that’s not going to be the end. If it takes anoth­er year, or two years, or 10 or 20, this effort is going to con­tin­ue. How do we know? Because the Kochs and their far-right oli­garch allies have been try­ing to dis­man­tle any and all gov­ern­ment safe­ty-net pro­grams for decades. They think things like Med­ic­aid griev­ous­ly harm their ‘free­dom’. Along with any­thing else that impinges on the wealth or prop­er­ty of bil­lion­aires like them­selves. Any­thing. For real. They actu­al­ly think this and have been decades qui­et­ly putting that moral per­spec­tive into law:

    The Guardian

    A despot in dis­guise: one man’s mis­sion to rip up democ­ra­cy

    James McGill Buchanan’s vision of total­i­tar­i­an cap­i­tal­ism has infect­ed pub­lic pol­i­cy in the US. Now it’s being export­ed

    George Mon­biot

    Wednes­day 19 July 2017 00.29 EDT
    Last mod­i­fied on Wednes­day 19 July 2017 08.35 EDT

    It’s the miss­ing chap­ter: a key to under­stand­ing the pol­i­tics of the past half cen­tu­ry. To read Nan­cy MacLean’s new book, Democ­ra­cy in Chains: The Deep His­to­ry of the Rad­i­cal Right’s Stealth Plan for Amer­i­ca, is to see what was pre­vi­ous­ly invis­i­ble.

    The his­to­ry professor’s work on the sub­ject began by acci­dent. In 2013 she stum­bled across a desert­ed clap­board house on the cam­pus of George Mason Uni­ver­si­ty in Vir­ginia. It was stuffed with the unsort­ed archives of a man who had died that year whose name is prob­a­bly unfa­mil­iar to you: James McGill Buchanan. She says the first thing she picked up was a stack of con­fi­den­tial let­ters con­cern­ing mil­lions of dol­lars trans­ferred to the uni­ver­si­ty by the bil­lion­aire Charles Koch.

    Her dis­cov­er­ies in that house of hor­rors reveal how Buchanan, in col­lab­o­ra­tion with busi­ness tycoons and the insti­tutes they found­ed, devel­oped a hid­den pro­gramme for sup­press­ing democ­ra­cy on behalf of the very rich. The pro­gramme is now reshap­ing pol­i­tics, and not just in the US.

    Buchanan was strong­ly influ­enced by both the neolib­er­al­ism of Friedrich Hayek and Lud­wig von Mis­es, and the prop­er­ty suprema­cism of John C Cal­houn, who argued in the first half of the 19th cen­tu­ry that free­dom con­sists of the absolute right to use your prop­er­ty (includ­ing your slaves) how­ev­er you may wish; any insti­tu­tion that impinges on this right is an agent of oppres­sion, exploit­ing men of prop­er­ty on behalf of the unde­serv­ing mass­es.

    James Buchanan brought these influ­ences togeth­er to cre­ate what he called pub­lic choice the­o­ry. He argued that a soci­ety could not be con­sid­ered free unless every cit­i­zen has the right to veto its deci­sions. What he meant by this was that no one should be taxed against their will. But the rich were being exploit­ed by peo­ple who use their votes to demand mon­ey that oth­ers have earned, through invol­un­tary tax­es to sup­port pub­lic spend­ing and wel­fare. Allow­ing work­ers to form trade unions and impos­ing grad­u­at­ed income tax­es were forms of “dif­fer­en­tial or dis­crim­i­na­to­ry leg­is­la­tion” against the own­ers of cap­i­tal.

    Any clash between “free­dom” (allow­ing the rich to do as they wish) and democ­ra­cy should be resolved in favour of free­dom. In his book The Lim­its of Lib­er­ty, he not­ed that “despo­tism may be the only organ­i­sa­tion­al alter­na­tive to the polit­i­cal struc­ture that we observe.” Despo­tism in defence of free­dom.

    His pre­scrip­tion was a “con­sti­tu­tion­al rev­o­lu­tion”: cre­at­ing irrev­o­ca­ble restraints to lim­it demo­c­ra­t­ic choice. Spon­sored through­out his work­ing life by wealthy foun­da­tions, bil­lion­aires and cor­po­ra­tions, he devel­oped a the­o­ret­i­cal account of what this con­sti­tu­tion­al rev­o­lu­tion would look like, and a strat­e­gy for imple­ment­ing it.

    He explained how attempts to deseg­re­gate school­ing in the Amer­i­can south could be frus­trat­ed by set­ting up a net­work of state-spon­sored pri­vate schools. It was he who first pro­posed pri­vatis­ing uni­ver­si­ties, and impos­ing full tuition fees on stu­dents: his orig­i­nal pur­pose was to crush stu­dent activism. He urged pri­vati­sa­tion of social secu­ri­ty and many oth­er func­tions of the state. He sought to break the links between peo­ple and gov­ern­ment, and demol­ish trust in pub­lic insti­tu­tions. He aimed, in short, to save cap­i­tal­ism from democ­ra­cy.

    In 1980, he was able to put the pro­gramme into action. He was invit­ed to Chile, where he helped the Pinochet dic­ta­tor­ship write a new con­sti­tu­tion, which, part­ly through the clever devices Buchanan pro­posed, has proved impos­si­ble to reverse entire­ly. Amid the tor­ture and killings, he advised the gov­ern­ment to extend pro­grammes of pri­vati­sa­tion, aus­ter­i­ty, mon­e­tary restraint, dereg­u­la­tion and the destruc­tion of trade unions: a pack­age that helped trig­ger eco­nom­ic col­lapse in 1982.

    None of this trou­bled the Swedish Acad­e­my, which through his devo­tee at Stock­holm Uni­ver­si­ty Assar Lind­beck in 1986 award­ed James Buchanan the Nobel memo­r­i­al prize for eco­nom­ics. It is one of sev­er­al deci­sions that have turned this prize tox­ic.

    But his pow­er real­ly began to be felt when Koch, cur­rent­ly the sev­enth rich­est man in the US, decid­ed that Buchanan held the key to the trans­for­ma­tion he sought. Koch saw even such ide­o­logues as Mil­ton Fried­man and Alan Greenspan as “sell­outs”, as they sought to improve the effi­cien­cy of gov­ern­ment rather than destroy it alto­geth­er. But Buchanan took it all the way.

    MacLean says that Charles Koch poured mil­lions into Buchanan’s work at George Mason Uni­ver­si­ty, whose law and eco­nom­ics depart­ments look as much like cor­po­rate-fund­ed think­tanks as they do aca­d­e­m­ic fac­ul­ties. He employed the econ­o­mist to select the rev­o­lu­tion­ary “cadre” that would imple­ment his pro­gramme (Mur­ray Roth­bard, at the Cato Insti­tute that Koch found­ed, had urged the bil­lion­aire to study Lenin’s tech­niques and apply them to the lib­er­tar­i­an cause). Between them, they began to devel­op a pro­gramme for chang­ing the rules.

    The papers Nan­cy MacLean dis­cov­ered show that Buchanan saw stealth as cru­cial. He told his col­lab­o­ra­tors that “con­spir­a­to­r­i­al secre­cy is at all times essen­tial”. Instead of reveal­ing their ulti­mate des­ti­na­tion, they would pro­ceed by incre­men­tal steps. For exam­ple, in seek­ing to destroy the social secu­ri­ty sys­tem, they would claim to be sav­ing it, argu­ing that it would fail with­out a series of rad­i­cal “reforms”. (The same argu­ment is used by those attack­ing the NHS). Grad­u­al­ly they would build a “counter-intel­li­gentsia”, allied to a “vast net­work of polit­i­cal pow­er” that would become the new estab­lish­ment.

    Through the net­work of think­tanks that Koch and oth­er bil­lion­aires have spon­sored, through their trans­for­ma­tion of the Repub­li­can par­ty, and the hun­dreds of mil­lions they have poured into state con­gres­sion­al and judi­cial races, through the mass coloni­sa­tion of Trump’s admin­is­tra­tion by mem­bers of this net­work and lethal­ly effec­tive cam­paigns against every­thing from pub­lic health to action on cli­mate change, it would be fair to say that Buchanan’s vision is matur­ing in the US.

    ...

    In one respect, Buchanan was right: there is an inher­ent con­flict between what he called “eco­nom­ic free­dom” and polit­i­cal lib­er­ty. Com­plete free­dom for bil­lion­aires means pover­ty, inse­cu­ri­ty, pol­lu­tion and col­laps­ing pub­lic ser­vices for every­one else. Because we will not vote for this, it can be deliv­ered only through decep­tion and author­i­tar­i­an con­trol. The choice we face is between unfet­tered cap­i­tal­ism and democ­ra­cy. You can­not have both.

    ...

    ———

    “A despot in dis­guise: one man’s mis­sion to rip up democ­ra­cy” by George Mon­biot; The Guardian; 07/19/2017

    “The his­to­ry professor’s work on the sub­ject began by acci­dent. In 2013 she stum­bled across a desert­ed clap­board house on the cam­pus of George Mason Uni­ver­si­ty in Vir­ginia. It was stuffed with the unsort­ed archives of a man who had died that year whose name is prob­a­bly unfa­mil­iar to you: James McGill Buchanan. She says the first thing she picked up was a stack of con­fi­den­tial let­ters con­cern­ing mil­lions of dol­lars trans­ferred to the uni­ver­si­ty by the bil­lion­aire Charles Koch.

    And what else did Nan­cy MacLean dis­cov­er while uncov­er­ing the work and influ­ence of James McGill Buchanan and his Koch-backed financ­ing? A house of hor­rors that are in store for Amer­i­cans and the world if these schemes come to full fruition:

    ...
    Her dis­cov­er­ies in that house of hor­rors reveal how Buchanan, in col­lab­o­ra­tion with busi­ness tycoons and the insti­tutes they found­ed, devel­oped a hid­den pro­gramme for sup­press­ing democ­ra­cy on behalf of the very rich. The pro­gramme is now reshap­ing pol­i­tics, and not just in the US.

    Buchanan was strong­ly influ­enced by both the neolib­er­al­ism of Friedrich Hayek and Lud­wig von Mis­es, and the prop­er­ty suprema­cism of John C Cal­houn, who argued in the first half of the 19th cen­tu­ry that free­dom con­sists of the absolute right to use your prop­er­ty (includ­ing your slaves) how­ev­er you may wish; any insti­tu­tion that impinges on this right is an agent of oppres­sion, exploit­ing men of prop­er­ty on behalf of the unde­serv­ing mass­es.

    James Buchanan brought these influ­ences togeth­er to cre­ate what he called pub­lic choice the­o­ry. He argued that a soci­ety could not be con­sid­ered free unless every cit­i­zen has the right to veto its deci­sions. What he meant by this was that no one should be taxed against their will. But the rich were being exploit­ed by peo­ple who use their votes to demand mon­ey that oth­ers have earned, through invol­un­tary tax­es to sup­port pub­lic spend­ing and wel­fare. Allow­ing work­ers to form trade unions and impos­ing grad­u­at­ed income tax­es were forms of “dif­fer­en­tial or dis­crim­i­na­to­ry leg­is­la­tion” against the own­ers of cap­i­tal.

    Any clash between “free­dom” (allow­ing the rich to do as they wish) and democ­ra­cy should be resolved in favour of free­dom. In his book The Lim­its of Lib­er­ty, he not­ed that “despo­tism may be the only organ­i­sa­tion­al alter­na­tive to the polit­i­cal struc­ture that we observe.” Despo­tism in defence of free­dom.

    His pre­scrip­tion was a “con­sti­tu­tion­al rev­o­lu­tion”: cre­at­ing irrev­o­ca­ble restraints to lim­it demo­c­ra­t­ic choice. Spon­sored through­out his work­ing life by wealthy foun­da­tions, bil­lion­aires and cor­po­ra­tions, he devel­oped a the­o­ret­i­cal account of what this con­sti­tu­tion­al rev­o­lu­tion would look like, and a strat­e­gy for imple­ment­ing it.
    ...

    That’s def­i­nite­ly hor­ri­fy­ing. And it’s been hor­ri­fy­ing for decades as that vision suc­cess­ful­ly took over the Repub­li­can Par­ty and the Repub­li­can Par­ty large­ly took over gov­ern­ment. And now, final­ly, the pre­vi­ous­ly untouach­able enti­tle­ments are final­ly not just touch­able but dis­man­t­lable. And it’s all being sold as “Sav­ing [Medicaid/Medicare/Social Secu­ri­ty]”

    ...
    He explained how attempts to deseg­re­gate school­ing in the Amer­i­can south could be frus­trat­ed by set­ting up a net­work of state-spon­sored pri­vate schools. It was he who first pro­posed pri­vatis­ing uni­ver­si­ties, and impos­ing full tuition fees on stu­dents: his orig­i­nal pur­pose was to crush stu­dent activism. He urged pri­vati­sa­tion of social secu­ri­ty and many oth­er func­tions of the state. He sought to break the links between peo­ple and gov­ern­ment, and demol­ish trust in pub­lic insti­tu­tions. He aimed, in short, to save cap­i­tal­ism from democ­ra­cy.

    ...

    MacLean says that Charles Koch poured mil­lions into Buchanan’s work at George Mason Uni­ver­si­ty, whose law and eco­nom­ics depart­ments look as much like cor­po­rate-fund­ed think­tanks as they do aca­d­e­m­ic fac­ul­ties. He employed the econ­o­mist to select the rev­o­lu­tion­ary “cadre” that would imple­ment his pro­gramme (Mur­ray Roth­bard, at the Cato Insti­tute that Koch found­ed, had urged the bil­lion­aire to study Lenin’s tech­niques and apply them to the lib­er­tar­i­an cause). Between them, they began to devel­op a pro­gramme for chang­ing the rules.

    The papers Nan­cy MacLean dis­cov­ered show that Buchanan saw stealth as cru­cial. He told his col­lab­o­ra­tors that “con­spir­a­to­r­i­al secre­cy is at all times essen­tial”. Instead of reveal­ing their ulti­mate des­ti­na­tion, they would pro­ceed by incre­men­tal steps. For exam­ple, in seek­ing to destroy the social secu­ri­ty sys­tem, they would claim to be sav­ing it, argu­ing that it would fail with­out a series of rad­i­cal “reforms”. (The same argu­ment is used by those attack­ing the NHS). Grad­u­al­ly they would build a “counter-intel­li­gentsia”, allied to a “vast net­work of polit­i­cal pow­er” that would become the new estab­lish­ment.

    Through the net­work of think­tanks that Koch and oth­er bil­lion­aires have spon­sored, through their trans­for­ma­tion of the Repub­li­can par­ty, and the hun­dreds of mil­lions they have poured into state con­gres­sion­al and judi­cial races, through the mass coloni­sa­tion of Trump’s admin­is­tra­tion by mem­bers of this net­work and lethal­ly effec­tive cam­paigns against every­thing from pub­lic health to action on cli­mate change, it would be fair to say that Buchanan’s vision is matur­ing in the US.
    ...

    Yep, the fight to save Med­ic­aid isn’t just a major ele­ment of the fight to pre­vent and expand on Oba­macare and hope­ful­ly get sin­gle-pay­er sys­tem some­day like a com­pas­sion­ate soci­ety. It’s one of a hand­ful of cli­mac­tic bat­tles left in a stealth-war — a war on the New Deal and Great Soci­ety and the very idea that gov­ern­ment should be help­ful — that the Kochs and their allies have been wag­ing and win­ning for decades.

    It’s all a reminder that while Trump is con­stant­ly try­ing to cast Democ­rats and “the media” as vil­lains, if any­one should be his ene­my is the group of bil­lion­aires try­ing to make Trump the vil­lain of the peo­ple by get­ting him to be guy the ful­fills their decades-long plan to undo all those things Trump pledged to pro­tect. Paul Ryan might be an open Koch-head but Trump did­n’t cam­paign on that and it’s not in his best inter­est in the short or long run to be imple­ment­ing a Koch-head agen­da. And yet there is noth­ing Trump can do because the Koch net­work exerts a far big­ger influ­ence on the actions and votes of his fel­low GOP­ers than Trump. Trump has to be chief Koch-head because he has no oth­er option. Koch-head leg­is­la­tion is all he’s going to get. Trump isn’t the leader of the GOP. Charles and David Koch are and they do not want to screw up this his­toric oppor­tu­ni­ty to put that James McGill Buchanan vision into real­i­ty. Trump basi­cal­ly has to sign what­ev­er bills they direct Paul Ryan, Mitch McConnell, and the rest of the GOP to hand to Trump, mak­ing him face of the fruition of their decades-long plans, and there’s noth­ing Trump can do about it.

    Notice how, as Trump­care advances through one revi­sion after anoth­er to pla­cate the var­i­ous GOP hold outs — some who want it less con­ser­v­a­tive and some who want it more and have Koch net­work back­ing — the new­ly revised ver­sion is the Koch-backed ver­sion. That’s how this is hap­pen­ing and Trump does­n’t real­ly have a mean­ing­ful voice on the mat­ter. The Kochs, real Big League super-vil­lains, are mak­ing Trump, a mid-lev­el super-vil­lain who some­how end­ed up in the White House, their fall guy. Sure, he might be a will­ing, and even enthu­si­as­tic, fall guy. But that’s clear­ly what he is at this point since leg­is­la­tion is clear­ly being writ­ten by the Kochs. Leg­is­la­tion that’s so hor­ri­ble even the GOP can’t ful­ly back it. And if they some­how can’t pass it this year Trump is still the fall guy for that fail­ure. And they try again to gut health care lat­er. That’s how this is going to work because they are seri­ous about bring­ing James McGill Buchanan’s House of Hor­rors into every Amer­i­can home. And they might effec­tive­ly break the fil­i­buster for spend­ing bills by ignor­ing the Sen­ate Par­lia­men­tar­i­an and turn­ing the ‘Byrd Rule’ into a loop­hole that allows for any spend­ing bill that gets a 51 major­i­ty vote to pass with­out the threat of a fil­i­buster. And if that hap­pens, the gut­ting of the gov­ern­ment is going to get going in earnest. And don’t for­get the les­son from Chile: one of the tac­tics is to enshrine these pro-slav­ery prop­er­ty-rights extrem­ist views into the con­sti­tu­tion, which makes some things almost impos­si­ble to reverse:

    In 1980, he was able to put the pro­gramme into action. He was invit­ed to Chile, where he helped the Pinochet dic­ta­tor­ship write a new con­sti­tu­tion, which, part­ly through the clever devices Buchanan pro­posed, has proved impos­si­ble to reverse entire­ly. Amid the tor­ture and killings, he advised the gov­ern­ment to extend pro­grammes of pri­vati­sa­tion, aus­ter­i­ty, mon­e­tary restraint, dereg­u­la­tion and the destruc­tion of trade unions: a pack­age that helped trig­ger eco­nom­ic col­lapse in 1982.
    ...

    And what are the Koch’s work­ing on? Re-writ­ing the con­sti­tu­tion in one mas­sive move by trig­ger­ing an con­sti­tu­tion­al con­ven­tion. That is what they are work­ing on to ful­fill the Buchanan vision and shred gov­ern­ment. 34 states have to call for it. Wyoming became the 29th state in Feb­ru­ary of this year. And if they suc­ceed they’ll prob­a­bly be able to con­sti­tu­tion­al­ly enshrine all sorts of pro-bil­lion­aire prop­er­ty-rights stuff into the con­sti­tu­tion, sold to the pub­lic as a “fix” for things, and there’s either going to be a new con­sti­tu­tion­al con­ven­tion to undo it all or it’s going to be very hard to have a func­tion­al gov­ern­ment. One of many things they are work­ing on to ful­fill Buchanan’s vision. A direct­ing the GOP to do their bid­ding makes Trump their top fall guy. Even big­ger than Paul Ryan which is amaz­ing. And that vision one one that most­ly hands almost all the wealth and pow­er to peo­ple like the Kochs and the free­dom to be enslaved by them to the rest of us. Trump is the face of that now, which is why he’s the fall guy now. It’s a House of Hor­rors.

    So, yeah, Trump should prob­a­bly con­sid­er the Kochs as worth­while vil­lains to fix­ate on. They’re aren’t resist­ing him. They’re direct­ing him to fall for them. And fall Bigly. And when he does, the Koch/Buchanan agen­da will pick him up and tell him to try hard­er for them next time. Trump def­i­nite­ly has some vil­lains plagu­ing him and the Democ­rats and the media aren’t the vil­lains Trump needs to fear.

    Posted by Pterrafractyl | July 22, 2017, 9:18 pm
  7. Fol­low­ing the cliff-hang­er failed attempt by the Sen­ate GOP to pass a “Skin­ny repeal” bill, a vote to pass a polit­i­cal­ly more palat­able ver­sion of an Oba­macare repeal bill that does­n’t include all the stuff that vot­ers hate in the House ver­sion of Trump­care so they can vot­er for the House ver­sion when the House and Sen­ate get togeth­er and cre­ate a joint con­fer­ence bill, two pri­ma­ry ques­tions loom over the GOP:

    1. Will there be a strate­gic pause in the GOP’s end­less quest to repeal Oba­macare and gut enti­tle­ments or is there going to be anoth­er push to make Trump­care hap­pen before the Sen­ate moves on to oth­er mat­ters?

    and...

    2. What will be the form and impact of Trump’s inevitable tantrum?

    And while it’s unclear what the answer to the first loom­ing ques­tion will be: As Trump tweet­ed Sat­ur­day, “Unless the Repub­li­can Sen­a­tors are total quit­ters, Repeal & Replace is not dead!” And accord­ing White House Bud­get Direc­tor Mick Mul­vaney, Trump’s rage tweet­ing was­n’t just talk. Trump seri­ous­ly wants the Sen­ate to stay focused on Trump­care:

    Talk­ing Points Memo
    Livewire

    Mul­vaney: Trump Wants Sen­ate To Vote On O’Care Repeal Before Any­thing Else

    By Esme Cribb
    Pub­lished July 30, 2017 2:23 pm

    White House bud­get chief Mick Mul­vaney on Sun­day said Pres­i­dent Don­ald Trump wants the Sen­ate to hold anoth­er vote to repeal Oba­macare before mov­ing on to any oth­er leg­isla­tive busi­ness.

    “Is this offi­cial White House pol­i­cy, that noth­ing should be vot­ed on in Con­gress, not even the debt ceil­ing, before the Sen­ate votes again on health care?” Jake Tap­per asked Mul­vaney on CNN’s “State of the Union.”

    “Well, I think — yes. And I think what you’re see­ing there is the Pres­i­dent sim­ply reflect­ing the mood of the peo­ple,” Mul­vaney said.

    ...

    “So in the White House’s view, they can’t move on in the Sen­ate,” Mul­vaney said. “They need to stay, they need to work, they need to pass some­thing and I think that’s not only the offi­cial White House posi­tion on this right now, it’s sort of the nation­al atti­tude towards it.”

    “Well, polls indi­cate that the Amer­i­can peo­ple — a plu­ral­i­ty of them — sup­port Oba­macare,” Tap­per replied.

    Trump on Sat­ur­day urged Repub­li­can sen­a­tors to “demand anoth­er vote before vot­ing on any oth­er bill.”

    “Unless the Repub­li­can Sen­a­tors are total quit­ters, Repeal & Replace is not dead!” he tweet­ed, a day after Sen­ate Repub­li­cans’ lat­est effort to repeal Oba­macare failed in a dra­mat­ic ear­ly-morn­ing vote.

    ———-

    “Mul­vaney: Trump Wants Sen­ate To Vote On O’Care Repeal Before Any­thing Else” by Esme Cribb; Talk­ing Points Memo; 07/30/2017

    “So in the White House’s view, they can’t move on in the Sen­ate,” Mul­vaney said. “They need to stay, they need to work, they need to pass some­thing and I think that’s not only the offi­cial White House posi­tion on this right now, it’s sort of the nation­al atti­tude towards it.””

    It sham­bles on. Assum­ing the Sen­ate GOP fol­lows Trump’s lead/taunts. And you can bet the Koch net­work and oth­er mega-donors would­n’t mind see­ing the Sen­ate take anoth­er stab at it.

    But Trump’s trash tralk isn’t the only tool he’s employ­ing to per­suade the Sen­ate. There’s also the threats. Threat’s that kind of make sense from a polit­i­cal stand­point, like the threat Trump is mak­ing to strip away health care cov­er­age for Con­gress. Also the threats that make no polit­i­cal sense at all, like the threat Trump is mak­ing to end the sub­si­dies for insur­ance com­pa­nies (“bailouts” as he calls it) that enable the sub­si­dies for low­er-income Oba­macare recip­i­ents and pre­vent a fur­ther desta­bi­liza­tion of the insur­ance mar­ket. Yes, he’s actu­al­ly threat­en­ing to simul­ta­ne­ous­ly desta­bi­lize mar­kets and cut sub­si­dies for the poor as a means of forc­ing Con­gress to get some­thing passed on health care. And no, he does­n’t appear to real­ize that issu­ing such threats looks hor­ri­ble:

    Talk­ing Points Memo
    DC

    Trump Threat­ens To End Health Care Sub­si­dies For Poor Amer­i­cans, Con­gress

    By Alle­gra Kirk­land
    Pub­lished July 29, 2017 3:36 pm

    Still blis­ter­ing over the lat­est defeat of Oba­macare repeal, Trump on Sat­ur­day threat­ened to do away with health care sub­si­dies that affect both the poor­est Amer­i­cans and Con­gress.

    “If a new Health­Care Bill is not approved quick­ly,” Trump tweet­ed. “BAILOUTS for Insur­ance Com­pa­nies and BAILOUTS for Mem­bers of Con­gress will end very soon!”

    If a new Health­Care Bill is not approved quick­ly, BAILOUTS for Insur­ance Com­pa­nies and BAILOUTS for Mem­bers of Con­gress will end very soon!— Don­ald J. Trump (@realDonaldTrump) July 29, 2017

    The first part of his tweet is a ref­er­ence to cost shar­ing reduc­tion pay­ments, sub­si­dies that allow insur­ers to off­set health-care costs for low-income Amer­i­cans. Trump has threat­ened to with­hold those sub­si­dies before—a move that insur­ers and health care providers warn would desta­bi­lize the indi­vid­ual health insur­ance mar­ket and cause pre­mi­ums to soar.

    The sec­ond half of the mis­sive indi­cates that Trump is going to con­tin­ue to tar­get his own GOP-con­trolled Con­gress for their inabil­i­ty to undo for­mer Pres­i­dent Obama’s sig­na­ture achieve­ment. Trump’s com­ment sug­gests he’d con­sid­er end­ing the employ­er con­tri­bu­tion for health insur­ance cur­rent­ly pro­vid­ed to law­mak­ers.

    ...

    Ear­li­er Sat­ur­day, he accused Sen­ate Repub­li­cans of “look­ing like fools” and urged them to abol­ish pro­ce­dur­al rules like the fil­i­buster imme­di­ate­ly in order to make progress on health­care.

    ———-

    “Trump Threat­ens To End Health Care Sub­si­dies For Poor Amer­i­cans, Con­gress” by Alle­gra Kirk­land; Talk­ing Points Memo; 07/29/2017

    ““If a new Health­Care Bill is not approved quick­ly,” Trump tweet­ed. “BAILOUTS for Insur­ance Com­pa­nies and BAILOUTS for Mem­bers of Con­gress will end very soon!””

    Burn­ing the insur­ance mar­kets down to ‘save’ them — when ‘sav­ing’ health care is real­ly ush­er­ing in an era of Paul Ryan/Koch Broth­ers-style health care night­mare land­scape — is a strat­e­gy the pres­i­dent open­ly employs. It’s like a new Biz­zaro Pyrrhic vic­to­ry that only makes sense in Trum­p­land:

    ...
    The first part of his tweet is a ref­er­ence to cost shar­ing reduc­tion pay­ments, sub­si­dies that allow insur­ers to off­set health-care costs for low-income Amer­i­cans. Trump has threat­ened to with­hold those sub­si­dies before—a move that insur­ers and health care providers warn would desta­bi­lize the indi­vid­ual health insur­ance mar­ket and cause pre­mi­ums to soar.

    The sec­ond half of the mis­sive indi­cates that Trump is going to con­tin­ue to tar­get his own GOP-con­trolled Con­gress for their inabil­i­ty to undo for­mer Pres­i­dent Obama’s sig­na­ture achieve­ment. Trump’s com­ment sug­gests he’d con­sid­er end­ing the employ­er con­tri­bu­tion for health insur­ance cur­rent­ly pro­vid­ed to law­mak­ers.
    ...

    Yep, cost shar­ing reduc­tion pay­ments that sub­si­dize pri­vate insur­ance for low-income peo­ple are now being held polit­i­cal hostage to force through Trump­care. That’s hap­pen­ing.

    And as White House Bud­get Direc­tor Mick Mul­vaney con­firmed, that was­n’t just a tem­po­rary Trumpian twit­ter tantrum. It was cold, cal­cu­late (yet con­fused) Trumpian tough-guy tweet Twit­ter talk:

    Talk­ing Points Memo
    Livewire

    Mul­vaney: Trump Thinks O’Care Should ‘Hurt’ Insur­ance Providers, Law­mak­ers

    By Esme Cribb
    Pub­lished July 30, 2017 12:31 pm

    White House bud­get chief Mick Mul­vaney on Sun­day said Pres­i­dent Don­ald Trump threat­ened to cut Oba­macare pro­vi­sions because he thinks the law should “hurt insur­ance com­pa­nies” and law­mak­ers if they can’t cor­ral enough votes to repeal it.

    Asked on CNN’s “State of the Union” about Trump’s threat on Sat­ur­day to end sub­si­dies that affect low-income indi­vid­u­als, Mul­vaney said he “talked to the Pres­i­dent at length about that exact issue yes­ter­day.”

    “I think his atti­tude is this, and his atti­tude is pret­ty sim­ple,” Mul­vaney said. “What he’s say­ing is, look, if Oba­macare is hurt­ing peo­ple — and it is — then why shouldn’t it hurt insur­ance com­pa­nies and more impor­tant­ly per­haps for this dis­cus­sion, mem­bers of Con­gress?”

    ...

    “I think the President’s sim­ply look­ing at this and going, is this fair?” Mul­vaney said. “We’ll see what hap­pens as we move for­ward.”

    ———-

    “Mul­vaney: Trump Thinks O’Care Should ‘Hurt’ Insur­ance Providers, Law­mak­ers” by Esme Cribb; Talk­ing Points Memo; 07/30/2017

    ““I think his atti­tude is this, and his atti­tude is pret­ty sim­ple,” Mul­vaney said. “What he’s say­ing is, look, if Oba­macare is hurt­ing peo­ple — and it is — then why shouldn’t it hurt insur­ance com­pa­nies and more impor­tant­ly per­haps for this dis­cus­sion, mem­bers of Con­gress?”

    Oba­macare is hurt­ing peo­ple so why not get rid of the insur­ance com­pa­ny sub­si­dies for keep­ing costs down for low­er-income peo­ple. That’s the Trump’s ratio­nale as explained by Mick Mul­vaeney. And it was­n’t just Mul­vaney. Kellyanne Con­way and HHS Sec­re­tary Tom Price also made clear that Trump isn’t sure yet if he’s going to sab­o­tage the insur­ance sub­si­dies for low-income peo­ple:

    Bloomberg Pol­i­tics

    Health Chief Says No Deci­sion on Con­tin­u­ing Oba­macare Sub­si­dies

    * Trump tweet­ed that he plans to end insur­ance ‘bailouts’ soon
    * Pre­mi­um sub­si­dies for law­mak­ers, staff may also be at risk

    By Sale­ha Mohsin
    July 29, 2017, 1:06 PM CDT July 30, 2017, 9:40 AM CDT

    Health and Human Ser­vices Sec­re­tary Tom Price said Sun­day that “no decision’s been made” on whether to con­tin­ue key Afford­able Care Act sub­si­dies to health-insur­ance com­pa­nies, but that the administration’s job is “to fol­low the law of the land.” A top White House aide said Pres­i­dent Don­ald Trump will decide soon.

    Smart­ing from the fail­ure of Sen­ate Repub­li­cans to pass an Oba­macare repeal and replace bill, Trump on Sat­ur­day threat­ened in a tweet to end the sub­sidy pay­ments, which help make insur­ance acces­si­ble to poor­er Amer­i­cans, a move that could crit­i­cal­ly desta­bi­lize health exchanges if it went ahead.

    The admin­is­tra­tion has pre­vi­ous­ly float­ed the idea to stop pay­ing the sub­si­dies that help insur­ers off­set health-care costs for low-income Amer­i­cans, called a cost-shar­ing reduc­tion, or CSR. The next pay­ment is due on Aug. 21.

    “If a new Health­Care Bill is not approved quick­ly, BAILOUTS for Insur­ance Com­pa­nies and BAILOUTS for Mem­bers of Con­gress will end very soon!” the pres­i­dent said in Saturday’s tweet. It fol­lowed a Twit­ter mes­sage on Fri­day in which he vowed to “let Oba­maCare implode.”

    Law of the Land

    Asked on ABC’s “This Week” how soon the Trump admin­is­tra­tion could stop the cost-shar­ing pay­ments, Price said no deci­sion has been made and he can’t com­ment fur­ther because of a pend­ing court case. He also declined to clar­i­fy what Trump meant by “implode,” say­ing the president’s com­ment “punc­tu­ates the con­cern” he has about chang­ing he direc­tion of the health-care sys­tem and get­ting Con­gress to act.

    Price said in a sep­a­rate inter­view on NBC’s “Meet the Press” that the administration’s “job is to fol­low the law of the land” and that “we take that respon­si­bil­i­ty very seri­ous­ly and we will con­tin­ue to do so.”

    White House coun­selor Kellyanne Con­way said on “Fox News Sun­day” that Trump will soon decide the fate of the sub­sidy pay­ments. “He’s going to make that deci­sion this week, and that’s a deci­sion that only he can make,” Con­way said.

    Trump’s tweet on Sat­ur­day also implied that he may tar­get sub­si­dies made avail­able to mem­bers of Con­gress and their staff, who as part of the Afford­able Care Act are enrolled in plans on the Wash­ing­ton, D.C., health insur­ance exchange. Sub­si­dies are sim­i­lar to those made by employ­ers to pay for their work­ers’ health insur­ance pre­mi­ums.

    Weeks of Brinkman­ship

    Mick Mul­vaney, direc­tor of the Office of Man­age­ment and Bud­get, said on CNN’s “State of the Union” on Sun­day that the pres­i­dent is weigh­ing such a move, which was urged this month by a coali­tion of right-wing groups. “It’s not a con­cept of tak­ing cov­er­age away,” he said. “It’s the approach of actu­al­ly oblig­ing mem­bers of Con­gress to fol­low the exact law that the folks that they gov­ern are fol­low­ing.”

    Sen­a­tor Susan Collins of Maine, one of the three Repub­li­cans to sink the Sen­ate bill last week, was asked on CNN’s “State of the Union” on Sun­day if a threat from the pres­i­dent to cut off fund­ing for health care plans for mem­bers of Con­gress would change her vote. “No,” she said.

    The months-long effort by Sen­ate Repub­li­cans to pass health-care leg­is­la­tion col­lapsed ear­ly Fri­day after Repub­li­can John McCain of Ari­zona joined Collins and Lisa Murkows­ki of Alas­ka to block a stripped-down Oba­macare repeal bill. McCain’s “no” vote came after weeks of brinkman­ship and after his dra­mat­ic return from can­cer treat­ment to cast the 50th vote to start debate on the bill ear­li­er in the week. The “skin­ny” repeal bill was defeat­ed 49–51, falling just short of the 50 votes need­ed to advance it.

    Sen­ate Major­i­ty Leader Mitch McConnell has said he’ll move on to oth­er leg­isla­tive busi­ness. But in a lat­er tweet on Sat­ur­day, Trump sug­gest­ed he isn’t giv­ing up. “Unless the Repub­li­can Sen­a­tors are total quit­ters, Repeal & Replace is not dead! Demand anoth­er vote before vot­ing on any oth­er bill!”

    ‘Look Like Fools’

    The pres­i­dent said ear­li­er that Sen­ate Repub­li­cans “look like fools” after the repeal bill went down, and made a renewed call for the Sen­ate to abol­ish a rule requir­ing 60 votes for some bills — although the health-care mea­sure need­ed only a 51-vote major­i­ty to pass, and fell short.

    Trump reit­er­at­ed that posi­tion in a Twit­ter post­ing on Sun­day, say­ing, “Don’t give up Repub­li­can Sen­a­tors, the World is watch­ing: Repeal & Replace...and go to 51 votes.”

    “The pres­i­dent will not accept those who said, quote, ‘it’s time to move on,”’ Con­way said.

    Repub­li­can Sen­a­tors Lind­sey Gra­ham of South Car­oli­na, Bill Cas­sidy of Louisiana and Dean Heller of Neva­da met with Trump Fri­day on a fresh pro­pos­al. Gra­ham said in a state­ment that Trump had been “opti­mistic” about the trio’s plan. “I had a great meet­ing with the pres­i­dent and know he remains ful­ly com­mit­ted to repeal­ing and replac­ing Oba­macare,” Gra­ham said.

    For more on the efforts to repeal the ACA, click here.

    End­ing the CSR sub­si­dies, paid month­ly to insur­ers, is one way that Trump could has­ten Obamacare’s demise with­out leg­is­la­tion, by prompt­ing more com­pa­nies to raise pre­mi­ums in the indi­vid­ual mar­ket or even to stop offer­ing cov­er­age. The admin­is­tra­tion last made a pay­ment about a week ago for the pre­vi­ous 30 days, but hasn’t made a long-term com­mit­ment.

    Andrew Slavitt, act­ing admin­is­tra­tor of the Cen­ters for Medicare and Med­ic­aid Ser­vices in the Oba­ma admin­is­tra­tion, said the impact of cut­ting off sub­sidy pay­ments “will be felt by the mid­dle class who will pay more to sub­si­dize low income” peo­ple.

    Health-care ana­lyst Spencer Perl­man at Veda Part­ners LLC said in a research note on Fri­day, before the president’s tweets, that there’s a 30 per­cent chance Trump will end CSR pay­ments, which may “imme­di­ate­ly desta­bi­lize the exchanges, per­haps fatal­ly.”

    America’s Health Insur­ance Plans, a lob­by­ing group for the indus­try, has esti­mat­ed that pre­mi­ums would rise by about 20 per­cent if the CSR pay­ments aren’t made. Many insur­ers have already dropped out of Oba­macare mar­kets in the face of mount­ing loss­es, and blamed the uncer­tain­ty over the future of the cost-shar­ing sub­si­dies and the indi­vid­ual man­date as one of the rea­sons behind this year’s pre­mi­um increas­es.

    Who Owns It?

    Moments after the Sen­ate vot­ed down the Repub­li­can bill on Fri­day morn­ing, McConnell called on Democ­rats to offer their ideas for mov­ing for­ward with health care. But he warned: “Bail­ing out insur­ance com­pa­nies, with no thought of any kind of reform, is not some­thing I want to be a part of.”

    A sur­vey in April by the non­par­ti­san Kaiser Fam­i­ly Foun­da­tion showed that 61 per­cent Amer­i­cans believe Trump and Repub­li­cans are respon­si­ble for future prob­lems with the ACA, while 31 per­cent said Pres­i­dent Barack Oba­ma and Democ­rats would be at fault.

    ...

    Collins on CNN said law­mak­ers need to go back to com­mit­tee, eval­u­ate pos­si­ble solu­tions through hear­ings, and pro­duce a “series of bills” to fix exist­ing prob­lems with the ACA, includ­ing the poten­tial col­lapse of the insur­ance mar­kets.

    “I cer­tain­ly hope the admin­is­tra­tion does not do any­thing in the mean­time to has­ten that col­lapse,” she said.

    ———-

    “Health Chief Says No Deci­sion on Con­tin­u­ing Oba­macare Sub­si­dies” by Sale­ha Mohsin; Bloomberg Pol­i­tics; 07/29/2017

    End­ing the CSR sub­si­dies, paid month­ly to insur­ers, is one way that Trump could has­ten Obamacare’s demise with­out leg­is­la­tion, by prompt­ing more com­pa­nies to raise pre­mi­ums in the indi­vid­ual mar­ket or even to stop offer­ing cov­er­age. The admin­is­tra­tion last made a pay­ment about a week ago for the pre­vi­ous 30 days, but hasn’t made a long-term com­mit­ment.”

    Not to alarm any­one, but yes, Trump alone real­ly can under­mine the pri­vate health insur­ance mar­kets by get­ting rid of those sub­si­dies. And accord­ing to all his White House prox­ies on the Sun­day Morn­ing news shows, Trump is seri­ous­ly con­sid­er­ing this. Also, he thinks the Sen­ate should get rid of the fil­i­buster and just go with 51 votes:

    ...
    Asked on ABC’s “This Week” how soon the Trump admin­is­tra­tion could stop the cost-shar­ing pay­ments, Price said no deci­sion has been made and he can’t com­ment fur­ther because of a pend­ing court case. He also declined to clar­i­fy what Trump meant by “implode,” say­ing the president’s com­ment “punc­tu­ates the con­cern” he has about chang­ing he direc­tion of the health-care sys­tem and get­ting Con­gress to act.

    Price said in a sep­a­rate inter­view on NBC’s “Meet the Press” that the administration’s “job is to fol­low the law of the land” and that “we take that respon­si­bil­i­ty very seri­ous­ly and we will con­tin­ue to do so.”

    White House coun­selor Kellyanne Con­way said on “Fox News Sun­day” that Trump will soon decide the fate of the sub­sidy pay­ments. “He’s going to make that deci­sion this week, and that’s a deci­sion that only he can make,” Con­way said.

    ...

    ‘Look Like Fools’

    The pres­i­dent said ear­li­er that Sen­ate Repub­li­cans “look like fools” after the repeal bill went down, and made a renewed call for the Sen­ate to abol­ish a rule requir­ing 60 votes for some bills — although the health-care mea­sure need­ed only a 51-vote major­i­ty to pass, and fell short.

    Trump reit­er­at­ed that posi­tion in a Twit­ter post­ing on Sun­day, say­ing, “Don’t give up Repub­li­can Sen­a­tors, the World is watch­ing: Repeal & Replace...and go to 51 votes.”

    “The pres­i­dent will not accept those who said, quote, ‘it’s time to move on,”’ Con­way said.
    ...

    “Trump reit­er­at­ed that posi­tion in a Twit­ter post­ing on Sun­day, say­ing, “Don’t give up Repub­li­can Sen­a­tors, the World is watch­ing: Repeal & Replace...and go to 51 votes.””

    So Trump is appar­ent­ly look­ing to tem­porar­i­ly uncut the pri­vate insur­ance mar­kets for the poor in the hopes of pres­sur­ing the GOP Sen­ate to blow up the fil­i­buster to pass a bill that will per­ma­nent­ly under­cut pub­lic and pri­vate insur­ance for the poor and every­one else.

    If there’s one pos­i­tive thing aobut this whole sit­u­a­tion, it’s that at least it’s going to be hard­er for the GOP to hide the fact that it’s been sys­tem­at­i­cal­ly under­min­ing Oba­macare for years now with things like Mar­co Rubio’s 2015 gut­ting of the “risk cor­ri­dor” sub­si­dies and the GOP’s ongo­ing law­suit argu­ing that the Oba­macare sub­si­dies for low-income peo­ple aren’t legal­ly fund­ed. It’s a lot hard­er to ignore that hid­den his­to­ry with Trump threat-tweet­ing about cut­ting those sub­si­dies.

    And notice how Tom Price can’t say whether Trump is going to pre­vent the pay­ment of those sub­si­dies based on the GOP’s own law­suit:

    ...
    Asked on ABC’s “This Week” how soon the Trump admin­is­tra­tion could stop the cost-shar­ing pay­ments, Price said no deci­sion has been made and he can’t com­ment fur­ther because of a pend­ing court case. He also declined to clar­i­fy what Trump meant by “implode,” say­ing the president’s com­ment “punc­tu­ates the con­cern” he has about chang­ing he direc­tion of the health-care sys­tem and get­ting Con­gress to act.
    ...

    That “pend­ing court case” that pre­vent­ed Price from com­ment­ing fur­ther is the GOP’s law­suit against those sub­si­dies Trump is threat­en­ing to repeal.

    In oth­er words, the GOP was already try­ing to get rid of the sub­si­dies via a law­suit that Trump is now threat­en­ing to block.

    It’s all a reminder that, as tox­ic as Trump’s lead­er­ship style has been in terms of its impact on the nation, he’s still a pret­ty decent GOP stan­dard-bear­er.

    It’s also, of course, a reminder that Trump and the GOP are still schem­ing Bizarro Pyrrhic schemes to ‘save’ Amer­i­ca’s health care sys­tem by destroy­ing it.

    Posted by Pterrafractyl | July 30, 2017, 11:11 pm
  8. Here’s a good news/bad news/treacherous news sto­ry about Ken­tuck­y’s health care safe­ty-net and the ongo­ing attempts to gut Med­ic­aid: Thanks to Ken­tuck­y’s 2014 accep­tance of the Med­ic­aid expan­sion the rates of unin­sured patients at the Uni­ver­si­ty of Louisville Hos­pi­tal, the city’s safe­ty net hos­pi­tal for the poor, dropped from 25 per­cent to 5 to 6 per­cent. That’s the good news.

    The bad is is that, thanks to that mas­sive drop off in the unin­sured, Ken­tuck­y’s GOP gov­er­nor Matt Bevin decid­ed to cut off funds for the Qual­i­ty and Char­i­ty Care Trust Inc., a trust fund set up to help pay for those med­ical ser­vices for the unin­sured.

    And then there’s the treach­er­ous news: at the same to the Ken­tucky GOP is argu­ing that the Med­ic­aid expan­sion has elim­i­nat­ed the need for the Qual­i­ty and Char­i­ty Care Trust Inc., Gov­er­nor Bevin is simul­ta­ne­ous­ly push­ing for a major over­haul in the state’s Med­ic­aid sys­tem. An over­haul that would­n’t just impact the peo­ple cov­ered under the Med­ic­aid expan­sion but all Med­ic­aid recip­i­ents. Changes includ­ing work require­ments for “able-bod­ied” adults with­out depen­dents. And that means that if you’re an unem­ployed able-bod­ied adult in Ken­tucky, you’re about to become offi­cial­ly expend­able in the eyes of the state.

    Sure, maybe you’ll find a job. Or maybe not. It’s up to you...and the broad­er Ken­tucky econ­o­my of which you have no con­trol. And sure, emer­gency room med­ical ser­vices will still pre­sum­ably be covered...for as long as there are hos­pi­tals around that can still cov­er them. But if, for instance, the state cuts the trust funds ded­i­cat­ed to help­ing hos­pi­tals cov­er the costs of pro­vid­ing med­ical ser­vices for the unin­sured while at the same time spik­ing the num­ber of unin­sured by imple­ment­ing new Med­ic­aid require­ments, you just might not have that many hos­pi­tals around to pro­vide those emer­gency ser­vices. And that med­ical ser­vice provider short­age isn’t just going to be a prob­lem for the big cities.

    But that’s appar­ent­ly Gov­er­nor Bev­in’s plan: imple­ment eli­gi­bil­i­ty require­ments that are cre­at­ed under the assump­tion that unem­ployed Med­ic­aid recip­i­ents are lazy leach­es (as opposed to peo­ple who can’t find a job or might have some oth­er rea­son­able rea­son for being unem­ployed) and thus designed to spike the num­ber of unin­sured. And that’s still the plan after Bevin elim­i­nat­ed the fund designed to help hos­pi­tals fund ser­vices for the unin­sured. And the icing on the cake is that the new work require­ments, which might be help­ful in a minor­i­ty of cas­es be are guar­an­teed to be cru­el and unrea­son­able in a large num­ber of cas­es, is being sold as away of help­ing the indi­vid­u­als kicked off of Med­ic­aid and the larg­er com­mu­ni­ty. So that’s the good/bad/treacherous news about Gov­er­nor Bev­in’s plans for Med­ic­aid:

    WDRB.com

    Fund that paid for unin­sured at Uni­ver­si­ty Hos­pi­tal scrapped after Med­ic­aid expan­sion changes land­scape

    By Chris Otts
    Post­ed: Jul 27, 2017 7:37 PM CST
    Updat­ed: Jul 27, 2017 7:38 PM CST

    LOUISVILLE, Ky. (WDRB) — A spe­cial gov­ern­ment fund set up in 1983 to help pay for unin­sured patients at Uni­ver­si­ty of Louisville Hos­pi­tal, the city’s safe­ty net hos­pi­tal for the poor, will be dis­solved soon as offi­cials say it’s no longer need­ed because of Kentucky’s expan­sion of Med­ic­aid.

    A board chaired by the sec­re­tary of Gov. Matt Bevin’s health cab­i­net vot­ed Thurs­day to dis­solve the Qual­i­ty and Char­i­ty Care Trust Inc., or QCCT.

    The trust had been fund­ed by the state, Louisville Metro gov­ern­ment and the Uni­ver­si­ty of Louisville.

    But the 2014 expan­sion of Med­ic­aid to cov­er more of Kentucky’s low-income pop­u­la­tion has cut the per­cent­age of unin­sured patients at the hos­pi­tal from about 25 per­cent to 5 to 6 per­cent, said Dr. Greg Pos­tel, U of L’s inter­im pres­i­dent and exec­u­tive vice pres­i­dent for health affairs.

    That means the hos­pi­tal is able to bill Med­ic­aid for a lot of care that was pre­vi­ous­ly fund­ed by city and state dol­lars put into the trust.

    Bevin vetoed state fund­ing for QCCT last year, and the trust has no remain­ing assets. The hospital’s last request for trust fund­ing was over a year ago.

    The move to dis­solve the trust comes despite the fact that changes could be in store for the state’s Med­ic­aid pro­gram.

    Bevin is seek­ing fed­er­al approval to add require­ments like work or vol­un­teer­ing and pre­mi­um pay­ments for some of Kentucky’s Med­ic­aid recip­i­ents, and Repub­li­cans in Con­gress are mak­ing efforts to repeal and replace the Afford­able Care Act, which allowed states such as Ken­tucky to expand Med­ic­aid.

    Pos­tel and Vick­ie Yates Brown Glis­son, sec­re­tary of the state Cab­i­net for Health and Fam­i­ly Ser­vices, said the issue of pub­lic fund­ing for Uni­ver­si­ty Hos­pi­tal could be raised again down the road, if need­ed.

    “The hos­pi­tal is fine as things are today, but if Med­ic­aid changes, then some kind of safe­ty net would have to be reestab­lished,” said Pos­tel, a mem­ber of the board that unan­i­mous­ly vot­ed Thurs­day to end the trust.

    Glis­son, who chairs that same board, said, “I think every­body is going to watch what’s hap­pen­ing on a fed­er­al lev­el and if things change, we may need to come back and look at this sit­u­a­tion.”

    There’s no point in keep­ing the trust around with­out the city and state fund­ing it, and an orga­ni­za­tion like the trust would not be dif­fi­cult to recast in the future if need­ed, Pos­tel said.

    Glis­son added that she doesn’t think Uni­ver­si­ty Hos­pi­tal will see more unin­sured patients as a result of the Med­ic­aid waiv­er Bevin is seek­ing.

    “These indi­vid­u­als (who got cov­er­age through the expan­sion) are still eli­gi­ble. The only thought would be that … if you are able-bod­ied, with no depen­dents, that you will make that per­son­al choice to now go into the job mar­ket … and that they would then be cov­ered by their employ­er-spon­sored insur­ance,” she said. “…Nobody is los­ing their insur­ance; nobody is being pushed off.”

    ...

    ———-

    “Fund that paid for unin­sured at Uni­ver­si­ty Hos­pi­tal scrapped after Med­ic­aid expan­sion changes land­scape” by Chris Otts; wdrb.com; 07/27/2017

    ““The hos­pi­tal is fine as things are today, but if Med­ic­aid changes, then some kind of safe­ty net would have to be reestab­lished,” said Pos­tel, a mem­ber of the board that unan­i­mous­ly vot­ed Thurs­day to end the trust.”

    Yes, the main hos­pi­tal for the poor in Louisville that just had its spe­cial fund to finance care for the unin­sured for­mal­ly closed should be finan­cial­ly fine as long as Med­ic­aid does­n’t change. And, of course, chang­ing Med­ic­aid in a way that increas­es the num­ber of unin­sured is the objec­tive of the Gov­er­nor’s request­ed changes to Med­ic­aid. Under the guise of help­ing peo­ple and the com­mu­ni­ty:

    ...
    But the 2014 expan­sion of Med­ic­aid to cov­er more of Kentucky’s low-income pop­u­la­tion has cut the per­cent­age of unin­sured patients at the hos­pi­tal from about 25 per­cent to 5 to 6 per­cent, said Dr. Greg Pos­tel, U of L’s inter­im pres­i­dent and exec­u­tive vice pres­i­dent for health affairs.

    That means the hos­pi­tal is able to bill Med­ic­aid for a lot of care that was pre­vi­ous­ly fund­ed by city and state dol­lars put into the trust.

    Bevin vetoed state fund­ing for QCCT last year, and the trust has no remain­ing assets. The hospital’s last request for trust fund­ing was over a year ago.

    The move to dis­solve the trust comes despite the fact that changes could be in store for the state’s Med­ic­aid pro­gram.

    Bevin is seek­ing fed­er­al approval to add require­ments like work or vol­un­teer­ing and pre­mi­um pay­ments for some of Kentucky’s Med­ic­aid recip­i­ents, and Repub­li­cans in Con­gress are mak­ing efforts to repeal and replace the Afford­able Care Act, which allowed states such as Ken­tucky to expand Med­ic­aid.
    ...

    But note the sooth­ing, ‘don’t wor­ry’ talk from Vick­ie Yates Brown Glis­son, the sec­re­tary of the state Cab­i­net for Health and Fam­i­ly Ser­vices, says that it will be fine because all the peo­ple kicked off Med­ic­aid will find jobs and get insur­ance through their new employ­ers. And if there is a prob­lem with grow­ing num­bers of unin­sured peo­ple impact­ing the finances of hos­pi­tals there’s noth­ing stop­ping the state from revis­it­ing the issue and reopen­ing the trust Bevin just defund­ed:

    ...
    Pos­tel and Vick­ie Yates Brown Glis­son, sec­re­tary of the state Cab­i­net for Health and Fam­i­ly Ser­vices, said the issue of pub­lic fund­ing for Uni­ver­si­ty Hos­pi­tal could be raised again down the road, if need­ed.

    “The hos­pi­tal is fine as things are today, but if Med­ic­aid changes, then some kind of safe­ty net would have to be reestab­lished,” said Pos­tel, a mem­ber of the board that unan­i­mous­ly vot­ed Thurs­day to end the trust.

    Glis­son, who chairs that same board, said, “I think every­body is going to watch what’s hap­pen­ing on a fed­er­al lev­el and if things change, we may need to come back and look at this sit­u­a­tion.”

    There’s no point in keep­ing the trust around with­out the city and state fund­ing it, and an orga­ni­za­tion like the trust would not be dif­fi­cult to recast in the future if need­ed, Pos­tel said.

    Glis­son added that she doesn’t think Uni­ver­si­ty Hos­pi­tal will see more unin­sured patients as a result of the Med­ic­aid waiv­er Bevin is seek­ing.

    “These indi­vid­u­als (who got cov­er­age through the expan­sion) are still eli­gi­ble. The only thought would be that … if you are able-bod­ied, with no depen­dents, that you will make that per­son­al choice to now go into the job mar­ket … and that they would then be cov­ered by their employ­er-spon­sored insur­ance,” she said. “…Nobody is los­ing their insur­ance; nobody is being pushed off.”
    ..

    “Glis­son added that she doesn’t think Uni­ver­si­ty Hos­pi­tal will see more unin­sured patients as a result of the Med­ic­aid waiv­er Bevin is seek­ing.”

    Hos­pi­tals won’t see more unin­sured peo­ple after gov­er­nor Bev­in’s plan kicks all these peo­ple off Med­ic­aid because they’re all going to find jobs. That’s what the gov­er­nor’s team is telling peo­ple.

    And if you’re won­der­ing whether or not the new work require­ments will include the vast major­i­ty of nurs­ing home res­i­dents on Med­ic­aid, note that the waivers work require­ment does of course have the able-bod­i­ness require­ment along with a “med­ical frailty” waiv­er. But it’s worth not­ing that when you look at the details they’ve released for Bev­in’s pro­posed changes, the list of waivers for the 20 hour a week work require­ment does­n’t appear to include an age cap:

    Ken­tucky Health

    Help­ing to Engage and Achieve Long Term Health

    ...

    The pro­posed change is lim­it­ed to elim­i­nat­ing the increas­ing scale for the com­mu­ni­ty engage­ment and employ­ment hour require­ments. Sus­pen­sions for com­mu­ni­ty engage­ment and employ­ment non-com­pli­ance and all exemp­tions will remain unchanged. Specif­i­cal­ly, the Com­mon­wealth con­tin­ues to seek an exemp­tion of the com­mu­ni­ty engage­ment and employ­ment ini­tia­tive for the fol­low­ing indi­vid­u­als:

    Chil­dren under the age of 19 enrolled in Ken­tucky HEALTH;

    Preg­nant women;

    Pri­ma­ry care­givers of a depen­dent, includ­ing either a depen­dent minor child or dis­abled adult depen­dent (lim­it­ed to only one exemp­tion per house­hold);

    Indi­vid­u­als iden­ti­fied as med­ical­ly frail; and

    Full time stu­dents.

    ...

    So part-time stu­dents will have a 20 hour a week work require­ment, unless they’re preg­nant or have a depen­dent. And indi­vid­u­als iden­ti­fied as med­ical­ly frail, which will cer­tain­ly include a large pro­por­tion of nurs­ing home or assist­ed liv­ing res­i­dents, will get a work waiv­er. But what about those nurs­ing home res­i­dents who are liv­ing at a nurs­ing home for a rea­son that does­n’t some­how make them unable to work 20 hours a week? Are they going to be expect­ed to work for the Med­ic­aid cov­er­age of their nurs­ing home res­i­den­cy? We’ll just have to find out appar­ent­ly because it’s not like Bev­in’s team is being upfront about the real costs of this scheme.

    Of course, since Med­ic­aid is a joint fed­er­al and state pro­gram with fed­er­al require­ments, Bev­in’s entire scheme is reliant on the fed­er­al gov­ern­ment giv­ing the go ahead. Which it will, of course, do for Ken­tucky and any oth­er state that has a scheme designed to throw peo­ple off Med­ic­aid:

    Talk­ing Points Memo
    DC

    Repub­li­cans Have A New Plot To Gut Med­ic­aid And They Don’t Need Con­gress

    By Alice Oll­stein
    Pub­lished August 17, 2017 6:00 am

    A wave of Repub­li­can-con­trolled states are peti­tion­ing the Depart­ment of Health and Human Ser­vices (HHS) for per­mis­sion to enact mea­sures that will knock more peo­ple off Med­ic­aid and the Trump admin­is­tra­tion has sig­naled they will give a green light to these efforts.

    After the col­lapse of Oba­macare repeal in Con­gress, which would have cut hun­dreds of bil­lions of dol­lars and mil­lions of peo­ple from Medicaid–the pub­lic health insur­ance pro­gram for the poor–red states and their allies in the Trump admin­is­tra­tion are prepar­ing to use a pow­er­ful admin­is­tra­tive tool as a back­door route to that same goal.

    Over the past few months, after Trump’s HHS sig­naled open­ness to grant­i­ng these Med­ic­aid waivers, near­ly a dozen Repub­li­can-con­trolled states have sub­mit­ted or are prepar­ing to sub­mit requests that they open­ly acknowl­edge will lead to few­er peo­ple being cov­ered as a result. In those so-called waiv­er requests, some states are seek­ing to impose work require­ments and drug tests on the low-income pop­u­la­tion that depends on Med­ic­aid, while oth­ers are propos­ing cuts in cov­er­age for vision, den­tal care, and non-emer­gency med­ical trans­porta­tion, life­time lim­its, defund­ing of women’s health clin­ics, and requir­ing peo­ple below the fed­er­al pover­ty line to pay insur­ance pre­mi­ums.

    The gov­er­nors gun­ning for the waivers say it will save mil­lions in tax­pay­er dol­lars and shore up the Med­ic­aid pro­gram. But for­mer HHS offi­cials and health law experts tell TPM that these proposals—which HHS has all but promised to approve—undermine the pur­pose of Med­ic­aid and could open the Trump admin­is­tra­tion up to law­suits in the months ahead.

    Red Lines

    Under fed­er­al law, any waivers grant­ed to states to loosen restric­tions on how they admin­is­ter Med­ic­aid have to clear a fair­ly high bar. States must pro­pose a “exper­i­ment” that tests ways to more effi­cient­ly and effec­tive­ly pro­mote Medicaid’s objectives—namely, pro­vid­ing afford­able and qual­i­ty health insur­ance to low-income peo­ple.

    Pro­pos­als sim­i­lar to those sub­mit­ted this year request­ing per­mis­sion to impose a work require­ment and to kick peo­ple off the Med­ic­aid rolls after a cer­tain peri­od of time were pre­vi­ous­ly reject­ed by the Oba­ma admin­is­tra­tion.

    “I’m not sure how deny­ing cov­er­age for peo­ple based on their inabil­i­ty to find work real­ly meets the objec­tive of pro­vid­ing health insur­ance to low-income indi­vid­u­als,” said Jes­si­ca Schubel, a senior advi­sor in the office that over­saw Med­ic­aid at the Cen­ters for Medicare & Med­ic­aid Ser­vices (CMS) dur­ing the Oba­ma admin­is­tra­tion. “As for the time lim­its, it’s intend­ed to be an open-end­ed pro­gram that is there for peo­ple when they need it.”

    Schubel, who now works on health care pol­i­cy for the Cen­ter on Bud­get and Pol­i­cy Pri­or­i­ties, not­ed that the Oba­ma admin­is­tra­tion was not com­plete­ly inflex­i­ble. Post-Oba­macare, when sev­er­al states were on the fence about expand­ing Med­ic­aid, they approved waiv­er appli­ca­tions that allowed some states to make Med­ic­aid ben­e­fi­cia­ries pay a share of their health care costs.

    “One exam­ple is Arkansas’ pri­vate option,” she explained. “It was an inno­v­a­tive approach that the state want­ed to test, and it was a path­way for­ward to get­ting [Med­ic­aid] expan­sion through. The same with Montana’s expan­sion waiv­er that includ­ed cost-shar­ing and pre­mi­ums. We worked close­ly with them to pro­vide exemp­tions for folks with chron­ic con­di­tions.”

    But this year, thanks to sig­nals of increased lenien­cy from HHS the ear­ly months of the Trump pres­i­den­cy, a host of states have moved for­ward with an array of waiv­er requests that nev­er would have won approval before.

    “Pre­vi­ous admin­is­tra­tions of both par­ties had the goal of increas­ing Med­ic­aid cov­er­age,” said Eliot Fish­man, who ran CMS’ office eval­u­at­ing state Med­ic­aid waivers from 2013 to ear­ly 2017. “Remem­ber, the Bush admin­is­tra­tion nego­ti­at­ed the ‘Rom­n­ey­care’ demon­stra­tion, [a pre­cur­sor to Oba­macare in Mass­a­chu­setts]. They were active­ly engaged in try­ing to expand cov­er­age through that demon­stra­tion.”

    Fish­man, now the senior direc­tor of health pol­i­cy at Fam­i­lies USA, said what he saw in the ear­ly days of the Trump admin­is­tra­tion was a sharp depar­ture from the his­toric goal of the Med­ic­aid pro­gram.

    “The use of Med­ic­aid author­i­ties to sig­nif­i­cant­ly reduce cov­er­age is real­ly nov­el and real­ly legal­ly sus­pect,” he told TPM. “Their fun­da­men­tal prin­ci­ple is that it’s the state’s call in terms of restrict­ing eli­gi­bil­i­ty.”

    Open­ing the flood­gates

    In March, HHS Sec­re­tary Tom Price and CMS Admin­is­tra­tor Seema Ver­ma wrote an open let­ter to the nation’s gov­er­nors promis­ing them “more free­dom” from “rigid and out­dat­ed imple­men­ta­tion and inter­pre­ta­tion of fed­er­al rules and require­ments.” The let­ter specif­i­cal­ly encour­aged states to sub­mit pro­pos­als for boot­ing unem­ployed peo­ple from the Med­ic­aid rolls, say­ing HHS is now inter­est­ed in “mer­i­to­ri­ous inno­va­tions that build on the human dig­ni­ty that comes with train­ing, employ­ment and inde­pen­dence.”

    With this green light, dozens of states sub­mit­ted appli­ca­tions.

    Indi­ana wants to require all able-bod­ied Med­ic­aid recip­i­ents to work at least 20 hours a week. Wis­con­sin also wants a work require­ment and wants to make Med­ic­aid enrollees pass a drug test in order to receive ben­e­fits. Maine wants a work require­ment and the abil­i­ty to charge peo­ple pre­mi­ums even when their income is well below the fed­er­al pover­ty line. Ken­tucky wants a work require­ment, the elim­i­na­tion of cov­er­age of vision and den­tal care, and the abil­i­ty to kick some­one off Med­ic­aid if they fail to report even a small change in their finan­cial sit­u­a­tion. Texas wants to deny Med­ic­aid dol­lars to women’s health clin­ics that pro­vide abor­tions.

    Not all states pro­vide pro­jec­tions of how many peo­ple would lose cov­er­age if the waivers are grant­ed, though Ken­tucky esti­mates that 95,000 will be denied Med­ic­aid, and Indi­ana pre­dicts that about 25,000 won’t be able to com­ply with the new restric­tions. Tak­en all togeth­er, Schubel esti­mates, the pro­pos­als have the poten­tial to shrink the Med­ic­aid rolls by dis­qual­i­fy­ing hun­dreds of thou­sands of peo­ple.

    “The March let­ter from CMS real­ly opened in the flood­gate to pro­pos­als that in my view don’t com­ply with the pur­pose of Med­ic­aid,” she told TPM. “They’re basi­cal­ly say­ing, ‘Hey, we’re open for busi­ness for any type of pro­pos­al.’”

    A spokesper­son for CMS declined to com­ment, say­ing he could not “spec­u­late on future waiv­er pol­i­cy.”

    A deci­sion on the first waiv­er in the queue, from Ken­tucky, could come in the next few weeks.

    Sarah Somers, a man­ag­ing attor­ney with the Nation­al Health Law Pro­gram, says if CMS approves it, it will embold­en oth­er states to seek sim­i­lar pass­es.

    “It’ll be a race to the bot­tom in some respects,” she warned. “If one state gets work require­ments approved, there’s no rea­son to say a whole slew of new states won’t seek them.”

    Somers told TPM that she believes many of the waiv­er appli­ca­tions cur­rent­ly pend­ing are “not con­sis­tent with goals of Med­ic­aid,” and the Nation­al Health Law Pro­gram may bring legal chal­lenges if the Trump admin­is­tra­tion grants them.

    “We are explor­ing all legal options,” she said. “We feel they amount to bur­dens placed on peo­ple who are already way over­bur­dened, and they weed out peo­ple who should be able to get assis­tance.”

    In par­tic­u­lar, Somers expressed con­cern about Wisconsin’s plan for manda­to­ry drug tests, and the five states that want to impose a work require­ment. Wisconsin’s appli­ca­tion esti­mates that they will lead to about 5,102 few­er peo­ple being enrolled in the pro­gram over five years. But when Wis­con­sin enact­ed a sim­i­lar work require­ment for their state food assis­tance pro­gram, it led to more than 70,000 peo­ple los­ing their ben­e­fits over just two years.

    It’s a pol­i­cy, Somers says, that is “based on a neg­a­tive stereo­type of low-income peo­ple.”

    “To have a rule requir­ing peo­ple to work is based on a mis­con­cep­tion that peo­ple cov­ered by the Med­ic­aid expan­sion aren’t already work­ing,” she said. “This is a major­i­ty work­ing poor pop­u­la­tion, and if they aren’t work­ing, it’s because they can’t.”

    A study by the Kaiser Fam­i­ly Foun­da­tion found that only 27 per­cent of Med­ic­aid recip­i­ents are adults with­out dis­abil­i­ties, and 60 per­cent of that group are already work­ing. Many of those not employed care for a fam­i­ly mem­ber full-time, have a crim­i­nal record, live in an area with­out job oppor­tu­ni­ties, or face oth­er “major imped­i­ments” to employ­ment.

    ...

    ———-

    “Repub­li­cans Have A New Plot To Gut Med­ic­aid And They Don’t Need Con­gress” by Alice Oll­stein; Talk­ing Points Memo; 08/17/2017

    “After the col­lapse of Oba­macare repeal in Con­gress, which would have cut hun­dreds of bil­lions of dol­lars and mil­lions of peo­ple from Medicaid–the pub­lic health insur­ance pro­gram for the poor–red states and their allies in the Trump admin­is­tra­tion are prepar­ing to use a pow­er­ful admin­is­tra­tive tool as a back­door route to that same goal.”

    Yep, if the GOP can’t gut Med­ic­aid by pass­ing Trump­care, it always has the free­dom to grant states the free­dom to do the gut­ting them­selves, which is some­thing the Trump admin­is­tra­tion has offi­cials grant­ed back in March along with the sug­ges­tion to states they they kick the unem­ployed peo­ple off of Med­ic­aid. Alleged­ly in the spir­it of build­ing upon the human dig­ni­ty of the very poor unem­ployed peo­ple now with­out health care. And many states heard that call and respond­ed with plen­ty of “inno­va­tions” designed to kick peo­ple off Med­ic­aid:

    ...
    In March, HHS Sec­re­tary Tom Price and CMS Admin­is­tra­tor Seema Ver­ma wrote an open let­ter to the nation’s gov­er­nors promis­ing them “more free­dom” from “rigid and out­dat­ed imple­men­ta­tion and inter­pre­ta­tion of fed­er­al rules and require­ments.” The let­ter specif­i­cal­ly encour­aged states to sub­mit pro­pos­als for boot­ing unem­ployed peo­ple from the Med­ic­aid rolls, say­ing HHS is now inter­est­ed in “mer­i­to­ri­ous inno­va­tions that build on the human dig­ni­ty that comes with train­ing, employ­ment and inde­pen­dence.”

    With this green light, dozens of states sub­mit­ted appli­ca­tions.

    Indi­ana wants to require all able-bod­ied Med­ic­aid recip­i­ents to work at least 20 hours a week. Wis­con­sin also wants a work require­ment and wants to make Med­ic­aid enrollees pass a drug test in order to receive ben­e­fits. Maine wants a work require­ment and the abil­i­ty to charge peo­ple pre­mi­ums even when their income is well below the fed­er­al pover­ty line. Ken­tucky wants a work require­ment, the elim­i­na­tion of cov­er­age of vision and den­tal care, and the abil­i­ty to kick some­one off Med­ic­aid if they fail to report even a small change in their finan­cial sit­u­a­tion. Texas wants to deny Med­ic­aid dol­lars to women’s health clin­ics that pro­vide abor­tions.
    ...

    And remem­ber how Ken­tuck­y’s sec­re­tary for Health and Fam­i­ly Ser­vices, Vick­ie Yates Brown Glis­son, pre­dict­ed that no one was going to be los­ing any insur­ance under Bev­in’s pro­posed Med­ic­aid cuts. Well, it looks like Ken­tucky is pre­dict­ing its new plan will deny 95,000 peo­ple Med­ic­aid, includ­ing 25,000 peo­ple who “can’t com­ply with the new restric­tions.” Which is a pleas­ant sound­ing way of say­ing peo­ple who don’t have a job and don’t find one. And those num­bers are just the pub­lic pre­dic­tion ped­dled by a gov­er­nor ded­i­cat­ed to sell­ing poi­so­nous snake oil pol­i­cy. As Wis­con­sin reminds us, those num­bers could be a lot high­er:

    ...
    Not all states pro­vide pro­jec­tions of how many peo­ple would lose cov­er­age if the waivers are grant­ed, though Ken­tucky esti­mates that 95,000 will be denied Med­ic­aid, and Indi­ana pre­dicts that about 25,000 won’t be able to com­ply with the new restric­tions. Tak­en all togeth­er, Schubel esti­mates, the pro­pos­als have the poten­tial to shrink the Med­ic­aid rolls by dis­qual­i­fy­ing hun­dreds of thou­sands of peo­ple.

    ...

    In par­tic­u­lar, Somers expressed con­cern about Wisconsin’s plan for manda­to­ry drug tests, and the five states that want to impose a work require­ment. Wisconsin’s appli­ca­tion esti­mates that they will lead to about 5,102 few­er peo­ple being enrolled in the pro­gram over five years. But when Wis­con­sin enact­ed a sim­i­lar work require­ment for their state food assis­tance pro­gram, it led to more than 70,000 peo­ple los­ing their ben­e­fits over just two years.

    It’s a pol­i­cy, Somers says, that is “based on a neg­a­tive stereo­type of low-income peo­ple.”

    “To have a rule requir­ing peo­ple to work is based on a mis­con­cep­tion that peo­ple cov­ered by the Med­ic­aid expan­sion aren’t already work­ing,” she said. “This is a major­i­ty work­ing poor pop­u­la­tion, and if they aren’t work­ing, it’s because they can’t.”
    ...

    So after kick­ings 70,000 peo­ple off a state food assis­tance pro­gram after impos­ing a work require­ment (for human dig­ni­ty, of course), Wis­con­sin is now esti­mat­ing that 5,102 will lose Med­ic­aid after also impos­ing a work require­ment. Gee, is it pos­si­ble that the peo­ple will­ing to kick peo­ple off Med­ic­aid would be will­ing to lie about the num­bers? No, no, because that would be wrong. Lying is bad. But kick­ing poor peo­ple off Med­ic­aid , includ­ing per­haps Grand­ma is she’s still got some spring in her step, with­out any mean­ing­ful con­sid­er­a­tion for their per­son­al cir­cum­stances and just broad­ly assum­ing that those with­out jobs are prob­a­bly just lazy leach­es per­fect­ly capa­ble of find­ing mean­ing­ful work is appar­ent­ly a good thing to do. For human dig­ni­ty. And the com­mu­ni­ty. Includ­ing the hos­pi­tals that are about to pay for a lot more unin­sured peo­ple. It’s all being done for their best inter­ests in mind. Or at least some­one’s best inter­ests in mind.

    Posted by Pterrafractyl | August 20, 2017, 9:04 pm
  9. The sit­u­a­tion for “Dream­ers”, the ~800,000 undoc­u­ment­ed adults in the US who were brought in by their par­ents while they were chil­dren under the age of 16 hop­ing to be allowed to stay in the US under the the DACA pro­gram after vol­un­tar­i­ly com­ing out of the shad­ows and reg­is­ter­ing with the gov­ern­ment, is sud­den­ly look­ing up a bit after Ten­neessee’s Attor­ney Gen­er­al, Her­bert Slatery III, snapped to his sens­es and removed him­self from the law­suit col­lec­tive threat being brought against the Trump Admin­is­tra­tion by 10 Repub­li­can Attor­ney Gen­er­al to include the DACA pro­gram in a larg­er law­suit in order to force an end to the pro­gram if Trump did­n’t do it first. He cit­ed “the human ele­ment” as his rea­son, which is a great rea­son since includ­ing DACA in the law­suit would throw humans who grew up in the US — and that’s large­ly all they know at this point in their lives — out of the coun­try. But Slatery had his epiphany so that’s good news. 9 more epipha­nies to go.

    And then Pres­i­dent Trump — who threat­ened to deport all undoc­u­ment­ed adults and chil­dren includ­ing the Dream­ers on the cam­paign but then deferred that deci­sion back in Junegave a non-com­mit­tal “we thing the Dream­ers are ter­rif­ic” and “we love the Dream­ers” respons­es to ques­tions about the deci­sion on DACA that he’s sched­uled to make on Tues­day. So it’s still a gen­er­al­ly bleak out­look in terms of what Trump will do for the Dream­ers but it could be worse if he’s talk­ing about lov­ing them and how ter­rif­ic they are. Did Trump have a “human ele­ment” epiphany of his own? Let’s hope so. And if that’s the case he ust have had that epiphany Fri­day morn­ing because word on Thurs­day was that Trump was get­ting ready to phase out DACA:

    New York Mag­a­zine

    Trump May End DACA — and Still Hold Dream­ers Hostage

    By Ed Kil­go­re

    August 31, 2017 2:54 pm

    With an ulti­ma­tum from Repub­li­can state attor­neys gen­er­al about to run out, mul­ti­ple reports indi­cate that the pres­i­dent will tomor­row announce the end of the Deferred Action for Child­hood Arrivals pro­gram, which pro­tects around 800,000 Dream­ers (young peo­ple brought into the coun­try ille­gal­ly as chil­dren who meet var­i­ous cri­te­ria indi­cate exem­plary behav­ior) from pros­e­cu­tion. Accord­ing to McClatchy, which has the most thor­ough ini­tial account, Trump will end new DACA des­ig­na­tions and renewals, which means cur­rent DACA enrollees will be pro­tect­ed from pros­e­cu­tion until their two-year work per­mits run out (which will hap­pen at vary­ing times over the next two years depend­ing on when they were issued). Sev­er­al hun­dred thou­sand more DACA-eli­gi­ble immi­grants will be out of luck for the time being.

    The tim­ing isn’t ide­al, with Trump try­ing to show a com­pas­sion­ate side in the wake of the dis­as­ter in Hous­ton, where an esti­mat­ed 68,000 DACA-eli­gi­ble immi­grants live. You could say the same of Texas attor­ney gen­er­al Ken Pax­ton, the ring­leader of the group threat­en­ing to haul DACA before the same unfriend­ly Texas fed­er­al judge who stopped Barack Obama’s effort to expand DACA and also pro­vide pro­tec­tion for the par­ents of Dream­ers. But with just six days to go before the Sep­tem­ber 5 dead­line Paxton’s group set for Trump to act, the White House appar­ent­ly decid­ed to act.

    ...

    But Trump’s nativist base proved to be a more com­pelling fac­tor. Bre­it­bart News sneered at CEO pleas to save DACA with this head­line: “‘Mas­ters of the Uni­verse’ Beg Don­ald Trump to Save DACA Amnesty.” With Trump quite pos­si­bly on the brink of aban­don­ing a threat to shut down the gov­ern­ment if he doesn’t get bor­der-wall fund­ing, anoth­er immi­gra­tion-relat­ed dis­ap­point­ment could cause some heart­burn in the base.

    In the broad­er scheme of things, how­ev­er, DACA could be a bar­gain­ing chip in a deal that includes not only bor­der-wall fund­ing but restric­tions on legal immi­gra­tion and oth­er nativist pri­or­i­ties. Congress—and Con­gress alone—can pro­vide a per­ma­nent res­o­lu­tion of the plight of Dream­ers (whose very moniker, after all, was cre­at­ed by a nev­er-enact­ed bill called the DREAM Act, which refers to Devel­op­ment, Relief, and Edu­ca­tion for Alien Minors). Trump’s deci­sion to slow­ly kill DACA instead of expos­ing the entire eli­gi­ble pop­u­la­tion to the pos­si­bil­i­ty of imme­di­ate depor­ta­tion (not that the fed­er­al gov­ern­ment has the resources to do that any­way) seems high­ly com­pat­i­ble with a strat­e­gy of mak­ing a deal that doesn’t look like a flip-flop.

    ———-

    “Trump May End DACA — and Still Hold Dream­ers Hostage” by Ed Kil­go­re; New York Mag­a­zine; 08/31/2017

    With an ulti­ma­tum from Repub­li­can state attor­neys gen­er­al about to run out, mul­ti­ple reports indi­cate that the pres­i­dent will tomor­row announce the end of the Deferred Action for Child­hood Arrivals pro­gram, which pro­tects around 800,000 Dream­ers (young peo­ple brought into the coun­try ille­gal­ly as chil­dren who meet var­i­ous cri­te­ria indi­cate exem­plary behav­ior) from pros­e­cu­tion. Accord­ing to McClatchy, which has the most thor­ough ini­tial account, Trump will end new DACA des­ig­na­tions and renewals, which means cur­rent DACA enrollees will be pro­tect­ed from pros­e­cu­tion until their two-year work per­mits run out (which will hap­pen at vary­ing times over the next two years depend­ing on when they were issued). Sev­er­al hun­dred thou­sand more DACA-eli­gi­ble immi­grants will be out of luck for the time being.”

    Well, it sound like those 9 remain­ing GOP Attor­ney Gen­er­als won’t need to add the DACA amend­ment to their law­suit. Trump will take care of that for them. But then again, Trump said he loved the Dream­ers and thinks they’re ter­rif­ic and it’s not like the pol­i­tics aren’t polit­i­cal­ly tox­ic for Trump. He’s con­sid­er­ing some­thing as extreme as deport­ing Dream­ers pri­mar­i­ly to please the the rel­a­tive­ly nar­row Trumpian base that wants him to go that far because the vast of US vot­ers sup­port DACA, includ­ing a major­i­ty of Repub­li­cans. So it’s pos­si­ble he real­ly will make a last minute deci­sion to save the Dream­ers. “Trump the Mer­ci­ful!” could be a good brand move for him right now. Espe­cial­ly after par­don­ing Joe Arpaio dur­ing hur­ri­cane Har­vey for high­er rat­ings and admit­ting it. Plus the whole Char­lottesville stick­ing up for “some” of the atten­dees at a hate ral­ly thing. And the tax cuts for the rich that were announced dur­ing his trip to the Hur­ri­cane Har­vey after­math. Adding kick­ing out the Dream­ers to that list isn’t nec­es­sar­i­ly the best polit­i­cal move at this point.

    But that’s not how his base is going to see it, and that’s why he just might announce the end of DACA in just a few days:

    ...
    But Trump’s nativist base proved to be a more com­pelling fac­tor. Bre­it­bart News sneered at CEO pleas to save DACA with this head­line: “‘Mas­ters of the Uni­verse’ Beg Don­ald Trump to Save DACA Amnesty.” With Trump quite pos­si­bly on the brink of aban­don­ing a threat to shut down the gov­ern­ment if he doesn’t get bor­der-wall fund­ing, anoth­er immi­gra­tion-relat­ed dis­ap­point­ment could cause some heart­burn in the base.
    ...

    So if Trump real­ly is explor­ing the pos­si­bil­i­ty of revers­ing his cam­paign pledge and let­ting the Dream­ers stay he’s going to have to fig­ure out how to give him­self the polit­i­cal cov­er with the Trumpian base soon who want vir­tu­al­ly all the Dream­ers deport­ed and he’s going to have to fig­ure it out soon. Don’t for­get it’s a Sep­tem­ber 5th dead­line. Some sort of ‘red meat’ for the base about to be dis­ap­point­ed that the ‘the Dream’ isn’t about to be deport­ed.

    So it’s worth keep­ing in mind that an end­less string of new moral­ly out­ra­geous pro­pos­als can act as a vir­tu­al form of polit­i­cal cov­er sim­ply be dis­tract­ing every­one. It’s some­thing to keep in mind with Trump admin­is­tra­tion: an end­less string of moral out­rages can oper­ate as polit­i­cal cov­er for Trump and the GOP actu­al­ly not act­ing on the pre­vi­ous moral out­rages they’ve pledged to do. Like repeal­ing Obamacare...debating about things like deport­ing the Dream­ers is a great dis­trac­tion from the GOP’s epic fail­ure to repeal Oba­macare. Sim­ply talk­ing about the upcom­ing plans in the GOP’s hor­ri­ble agen­da can actu­al­ly deflect from a recent fail­ure to actu­al­ly imple­ment that hor­ri­ble agen­da. Some­one needs to make sure Trump rec­og­nizes that in case he decides to stop cra­ter­ing his approval rat­ings.

    And just as Trump’s moral out­rages oper­ate as a great dis­trac­tion from the con­gres­sion­al GOP’s epic fail­ure the con­gres­sion­al of the GOP could make the hor­ri­ble pro­pos­al instead and pro­tect Trump with the Dream­ers. For instance, remem­ber how Trump’s bud­get pro­pos­al involved mas­sive cuts to fed­er­al pro­grams for all chil­dren in Amer­i­ca? Well, guess which pro­gram might get used as a hostage in order to force Democ­rats into sup­port­ing a tax cut on med­ical device man­u­fac­tur­ers? That’s right, the Children’s Health Insur­ance Pro­gram (CHIP), which pro­vides health cov­er­age to mil­lions of chil­dren in low-income fam­i­lies and expires at the end of Sep­tem­ber and must be renewed, is going to be held hostage as a ‘bar­gain­ing chip’ in nego­ti­a­tions with the Democ­rats over whether to refund it. In order to cut one of the cor­po­rate tax­es in Oba­macare. There’s, like, a whole month of dis­trac­tion moral out­rage Trump could extract out of that kind of idea:

    Talk­ing Points Memo
    Livewire

    Report: GOP­ers May Hold Children’s Health Insur­ance Hostage For Tax Cuts

    By Alice Oll­stein
    Pub­lished August 30, 2017 12:43 pm

    Con­gress returns next week to a night­mar­ish­ly short cal­en­dar dur­ing which they must pass a host of bills to keep the gov­ern­ment run­ning, includ­ing the reau­tho­riza­tion of the Children’s Health Insur­ance Pro­gram (CHIP) which pro­vides health cov­er­age to mil­lions of chil­dren in low-income fam­i­lies and expires on Sept. 30.

    Accord­ing to the Wall Street Jour­nal, Repub­li­cans may attempt to use the CHIP dead­line as a vehi­cle to revive their effort to chip away at the Afford­able Care Act, and could try to attach amend­ments to the bill to reau­tho­rize its fund­ing.

    Con­gres­sion­al sources told the Wall Street Jour­nal that Repub­li­cans are in par­tic­u­lar look­ing at link­ing a repeal of Obamacare’s med­ical device tax to CHIP. Oth­er law­mak­ers are con­sid­er­ing amend­ments that would sta­bi­lize Obamacare’s mar­ket­places, fear­ing that a stand­alone bill to do so would either not pass Con­gress or would draw a pres­i­den­tial veto.

    The Amer­i­can Acad­e­my of Pedi­atrics, The Nation­al Asso­ci­a­tion of Med­ic­aid Direc­tors and sev­er­al oth­er groups have voiced con­cerns about attempts to play pol­i­tics with the CHIP fund­ing, warn­ing that any attempt to attach a con­tro­ver­sial “poi­son pill” pro­vi­sion to the must-pass bill would put it in jeop­ardy.

    ———-

    “Report: GOP­ers May Hold Children’s Health Insur­ance Hostage For Tax Cuts” by Alice Oll­stein; Talk­ing Points Memo; 08/30/2017

    Con­gres­sion­al sources told the Wall Street Jour­nal that Repub­li­cans are in par­tic­u­lar look­ing at link­ing a repeal of Obamacare’s med­ical device tax to CHIP. Oth­er law­mak­ers are con­sid­er­ing amend­ments that would sta­bi­lize Obamacare’s mar­ket­places, fear­ing that a stand­alone bill to do so would either not pass Con­gress or would draw a pres­i­den­tial veto.”

    Give us the tax cut or the poor kids’ health care gets cut instead. It sure sounds like the whole GOP is going to need a new dis­tract­ing moral­ly out­ra­geous ideas at the end of the month if that’s seri­ous­ly what they’re pon­der­ing. Some­thing to dis­tract the rest of the coun­try that’s aghast at the idea of hold­ing health insur­ance for poor kids hostage for cor­po­rate tax cuts. What out­rage will they come up with next? Maybe Trump will swoop in with a new hor­ri­ble dis­trac­tion right when the hostage dra­ma hits its peak or maybe the con­gres­sion­al GOP will come up with a new dis­trac­tion of its own. Only time will tell. But some sort of new hor­ri­ble idea is most assured­ly guar­an­teed because that’s the GOP’s agen­da. A bad idea blitzkrieg that is so bad in so many dif­fer­ent ways that it pro­vides dis­tract­ing cov­er for itself.

    But let’s not for­get that the dis­tract­ing nature of the GOP mul­ti­fac­eted hor­ri­ble agen­da always pro­vides cov­er for not imple­ment­ing that agen­da too. A Trumpian base dis­ap­point­ed by the GOP’s fail­ures to imple­ment that hor­ri­ble agen­da it’s been promis­ing for years still has a seem­ing­ly end­less flood of a new hor­ri­ble agen­da items dan­gled in front of them and that’s real polit­i­cal cov­er for those fail­ures. At least Trump and the GOP and clear­ly try­ing to be hor­ri­ble, even if they fail some­times. Or a lot. Like not deport­ing the Dream­ers and, hope­ful­ly, not hold­ing chil­dren’s health care hostage for cor­po­rate tax cuts. In oth­er words, the ter­ri­fy­ing nature of the GOP agen­da means the GOP does­n’t need to fear its fail­ures too much. Fail­ure to be hor­ri­ble is a polit­i­cal­ly viable option. Let’s hope Trump rec­og­nizes that sub­tle nuance of nav­i­gat­ing his cur­rent Dream­er conun­drum. And the upcom­ing CHIP conun­drum. And all the future polit­i­cal conun­drums cause by the hor­ri­ble nature of the GOP agen­da.

    An abun­dance of epipha­nies is also an option. A much, much bet­ter option.

    Posted by Pterrafractyl | September 2, 2017, 6:02 am
  10. Iowa GOP Sen­a­tor Chuck Grass­ley made a “did he actu­al­ly say that?” state­ment regard­ing his atti­tude towards the lat­est, a sad­dest, GOP attempt to repeal Oba­macare and replace it with a joke sys­tem that removes almost all the pro­vi­sions of Oba­macare that pub­lic actu­al­ly likes and block grants Med­ic­aid: While Sen­a­tor Grass­ley read­i­ly admits that he could give “10 rea­sons why this bill should­n’t be con­sid­ered,” he’s still total­ly behind the bill. Why? Because the GOP promised to repeal Oba­macare. So because the GOP spent years promis­ing vot­ers that they will imme­di­ate repeal Oba­macare and replace it with some­thing that is cheap­er and bet­ter, Sen­a­tor Grass­ley feels com­pelled to pass a bill that’s going to make health care far more expen­sive for indi­vid­u­als due to much worse cov­er­age. That’s his rea­son for sup­port­ing a night­mare health care bill and he feels that rea­son is just as impor­tant as the actu­al con­tent of the bill. And yes, he did actu­al­ly say that. Explic­it­ly:

    Talk­ing Points Memo
    Livewire

    Grass­ley: Repeal­ing O’Care Is More Impor­tant Than What­ev­er Replaces It

    By Matt Shuham
    Pub­lished Sep­tem­ber 20, 2017 2:14 pm

    Sen. Chuck Grass­ley (R‑IA) said Wednes­day he could give “10 rea­sons why this bill shouldn’t be con­sid­ered,” refer­ring to the Senate’s final attempt to repeal Oba­macare this year—but he’s still dead-set on sup­port­ing it.

    Grass­ley said keep­ing Repub­li­cans’ cam­paign promise to get rid of for­mer Pres­i­dent Obama’s sig­na­ture accom­plish­ment was as impor­tant as the con­tents of the most recent health care bill, penned by Sens. Lind­sey Gra­ham (R‑SC) and Bill Cas­sidy (R‑LA).

    “You know, I could maybe give you 10 rea­sons why this bill shouldn’t be con­sid­ered,” Grass­ley told Iowa reporters on a call, accord­ing to the Des Moines Reg­is­ter. “But Repub­li­cans cam­paigns on this so often that you have a respon­si­bil­i­ty to car­ry out what you said in the cam­paign.”

    “That’s pret­ty much as much of a rea­son as the sub­stance of the bill,” he added.

    The Gra­ham-Cas­sidy leg­is­la­tion would repeal much of Oba­macare and shift Med­ic­aid fund­ing to the states in the form of block grants. States would also be allowed to apply for waivers from cer­tain Oba­macare reg­u­la­tions that, in effect, would allow insur­ance com­pa­nies to impose life­time caps or engage in price dis­crim­i­na­tion based on pre-exist­ing con­di­tions.

    ———-

    “Grass­ley: Repeal­ing O’Care Is More Impor­tant Than What­ev­er Replaces It” by Matt Shuham; Talk­ing Points Memo Livewire; 09/20/2017

    ““You know, I could maybe give you 10 rea­sons why this bill shouldn’t be con­sid­ered,” Grass­ley told Iowa reporters on a call, accord­ing to the Des Moines Reg­is­ter. “But Repub­li­cans cam­paigns on this so often that you have a respon­si­bil­i­ty to car­ry out what you said in the cam­paign.”

    Yes, the Repub­li­cans feel they have a respon­si­bil­i­ty to vot­ers to car­ry out their promise to repeal and replace Oba­macare. And that respon­si­bil­i­ty to keep their promise is just as impor­tant as the actu­al bil­l’s con­tent. So in Chuck Grass­ley’s mind, it would be irre­spon­si­ble for the GOP to pass up this oppor­tu­ni­ty to irre­spon­si­bly replace Oba­macare with a bill almost no one likes:

    ...
    “That’s pret­ty much as much of a rea­son as the sub­stance of the bill,” he added.

    The Gra­ham-Cas­sidy leg­is­la­tion would repeal much of Oba­macare and shift Med­ic­aid fund­ing to the states in the form of block grants. States would also be allowed to apply for waivers from cer­tain Oba­macare reg­u­la­tions that, in effect, would allow insur­ance com­pa­nies to impose life­time caps or engage in price dis­crim­i­na­tion based on pre-exist­ing con­di­tions.
    ...

    Life­time caps and pre-exist­ing con­di­tions dis­crim­i­na­tion. That does­n’t sounds like the kinds of things GOP­ers were promis­ing vot­ers the past 8 years but that’s what the GOP is once again about to make law. Out of a sense of respon­si­bil­i­ty appar­ent­ly.

    And the par­ty is so intent on ful­fill­ing that promise that it’s now plan­ning on putting Trump­care 3.0 up for a vote with an incom­plete CBO analy­sis, a sin­gle com­mit­tee hear­ing, 90 sec­onds of floor debate, and then a vote that will send it to the House to be passed as-is:

    Talk­ing Points Memo
    DC

    Sen­ate GOP Embraces FUBAR Process For Last-Ditch Oba­macare Repeal Effort

    By Alice Oll­stein
    Pub­lished Sep­tem­ber 20, 2017 6:00 am

    Cameron Joseph con­tributed report­ing.

    The Sen­ate has less than two weeks, and just a hand­ful of work­ing days, to repeal Oba­macare and block-grant Med­ic­aid with a mere 50 votes.

    “This vehi­cle that we’re using turns into a pump­kin on Sep­tem­ber 30th if we don’t get some­thing else done,” Sen. Mike Rounds (R‑SD) warned Tues­day.

    With the clock tick­ing, Sen­ate Repub­li­cans have thrown togeth­er a crude imi­ta­tion of reg­u­lar order in an attempt to quick­ly check all the nec­es­sary box­es and win over their col­leagues who are stick­lers for process. Next week, they plan to plow through a sin­gle hear­ing, receive an incom­plete analy­sis from the Con­gres­sion­al Bud­get Office, and if they shore up the votes, take it to the Sen­ate floor for a whop­ping 90 sec­onds of debate before launch­ing into a vote-a-rama.

    Some Repub­li­can law­mak­ers are less than pleased.

    “That’s prob­lem­at­ic because that is part of the prob­lem of short-cir­cuit­ing the process,” Sen. Susan Collins (R‑ME) com­plained, lament­ing that the last-minute repeal effort is hav­ing the side effect of killing the bipar­ti­san health care sta­bi­liza­tion bill she and oth­ers have spent months nego­ti­at­ing.

    Despite their paeans about respect­ing “reg­u­lar order,” and bar­ring any sur­prise defec­tions or changes, this is the process the GOP will use over the next week to take one last run at repeal­ing the Afford­able Care Act.

    Par­tial CBO report

    Ear­ly next week, the Con­gres­sion­al Bud­get Office will release a “pre­lim­i­nary assess­ment” of the Gra­ham-Cas­sidy-Heller-John­son bill that won’t include infor­ma­tion about what would hap­pen to insur­ance pre­mi­ums or how many peo­ple could lose their health insur­ance if the plan became law.

    “The CBO scor­ing is just a detail,” bill co-spon­sor Sen. Ron John­son (R‑WI) argued Tues­day, reviv­ing the pop­u­lar but inac­cu­rate Repub­li­can talk­ing point that the agency’s data can­not be trust­ed. “We’ve been high­ly dis­ap­point­ed in how CBO has con­duct­ed itself through­out this health care process. I have some real ques­tions about CBO.”

    Sen. John Thune (R‑SD), a mem­ber of the GOP lead­er­ship team, also char­ac­ter­ized the CBO score not as nec­es­sary infor­ma­tion but rather a hoop Repub­li­cans must jump through in order to use the 50-vote rec­on­cil­i­a­tion thresh­old.

    “The require­ment is that we have a CBO score, so we have to have some infor­ma­tion in order to vote,” he said. “I think that most of our mem­bers have already been attacked over and over again on pre­vi­ous CBO scores for not hav­ing enough peo­ple cov­ered back home. So I think for most of our peo­ple, at this point, their skin is pret­ty thick when it comes to the CBO.”

    But sev­er­al Repub­li­cans includ­ing, Collins, Lisa Murkows­ki (R‑AK) and Shel­ley Moore Capi­to (R‑WV) are not wav­ing away the lack of a com­plete CBO assess­ment.

    Collins called the omis­sion “pret­ty major.” Capi­to told TPM on Tues­day: “There is still more infor­ma­tion I need” to make a deci­sion.

    A sin­gle hear­ing

    Ear­ly on Mon­day evening, Sen­ate Finance Com­mit­tee Chair Orrin Hatch (R‑UT) argued to TPM that no hear­ing on the repeal bill was nec­es­sary because “peo­ple are pret­ty famil­iar with Gra­ham-Cas­sidy already.” Lat­er that evening, he announced a hear­ing, which will take place next Mon­day. It will not include a markup in which law­mak­ers could offer changes to the bill.

    Hatch told reporters Tues­day that because so many peo­ple were “com­plain­ing” about the lack of a hear­ing, “I decid­ed to just hold a hear­ing and that would solve a lot of the prob­lems.”

    Sen. Ron Wyden (D‑OR), the top Demo­c­rat on that com­mit­tee, said he wasn’t con­sult­ed or includ­ed at all in the deci­sion, a breach of Sen­ate norms.

    “This is a sham process that makes a mock­ery of reg­u­lar order,” he said in a fiery state­ment. “Even set­ting aside the dis­as­trous con­se­quences the Cas­sidy-Gra­ham-Heller bill would have for Amer­i­cans across the coun­try, the Finance Com­mit­tee can­not ade­quate­ly exam­ine a pro­pos­al this mas­sive in a sin­gle hear­ing.”

    The committee’s move is large­ly seen as a offer­ing to Sen. John McCain (R‑AZ), who has not yet pledged to vote for the bill and who has repeat­ed­ly insist­ed on fol­low­ing “reg­u­lar order.” But McCain sig­naled Tues­day that he may not be mol­li­fied by a sin­gle hear­ing with no bipar­ti­san col­lab­o­ra­tion mere days before the vote.

    “You think that that’s reg­u­lar order?” he asked IJR. “I always thought reg­u­lar order was hear­ings and debates and amend­ments and then to the floor with debates, dis­cus­sion, and amend­ments. That’s what I thought reg­u­lar order was.”

    Take it or leave it

    When Repub­li­cans were mar­shal­ing the votes for repeal­ing Oba­macare in July, they repeat­ed­ly assured law­mak­ers and the pub­lic that vot­ing for the bill was mere­ly a vote to advance the process, and that any prob­lems in the leg­is­la­tion could be fixed in con­fer­ence with the House.

    They are not mak­ing that argu­ment this time around.

    Instead Repub­li­cans are tout­ing the fact that the bill that was only unveiled last week could come straight to the Sen­ate floor, and if passed, would pass in the House and go straight to the president’s desk. Under the rules of rec­on­cil­i­a­tion, there is no time for a con­fer­ence between the House and Sen­ate to iron out pol­i­cy dif­fer­ences.

    And because the bill is struc­tured as an amend­ment to the under­ly­ing health care bill that got a clo­ture vote in May, it would only get 90 sec­onds of debate time in the Sen­ate. Law­mak­ers could offer amend­ments, but the process would ter­mi­nate in an up-or-down sim­ple major­i­ty vote.

    To cre­ate an addi­tion­al sense of urgency, Sen. Lind­sey Gra­ham (R‑SC) warned Tues­day that nei­ther the White House nor the GOP House were pre­pared to sup­port bipar­ti­san efforts to sta­bi­lize or, in his words, “prop up” Oba­macare. The mes­sage to waver­ing sen­a­tors was that Oba­macare will col­lapse any­way, so get on board with repeal.

    ...

    ———-

    “Sen­ate GOP Embraces FUBAR Process For Last-Ditch Oba­macare Repeal Effort” by Alice Oll­stein; Talk­ing Points Memo DC; 09/20/2017

    “With the clock tick­ing, Sen­ate Repub­li­cans have thrown togeth­er a crude imi­ta­tion of reg­u­lar order in an attempt to quick­ly check all the nec­es­sary box­es and win over their col­leagues who are stick­lers for process. Next week, they plan to plow through a sin­gle hear­ing, receive an incom­plete analy­sis from the Con­gres­sion­al Bud­get Office, and if they shore up the votes, take it to the Sen­ate floor for a whop­ping 90 sec­onds of debate before launch­ing into a vote-a-rama.”

    That’s what the GOP is plan­ning, appar­ent­ly out of fear that NOT doing this will result in the elec­torate pun­ish­ing them. It’s quite a cor­ner they’ve backed them­selves into: either break their promise to repeal and replace Oba­macare or keep their promise but break the health care sys­tem and mak­ing it worse than before in the process. And the lat­ter is the option the GOP appears to be going with.

    But that’s assum­ing the GOP can get the 51 votes it needs, and that’s still far from guar­an­teed. There’s clear­ly some addi­tion­al sales­man­ship required. And yet it’s also clear that the GOP wants to get this passed and quick­ly and qui­et­ly as pos­si­ble. So if there is any addi­tion­al sales­man­ship it’s prob­a­bly going to be lim­it­ed to sell­ing Sen­a­tors on the idea. The idea that vot­ing for a stealth sell­out of their con­stituents is good pol­i­tics. It’s not going be be an easy sale. But there is one fea­ture in this mess that just might be able to win over any par­tic­u­lar­ly spite­ful GOP hold­outs: This ver­sion of Trump­care will dra­mat­i­cal­ly reroute fed­er­al Med­ic­aid funds from blue states to red states and for the first decade some red state will actu­al­ly get more fed­er­al funds than they get today (although all states lose after the first decade):

    Talk­ing Points Memo
    DC

    New Report Shows GOP Repeal Bill Will Inflict Pain On Red And Blue States Alike

    By Alice Oll­stein
    Pub­lished Sep­tem­ber 20, 2017 11:39 am

    A new report released Wednes­day morn­ing reveals just how much states could lose under the Sen­ate GOP’s lat­est Oba­macare repeal bill—in total, a decrease of $215 bil­lion dol­lars in fed­er­al health care spend­ing by 2026 and more than $4 tril­lion cut by 2036, accord­ing to the report by the health care con­sult­ing group Avalere.

    The Sen­ate could poten­tial­ly vote next week on the Gra­ham-Cas­sidy bill to repeal much of the Afford­able Care Act and con­vert Med­ic­aid into a dwin­dling block grant. The bill’s Repub­li­can back­ers acknowl­edge that there will be win­ners and losers under the plan, but they are plan­ning to bring the bill to a vote with­out get­ting a com­plete analy­sis from the Con­gres­sion­al Bud­get Office of its cost and expect­ed cov­er­age loss­es, mak­ing inde­pen­dent assess­ments like Avalere’s among the few data points for ana­lyz­ing the bill’s impact.

    Under the bill’s for­mu­la, which large­ly redis­trib­utes mon­ey from blue states to red states, large, pro­gres­sive states that expand­ed Med­ic­aid under Oba­macare would see the biggest cuts, with Cal­i­for­nia and New York each los­ing tens of bil­lions of dol­lars over the next decade under the plan. It’s impor­tant to note, how­ev­er, that sev­er­al states rep­re­sent­ed by Repub­li­cans in the Sen­ate who are unde­cid­ed on the bill, includ­ing Maine, Alas­ka, West Vir­ginia, Ohio, and Ari­zona, would also see painful cuts.

    ...

    Cumu­la­tive Change in Fed­er­al Fund­ing to States Under Gra­ham-Cas­sidy Com­pared to Cur­rent Law, 2020–2026
    [see graph­ic of changes in fed­er­al fund­ing to states in first decade of Gra­ham-Cas­sidy]

    The worst cuts, how­ev­er, come in the sec­ond decade after the bill is enact­ed, when much low­er growth rates in Med­ic­aid per-capi­ta spend­ing kick in, and when the block grant fund­ing expires alto­geth­er. Avalere mod­eled what would hap­pen to fed­er­al health care spend­ing after 2026 under the Gra­ham-Cas­sidy plan, and found that the entire coun­try would face a fis­cal cliff, and that even the states that were “win­ners” in the first few years of the bill would see sharp reduc­tions fur­ther down the road.

    Cumu­la­tive Change in Fed­er­al Fund­ing to States Under Gra­ham-Cas­sidy Com­pared to Cur­rent Law, 2020–2036
    [see graph­ic of changes in fed­er­al fund­ing to states in sec­ond decade of Gra­ham-Cas­sidy]

    The Gra­ham-Cas­sidy bill, which could come to the Sen­ate floor with­out a com­plete CBO score and after only one com­mit­tee hear­ing, would end fed­er­al sup­port for Obamacare’s Med­ic­aid expan­sion and tax cred­its start­ing in 2020, kill the indi­vid­ual and employ­er man­dates, and allow state gov­ern­ments to waive many of the core pro­tec­tions in the ACA—such as the rule ban­ning insur­ers from charg­ing peo­ple with pre-exist­ing con­di­tions high­er rates.

    ———-

    “New Report Shows GOP Repeal Bill Will Inflict Pain On Red And Blue States Alike” by Alice Oll­stein; Talk­ing Points Memo DC; 09/20/2017

    Under the bill’s for­mu­la, which large­ly redis­trib­utes mon­ey from blue states to red states, large, pro­gres­sive states that expand­ed Med­ic­aid under Oba­macare would see the biggest cuts, with Cal­i­for­nia and New York each los­ing tens of bil­lions of dol­lars over the next decade under the plan. It’s impor­tant to note, how­ev­er, that sev­er­al states rep­re­sent­ed by Repub­li­cans in the Sen­ate who are unde­cid­ed on the bill, includ­ing Maine, Alas­ka, West Vir­ginia, Ohio, and Ari­zona, would also see painful cuts.”

    So that’s one pos­si­ble sell­ing point for the plan: it spite­ful­ly tries to divide red and blue states by harm­ing blue states while slight­ly help red states for the first decade. Although after that first decade every state los­es:

    ...
    The worst cuts, how­ev­er, come in the sec­ond decade after the bill is enact­ed, when much low­er growth rates in Med­ic­aid per-capi­ta spend­ing kick in, and when the block grant fund­ing expires alto­geth­er. Avalere mod­eled what would hap­pen to fed­er­al health care spend­ing after 2026 under the Gra­ham-Cas­sidy plan, and found that the entire coun­try would face a fis­cal cliff, and that even the states that were “win­ners” in the first few years of the bill would see sharp reduc­tions fur­ther down the road.
    ...

    And note that the three GOP Sen­a­tors who vot­ed against the Trump­care 2.0 mon­stros­i­ty (Sen­a­tors Collins, Murkows­ki, and McCain) rep­re­sent three of the red states that actu­al­ly lose out in the first decade (Maine, Alas­ka, and Ari­zona). So even if a red state/blue state divide-and-con­quer spite strat­e­gy was actu­al­ly part of the log­ic that went into the design of this bill it’s unclear how suc­cess­ful it will be at per­suad­ing any of these three key GOP hold outs.

    What is sad­ly clear after Sen­a­tor Lind­sey Gra­ham, one of the design­ers of the bill, dis­cussed his strat­e­gy for get­ting the nec­es­sary 51 votes is that the red state/blue state divide-and-con­quer spite strat­e­gy is actu­al­ly part of the strat­e­gy. As Gra­ham put it, “If you’re a Repub­li­can and you vote against [this bill], you got to explain to peo­ple back home why Wash­ing­ton knows bet­ter and almost every state except the four I have described do very well under this new approach to tak­ing the mon­ey out of Washington...I real­ly believe we’re gonna get 50 Repub­li­can votes.” And those four states he was refer­ring to were the four large blue states of Cal­i­for­nia, New York, Mass­a­chu­setts, and Mary­land, with more than 60 mil­lion peo­ple.

    So sell­ing the GOP on the notion that the only losers under his plan are four large blue states is actu­al­ly part of the sales pitch. Of course, as we saw above, it’s far more than just those four blue states that will be imme­di­ate losers (and all states become losers after the first decade). Still, while Gra­ham’s argu­ment may be a fraud­u­lent argu­ment, that take-from-the-blue-to-give-to-the-red argu­ment real­ly is part of the sales pitch:

    Think Progress

    Lind­sey Gra­ham brags about his shock­ing­ly cyn­i­cal strat­e­gy to repeal Oba­macare
    It’s all about pit­ting Amer­i­cans against each oth­er.

    Judd Legum
    Sep 19, 2017, 3:35 pm

    Speak­ing at the U.S. Capi­tol on Tues­day, Sen. Lind­sey Gra­ham (R‑SC) dis­cussed his bill to repeal Oba­macare, which is quick­ly gain­ing momen­tum. In his remarks, Gra­ham admit­ted that his strat­e­gy was large­ly based on redis­trib­ut­ing large sums of mon­ey from large Demo­c­ra­t­ic-led states like Cal­i­for­nia, New York, Mass­a­chu­setts, and Mary­land to states that are more Repub­li­can.

    In oth­er words, Gra­ham is attempt­ing to pur­chase GOP votes by pit­ting Amer­i­cans against each oth­er — and explic­it­ly work­ing against the inter­ests of more than 60 mil­lion peo­ple, the com­bined pop­u­la­tion of Cal­i­for­nia, New York, Mass­a­chu­setts, and Mary­land.

    “If you’re a Repub­li­can and you vote against [this bill], you got to explain to peo­ple back home why Wash­ing­ton knows bet­ter and almost every state except the four I have described do very well under this new approach to tak­ing the mon­ey out of Wash­ing­ton,” Gra­ham said. “I real­ly believe we’re gonna get 50 Repub­li­can votes.”

    Gra­ham also has his facts wrong.

    A Cen­ter for Bud­get and Pol­i­cy Pri­or­i­ties analy­sis of his leg­is­la­tion, known as the Gra­ham-Cas­sidy bill, found that 20 states would face fund­ing cuts of at least 35 per­cent by 2026. This would include the blue states he men­tioned — but it would also include Repub­li­can strong­holds like Alas­ka (-$255 mil­lion), Louisiana (-$3.2 bil­lion), Ken­tucky (-$3.1 bil­lion), Mon­tana (-$515 mil­lion) and North Dako­ta (-$211 mil­lion).

    ...

    ———-

    “Lind­sey Gra­ham brags about his shock­ing­ly cyn­i­cal strat­e­gy to repeal Oba­macare” by Judd Legum; Think Progress; 09/19/2017

    “A Cen­ter for Bud­get and Pol­i­cy Pri­or­i­ties analy­sis of his leg­is­la­tion, known as the Gra­ham-Cas­sidy bill, found that 20 states would face fund­ing cuts of at least 35 per­cent by 2026. This would include the blue states he men­tioned — but it would also include Repub­li­can strong­holds like Alas­ka (-$255 mil­lion), Louisiana (-$3.2 bil­lion), Ken­tucky (-$3.1 bil­lion), Mon­tana (-$515 mil­lion) and North Dako­ta (-$211 mil­lion).”

    Part of what’s almost dark­ly amus­ing about this sit­u­a­tion is that nor­mal­ly the GOP is focused on work­ing togeth­er to fool and fleece the elec­torate using a com­bi­na­tion of obfus­ca­tion, mis­in­for­ma­tion, and out­right lying. But in this case it appears the obfus­ca­tion, mis­in­for­ma­tion, and out­right lying is being direct­ed at those hold out GOP Sen­a­tors because if you’re telling Sen­a­tors from Alas­ka, Maine, and Ari­zona that only Cal­i­for­nia, New York, Mass­a­chu­setts, and Mary­land would lose out under this bill you’re obvi­ous­ly assum­ing these are clue­less peo­ple sus­cep­ti­ble to being eas­i­ly mis­led.

    But, of course, as amus­ing as it is to see Sen­ate GOP­ers use­ing Sith Lord mind tricks on fel­low Sen­ate GOP­ers, it’s not an amus­ing sit­u­a­tion over­all because we’re now look­ing at the the GOP’s third major attempt to repeal and replace Oba­macare (and destroy Med­ic­aid) this year and it appears that the GOP has learned from its past mis­takes and decid­ed on a whole new set of tac­tics this time to avoid all those angry town halls and protests: extreme speed, extreme stealth, and lies for when speed and stealth don’t work. And now was have overt red state vs blue state divide-and-con­quer spite tac­tics too. In oth­er words, the only pos­i­tive spin the GOP is both­er­ing to put on their sales pitch this time around is the pos­i­tive feel­ings one might get while being spite­ful towards blue states. Oth­er than that the GOP does­n’t appear to even want the pub­lic to be aware that this law is about to hap­pen. And if the Sen­ate GOP­ers can reach that 51 vote thresh­old before the Sep­tem­ber 30th dead­line this whole night­mare bill real­ly could become law. Rapid­ly. And if that hap­pens the bill won’t be in stealth mode any­more. It will be law. The kind of law that is going to gen­er­ate a lot more spite although it will prob­a­bly be the more clas­sic kind of spite that vot­ers direct towards the elect­ed offi­cials who com­plete­ly lied to them and destroyed their life, so hope­ful­ly the spite vot­ers feel towards the GOP after they real­ize they’ve once again been fleeced will help heal the dam­age done by this dis­gust­ing red state/blue state divide and con­quer strat­e­gy.

    Posted by Pterrafractyl | September 20, 2017, 2:51 pm
  11. One of the more impres­sive and destruc­tive meme-coups of the GOP in the Trump era has been the suc­cess­ful con­vo­lut­ing of the con­cepts of The Swamp with Big Gov­ern­ment. Slash and burn aus­ter­i­ty to the fed­er­al pro­grams most Amer­i­cans love and a refusal to even ade­quate­ly staff gov­ern­ment agen­cies gets repack­aged as ‘drain­ing The Swamp’ and some sort of pop­ulist act. It’s Trump and the GOP stick­ing it to all those face­less bureau­crats. Big Gov­ern­ment is a prod­uct of The Swamp, and the way you fight The Swamp is cut­ting Big Gov­ern­ment. That’s one of the mind­less new memes of the Trump era.

    And yet when it comes to health care, and the GOP’s end­less ambi­tions to gut Med­ic­aid by turn­ing it into a block grant­ed state-run pro­gram, that meme-coup of ‘Big Gov­ern­ment’ = ‘The Swamp’ has­n’t real­ly helped. It’s part of why Trump and the GOP real­ly should be thank­ing Ari­zona Sen­a­tor John McCain for once again tor­pe­do­ing Trump­care as he appeared to do late last week: despite the raw pro­pa­gan­dis­tic force of the right-wing meme machine, even con­ser­v­a­tive vot­ers still don’t like the GOP’s plans to gut Oba­macare and Med­ic­aid. Which means pret­ty much the only polit­i­cal­ly sig­nif­i­cant group that actu­al­ly sup­ports Trump­care is right-wing bil­lion­aires thanks to the fail­ure of the right-wing media infra­struc­ture to sell the pub­lic on the idea of Trump­care. And that’s why they tried to rush through Gra­ham-Cas­sidy in stealth mode last week and are still try­ing to accom­plish before the Sep­tem­ber 30th dead­line. Rush­ing it through in stealth mode is the best shot for a health care pack­age that’s so unpop­u­lar only the bil­lion­aires sup­ports it.

    It’s also a reminder that you almost can’t find some­thing more emblem­at­ic for “The Swamp” than a bunch of cranky right-wing bil­lion­aires forc­ing their pup­pets to try again and again pass a law that no one else likes because it only helps bil­lion­aires:

    New York Mag­a­zine

    No One Wants the Lat­est Trump­care Bill — Except Right-Wing Bil­lion­aires

    By Eric Levitz

    Sep­tem­ber 22, 2017 11:11 am

    Sen­ate Repub­li­cans know very lit­tle about what their new health-care plan would actu­al­ly do. This is because the bill’s pri­ma­ry author left the Sen­ate in 2006, and the leg­is­la­tion he wrote has been pub­lic for all of eight days. “If there was an oral exam on the con­tents of the pro­pos­al, grad­ed on a gen­er­ous curve, only two Repub­li­cans could pass it,” a senior Repub­li­can aide told a reporter this week — before stip­u­lat­ing that the bill’s puta­tive co-author, Lind­sey Gra­ham, was not one of them.

    But you need not take an anony­mous aide’s word on it. On Tues­day, Vox’s Jeff Stein asked nine GOP sen­a­tors what prob­lems the Gra­ham-Cas­sidy health-care bill solves, and how it solves them. The law­mak­ers respond­ed with plat­i­tudes about fed­er­al­ism, the phrase “read the bill and you’ll under­stand,” and a bizarre ref­er­ence to the final scene of Thel­ma and Louise.

    Still, Repub­li­cans know a few things about their lat­est iter­a­tion of Trump­care. They know that the bill reforms one-sixth of the Amer­i­can econ­o­my so rad­i­cal­ly the Con­gres­sion­al Bud­get Office will need weeks to gen­er­ate a detailed analy­sis of its like­ly effects; that every major health-care-indus­try stake­hold­er — from doc­tors and patients and hos­pi­tals to insur­ers and med­ical char­i­ties — oppos­es the leg­is­la­tion; that sev­en of their own party’s gov­er­nors also oppose it; that health-care-pol­i­cy ana­lysts believe the bill would make health insur­ance unaf­ford­able for many peo­ple with pre­ex­ist­ing con­di­tions; that it would rad­i­cal­ly reduce Med­ic­aid and fed­er­al sub­si­dies for health insur­ance; and that some ana­lysts say those cuts would increase the ranks of the unin­sured by 32 mil­lion over the next decade.

    And yet, accord­ing to reports, at least 48 Repub­li­can sen­a­tors are ready to vote for the bill next week. Which rais­es the ques­tion: Why is almost every GOP sen­a­tor ready to vote for wide­ly reviled leg­is­la­tion that they do not under­stand?

    The pop­u­lar answer is that they feel a polit­i­cal oblig­a­tion to make good on their promis­es to the con­ser­v­a­tive base, regard­less of the impli­ca­tions for pub­lic pol­i­cy. Remark­ably, sev­er­al sen­a­tors have stat­ed, explic­it­ly, that this is their cal­cu­lus.

    “You know, I could maybe give you ten rea­sons why this bill shouldn’t be con­sid­ered,” Iowa’s Chuck Grass­ley told reporters in his state Wednes­day. “But Repub­li­cans cam­paigned on this so often that you have a respon­si­bil­i­ty to car­ry out what you said in the cam­paign. That’s pret­ty much as much of a rea­son as the sub­stance of the bill.”

    Sen­a­tors are not sup­posed to sup­port leg­is­la­tion that they believe to be unwor­thy of con­sid­er­a­tion on sub­stan­tive grounds just because they promised their vot­ers that they would sup­port a bill of that gen­er­al type. The entire point of hav­ing a repub­lic — as opposed to a direct democ­ra­cy — is that the for­mer enables elect­ed rep­re­sen­ta­tives to exer­cise inde­pen­dent judge­ment in pol­i­cy-mak­ing.

    Still, as con­temptible as Grassley’s offi­cial ratio­nale for sup­port­ing Gra­ham-Cas­sidy is, his party’s actu­al moti­va­tion for push­ing the bill is (almost cer­tain­ly) more sin­is­ter. In truth, Gra­ham-Cas­sidy does not ful­fill the Repub­li­can Party’s promis­es to its vot­ers — and there is vir­tu­al­ly no evi­dence that said vot­ers would pun­ish the par­ty for fail­ing to pass it. The bill does, how­ev­er, advance the pri­or­i­ties of the GOP’s big-dol­lar donors — and there is sig­nif­i­cant evi­dence that they would pun­ish the Repub­li­can law­mak­ers if the leg­is­la­tion fails.

    It’s true that Repub­li­cans have spent near­ly a decade promis­ing vot­ers that they would “repeal and replace Oba­macare.” But most Repub­li­cans specif­i­cal­ly promised to replace the law with one that would make health-care ben­e­fits more gen­er­ous and uni­ver­sal­ly afford­able. Our Repub­li­can pres­i­dent promised to pre­serve Med­ic­aid in its cur­rent form and achieve uni­ver­sal cov­er­age with low­er deductibles. The mogul even went so far as to explic­it­ly dis­avow the con­ser­v­a­tive movement’s tra­di­tion­al hos­til­i­ty to the wel­fare state, telling 60 Min­utes, “There was a phi­los­o­phy in some cir­cles that if you can’t pay for it, you don’t get it. That’s not going to hap­pen with us.”

    Trump wasn’t the only one singing such a tune. Vir­tu­al­ly all of the GOP’s lead­ing lights attacked Oba­macare from the left, includ­ing Sen­ate Major­i­ty Leader Mitch McConnell, who lament­ed in Jan­u­ary, “There are 25 mil­lion Amer­i­cans who aren’t cov­ered now … And many Amer­i­cans who actu­al­ly did get insur­ance — when they did not have it before — have real­ly bad insur­ance that they have to pay for, and the deductibles are so high that it’s real­ly not worth much to them.”

    McConnell, Trump, and their co-par­ti­sans pre­tend­ed to sup­port a more gen­er­ous gov­ern­ment health pro­gram for a rea­son: That is what most Repub­li­can vot­ers want. Ear­li­er this year, a Morn­ing Con­sult sur­vey found that a major­i­ty of con­ser­v­a­tives — and a large plu­ral­i­ty of self-iden­ti­fied tea-par­ty sup­port­ers — thought that “the gov­ern­ment should spend more on health care.”

    Turns out Tea Par­ty vot­ers want more gov­ern­ment health­care spend­ing, yet sup­port Ryan’s health­care bill. Go fig­ure. https://t.co/y77gXZHn6j pic.twitter.com/VT7W2FqDPC— Guy Kawasa­ki (@GuyKawasaki) March 23, 2017

    Those find­ings are con­sis­tent with polling from Pew Research, which back in May found 61 per­cent of Repub­li­can vot­ers say­ing that gov­ern­ment fund­ing lev­els for health care should be main­tained or increased. Mean­while, accord­ing to a recent poll from the Kaiser Fam­i­ly Foun­da­tion, only 12 per­cent of all U.S. adults sup­port cuts to Med­ic­aid (which hap­pens to be about the per­cent­age of the pub­lic that sup­port­ed the Senate’s pre­vi­ous Med­ic­aid-gut­ting, Oba­macare-repeal bill).

    Gra­ham-Cas­sidy would cut fed­er­al spend­ing on insur­ance sub­sides and the Med­ic­aid expan­sion by an esti­mat­ed $243 bil­lion between 2020 and 2026. That is nei­ther what Repub­li­cans cam­paigned on, nor what their con­stituents want.

    But it is what their most afflu­ent donors want — or at least they believe it moves the ball in their desired direc­tion. While Repub­li­can vot­ers are broad­ly sup­port­ive of Med­ic­aid — and many GOP sen­a­tors from Med­ic­aid-expan­sion states have tout­ed their sup­port for the pol­i­cy — the con­ser­v­a­tive donor net­work fund­ed by the oil bil­lion­aires Charles and David Koch has been unequiv­o­cal in its oppo­si­tion to the fed­er­al pro­gram.

    “Our net­work vora­cious­ly opposed Med­ic­aid expan­sion in state after state,” Tim Phillips, head of the Koch-fund­ed non­prof­it Amer­i­cans for Pros­per­i­ty, told GOP donors at the Koch Network’s June retreat. “These Repub­li­cans who expand­ed Med­ic­aid were flat­ly wrong. So we’re going to con­tin­ue hold­ing these Repub­li­cans account­able.”

    At the same retreat, the Koch broth­ers them­selves com­plained that the Repub­li­can health-care bill — which, at the time, already includ­ed sig­nif­i­cant cuts to Med­ic­aid — was insuf­fi­cient­ly con­ser­v­a­tive. That bill failed, amid wide­spread pub­lic oppo­si­tion to its aus­ter­i­ty. Sen­ate Repub­li­cans respond­ed by draft­ing a new iter­a­tion of Trump­care that cuts Med­ic­aid — and sub­si­dies for health insur­ance — even more severe­ly.

    ...

    The notion that Repub­li­cans need to pass a bill that will increase the cost of health insur­ance — and break a vari­ety of sub­stan­tive promis­es to their con­stituents — for the sake of polit­i­cal expe­di­en­cy is bizarre. The only evi­dence for this view is that Repub­li­can vot­ers still sup­port “Oba­macare repeal.” But if GOP law­mak­ers want to vote for a health-care bill that breaks their sub­stan­tive promis­es to vot­ers — and call it “Oba­macare repeal” — they have bet­ter options.

    Days ago, Sen­ate Democ­rats offered to sup­port waivers that would allow red states to opt out of some Oba­macare reg­u­la­tions, in exchange for fund­ing to shore up the exchanges. This leg­is­la­tion would have avert­ed a sig­nif­i­cant spike in insur­ance pre­mi­ums next year — and, in keep­ing fed­er­al fund­ing for health-care con­stant, it would have been clos­er to the sub­stan­tive wish­es of GOP vot­ers than Gra­ham-Cas­sidy is. What’s more, some Democ­rats were pre­pared to let Pres­i­dent Trump call the mea­sure “Oba­macare repeal.”

    There is no rea­son to believe that the GOP’s polit­i­cal inter­ests would be bet­ter served by pass­ing a rad­i­cal bill that will increase health-insur­ance pre­mi­ums than by pass­ing a bipar­ti­san one that will reduce them — unless one stip­u­lates that doing the lat­ter would alien­ate big-dol­lar donors. Trump vot­ers over­whelm­ing­ly approved of the president’s bipar­ti­san debt-ceil­ing deal — and inde­pen­dents appear to have been even more enthu­si­as­tic.

    The GOP base is not aller­gic to bipar­ti­san­ship and com­pro­mise, so long as it’s their cham­pi­on who’s mak­ing the deals. But the Koch broth­ers are. The Kochs do not oppose Oba­macare because the pro­gram doesn’t work well enough — they oppose it because they find it moral­ly wrong for the state to take mon­ey from wealthy peo­ple and use it to sub­si­dize health insur­ance for non-wealthy peo­ple. Thus, tech­no­crat­ic fix­es that make gov­ern­ment-sub­si­dized health care work bet­ter are anti­thet­i­cal to their project. Their inter­est is not in improv­ing the Afford­able Care Act, but in dis­cred­it­ing the premise on which it is based: that redis­trib­u­tive gov­ern­ment pro­grams can improve health care for most Amer­i­cans.

    And the Kochs and their ilk have made clear that Repub­li­cans who buck them will face con­se­quences. This week, NBC News’ Kasie Hunt tweet­ed, “Repub­li­cans heard loud & clear from donors this August that do-noth­ing isn’t going to cut it.” At the Koch retreat in June, at least one major donor threat­ened to close “the Dal­las pig­gy bank” until repeal was passed. In August, one Repub­li­can donor respond­ed to the appar­ent death of Oba­macare repeal by actu­al­ly suing the par­ty for fraud.

    Repub­li­cans don’t need dona­tions from bil­lion­aires more than they need the votes of their base. But the for­mer pay far clos­er atten­tion to the details of pol­i­cy. On fis­cal mat­ters, it is much riski­er for Repub­li­cans to buck their donors than to betray the con­stituents who elect­ed them.

    Sen­ate Repub­li­cans are on the cusp of rad­i­cal­ly reform­ing our health-care sys­tem in ways that they do not ful­ly under­stand — and that indus­try stake­hold­ers and GOP vot­ers broad­ly oppose — out of fear that a few dozen obscene­ly wealthy lib­er­tar­i­ans will evict them from Con­gress if they don’t.

    If Gra­ham-Cas­sidy becomes law, our nation will enter a health-care cri­sis. But the fact that 40-some­thing sen­a­tors would vote for the bill, today, means that we have already entered a demo­c­ra­t­ic one.

    ———-

    “No One Wants the Lat­est Trump­care Bill — Except Right-Wing Bil­lion­aires” by Eric Levitz; New York Mag­a­zine; 09/22/2017

    “If Gra­ham-Cas­sidy becomes law, our nation will enter a health-care cri­sis. But the fact that 40-some­thing sen­a­tors would vote for the bill, today, means that we have already entered a demo­c­ra­t­ic one.”

    Yep, and that real cri­sis of democ­ra­cy that’s threat­en­ing to cre­ate a real health care cri­sis is The Swamp. And in this case, it’s a Koch Net­work-dom­i­nat­ed swamp where being The Swamp is an ide­o­log­i­cal imper­a­tive:

    ...
    There is no rea­son to believe that the GOP’s polit­i­cal inter­ests would be bet­ter served by pass­ing a rad­i­cal bill that will increase health-insur­ance pre­mi­ums than by pass­ing a bipar­ti­san one that will reduce them — unless one stip­u­lates that doing the lat­ter would alien­ate big-dol­lar donors. Trump vot­ers over­whelm­ing­ly approved of the president’s bipar­ti­san debt-ceil­ing deal — and inde­pen­dents appear to have been even more enthu­si­as­tic.

    The GOP base is not aller­gic to bipar­ti­san­ship and com­pro­mise, so long as it’s their cham­pi­on who’s mak­ing the deals. But the Koch broth­ers are. The Kochs do not oppose Oba­macare because the pro­gram doesn’t work well enough — they oppose it because they find it moral­ly wrong for the state to take mon­ey from wealthy peo­ple and use it to sub­si­dize health insur­ance for non-wealthy peo­ple. Thus, tech­no­crat­ic fix­es that make gov­ern­ment-sub­si­dized health care work bet­ter are anti­thet­i­cal to their project. Their inter­est is not in improv­ing the Afford­able Care Act, but in dis­cred­it­ing the premise on which it is based: that redis­trib­u­tive gov­ern­ment pro­grams can improve health care for most Amer­i­cans.
    ...

    And even a major­i­ty of Repub­li­can vot­ers don’t want to see the Koch Net­work’s pro-bil­lion­aire/an­ti-every­one-else poli­cies in this instance with health care. It’s a mas­sive vul­ner­a­bil­i­ty for the oli­garchs because they real­ly want to get rid of Oba­macare and gut Med­ic­aid. They want this intense­ly. It’s worth tril­lions of dol­lars to them in the long-run. But it’s also so incred­i­bly bad for the rest of the coun­try that even the right-wing media machine can’t sell its con­ser­v­a­tive audi­ences on this Trump­care mon­stros­i­ty.

    It’s a fas­ci­nat­ing dynam­ic because the per­ils of over­do­ing this Trump­care push are hard to over­state. The more this hap­pens the obvi­ous it is that the Repub­li­can Par­ty is The Swamp incar­nate. But tril­lions of dol­lars in reduced tax­es for the bil­lion­aires in com­ing decades from reduced health care spend­ing has got to be so damn tempt­ing. And those Med­ic­aid and Oba­macare cuts real­ly are going to be in the tril­lions. Ask­ing the GOP to com­mit short-to-medi­um-term polit­i­cal sui­cide over health care just might be worth it to the bil­lion­aires giv­en the scale of the cuts they are propos­ing. There’s always vot­er sup­pres­sion, elec­tron­ic vot­ing machine hack­ing, and oth­er forms of rig­ging that can help blunt the dam­age. Although maybe not at the state lev­el after Trump­care’s sched­ule for end­less Med­ic­aid becomes an issue in state-lev­el polit­i­cal races. There’s going to be a lot of vote rig­ging required by the GOP at the state-lev­el if Trump­care becomes law and Med­ic­aid cuts become a per­pet­u­al state issue..

    But The Swamp wants Trump­care, and the tril­lions in health care cuts it entails, to become real­i­ty and it wants it to become real­i­ty now. And accord­ing to the fol­low­ing report, The Swamp has spo­ken. To the GOP. In the form of rather pathet­ic dona­tions in recent months and the threat from the donor class that there won’t be future dona­tions if they don’t get some con­crete results.

    But even worse for the GOP, also accord­ing to the fol­low­ing report is that grass roots dona­tions to the GOP have also dried up in recent months with grass roots Repub­li­can donors express­ing their own frus­tra­tion with the GOP’s string of fail­ures. And as we’ve seen with health care, and it true too with issues like tax cuts, the donor class and the grass roots real­ly don’t want the same thing. That’s why Trump won the GOP pri­ma­ry so hand­i­ly. The grass­roots increas­ing­ly hates the donor class because their pro-bil­lion­aire poli­cies nev­er work out for any­one else. Even if the GOP grass­roots still gets fooled by the bil­lion­aires’ right-wing media infra­struc­ture on most issues they still haven’t been sold on Trump­care and much of that Trump base iden­ti­fies those bil­lion­aires with The Swamp. And the bil­lion­aires don’t care about piss­ing even the base off and are demand­ing Trump­care and mas­sive­ly unpop­u­lar Med­ic­aid cuts from their pet politi­cians or the donor spig­ot gets turned off. For a cabal of secre­tive right-wing oli­garchs who have spent decades build­ing a well-oiled Big Lie machine the health care debate is turn­ing out to be a sur­pris­ing­ly in-your-face les­son in how The Swamp oper­ates:

    The New York Times

    Behind New Oba­macare Repeal Vote: ‘Furi­ous’ G.O.P. Donors

    By CARL HULSE
    SEPT. 22, 2017

    WASHINGTON — As more than 40 sub­dued Repub­li­can sen­a­tors lunched on Chick-fil‑A at a closed-door ses­sion last week, Sen­a­tor Cory Gard­ner of Col­orado paint­ed a dire pic­ture for his col­leagues. Cam­paign fund-rais­ing was dry­ing up, he said, because of wide­spread dis­ap­point­ment among donors over the inabil­i­ty of the Repub­li­can Sen­ate to repeal the Afford­able Care Act or do much of any­thing else.

    Mr. Gard­ner is in charge of his party’s midterm re-elec­tion push, and he warned that donors of all stripes were refus­ing to con­tribute anoth­er pen­ny until the strug­gling major­i­ty pro­duced some con­crete results.

    “Donors are furi­ous,” one per­son knowl­edge­able about the pri­vate meet­ing quot­ed Mr. Gard­ner as say­ing. “We haven’t kept our promise.”

    The back­lash from big donors as well as the grass roots pan­icked Sen­ate Repub­li­cans and was part of the moti­va­tion behind the sud­den zeal to take one last crack at repeal­ing the health care law before the end of the month. That effort fal­tered Fri­day with new oppo­si­tion from Sen­a­tor John McCain of Ari­zona, the peren­ni­al mav­er­ick who had scut­tled the Senate’s first repeal effort. Now Repub­li­cans must con­front the pos­si­bil­i­ty that they will once again let down their back­ers with no big win in sight.

    The lat­est unsight­ly pile­up over health care was exact­ly what some Repub­li­cans had want­ed to avoid by aban­don­ing the repeal effort and skip­ping straight to tax cuts after the pre­vi­ous embar­rass­ing health care col­lapse about eight weeks ago. Instead, Sen­ate Repub­li­cans got caught up in a rushed, last-ditch repeal attempt that not only seems unlike­ly to pre­vail, but will only serve to remind dis­il­lu­sioned donors about the party’s gov­ern­ing dif­fi­cul­ties.

    This was not what Repub­li­cans had envi­sioned. Prepar­ing for the 2018 midterm elec­tions, they had thought they were in a strong posi­tion to main­tain or expand their major­i­ty. Democ­rats must defend 25 seats — includ­ing 10 in states won last year by Pres­i­dent Trump — while just eight Repub­li­can-held seats will be on the bal­lot. But their gov­ern­ing strug­gles — and attacks on con­gres­sion­al lead­ers by Mr. Trump — have soured their base, leav­ing the Sen­ate major­i­ty feel­ing des­per­ate.

    Address­ing his anx­ious col­leagues at their week­ly meet­ing on Sept. 12, Mr. Gard­ner had a sim­ple mes­sage: If we don’t have some­thing to run on, we are going to squan­der this oppor­tu­ni­ty.

    Repub­li­can sen­a­tors strive to keep dis­cus­sions at their week­ly lun­cheons secret to allow for can­did dis­cus­sions. This meet­ing was held off the Capi­tol grounds, at the head­quar­ters of the Nation­al Repub­li­can Sen­a­to­r­i­al Com­mit­tee, to enable a broad dis­cus­sion of pol­i­tics. Nei­ther law­mak­ers nor staff would go on the record to dis­cuss it, but the ses­sion was described by mul­ti­ple peo­ple knowl­edge­able about what occurred.

    They said Mr. Gard­ner did not specif­i­cal­ly urge approval of the so-called Gra­ham-Cas­sidy health pro­pos­al that Repub­li­cans were con­sid­er­ing bring­ing to the Sen­ate floor next week. He was seen as speak­ing more gen­er­al­ly and main­ly look­ing for­ward to the com­ing debate over tax cuts.

    But the fund-rais­ing drought has become a grow­ing wor­ry and law­mak­ers have not been ret­i­cent about not­ing that their polit­i­cal fate could be tied to the out­come on health care and how Sen­ate Repub­li­cans han­dle oth­er issues ahead.

    Sen­a­tor Charles E. Grass­ley of Iowa, who has been deeply involved in health pol­i­cy for years, told reporters back home that he could count 10 rea­sons the new health pro­pos­al should not reach the floor, but that Repub­li­cans need­ed to press ahead regard­less in order to ful­fill their long­stand­ing promise to replace and repeal Pres­i­dent Barack Obama’s Afford­able Care Act.

    “Repub­li­cans cam­paigned on this so often that we have a respon­si­bil­i­ty to car­ry out what you said in the cam­paign,” Grass­ley said in a con­fer­ence call with Iowa reporters. “That’s pret­ty much as much of a rea­son as the sub­stance of the bill.”

    Sen­a­tor Pat Roberts of Kansas, was even more blunt in a con­ver­sa­tion with Vox. “If we do noth­ing, it has a tremen­dous impact on the 2018 elec­tions, and whether or not Repub­li­cans still main­tain con­trol and we have the gav­el,” he said.

    Repub­li­cans say the fund-rais­ing drop-off has been steep and across the board, from big dona­tions to the small ones the par­ty solic­its online from the grass roots. They say the hos­tile views of both large and small donors are in unusu­al align­ment and that the neg­a­tive sen­ti­ment is crys­tal­lized in the fund-rais­ing decline.

    One par­ty offi­cial not­ed that Sen­ate Repub­li­cans had a lucra­tive March, rais­ing $7 mil­lion — an off-year record for the orga­ni­za­tion. But in the after­math of the failed health repeal effort before the August recess and oth­er set­backs, the take dropped to $2 mil­lion in July and August — a poor show­ing for a major­i­ty par­ty with a decid­ed advan­tage on the midterm map.

    The totals have left Repub­li­cans increas­ing­ly wor­ried about hav­ing the funds they need next year. Mr. Gard­ner told his col­leagues that a major Col­orado con­trib­u­tor who played a role in his own cam­paign says par­ty donors are reluc­tant to give any more mon­ey until con­gres­sion­al Repub­li­cans demon­strate results.

    ...

    Sen­ate Repub­li­cans are enter­ing a piv­otal week. They have been scram­bling to find the votes for the con­tentious new repeal effort before the Sept. 30 expi­ra­tion of spe­cial bud­get author­i­ty, which would allow the bill to pass with a sim­ple major­i­ty and not 60 votes. But Mr. McCain’s deci­sion to join at least two oth­er Repub­li­cans — Sen­a­tors Susan Collins of Maine and Rand Paul of Ken­tucky — in find­ing fault with the mea­sure put its fate in real per­il.

    If the bill is short of votes, Mr. McConnell could choose not to bring it to the floor at all to pre­vent a sec­ond embar­rass­ing defeat on health care and spare Repub­li­cans a dif­fi­cult vote.

    ...

    Repub­li­cans are also set to roll out their income tax over­haul plan next week in an effort to build sup­port for it and find some­thing the par­ty can deliv­er to the president’s desk. They see the tax plan as their best oppor­tu­ni­ty to win back the alle­giance of donors.

    With health care repeal tee­ter­ing yet again, the one thing they know for sure is that they need to show some accom­plish­ments, and they need to do so fast.

    ———-

    “Behind New Oba­macare Repeal Vote: ‘Furi­ous’ G.O.P. Donors” by CARL HULSE; The New York Times; 09/22/2017

    “Repub­li­cans say the fund-rais­ing drop-off has been steep and across the board, from big dona­tions to the small ones the par­ty solic­its online from the grass roots. They say the hos­tile views of both large and small donors are in unusu­al align­ment and that the neg­a­tive sen­ti­ment is crys­tal­lized in the fund-rais­ing decline.

    Every­one hates the GOP. The base was­n’t expect­ing Trump to offer a Koch-Clas­sic agen­da but that’s what they got. And the Koch Net­work isn’t get­ting the results it wants because its agen­da is so polit­i­cal­ly tox­ic it’s run­ning into resis­tance from with­in the GOP. And in this key health care debate the GOP is in the high­ly unfor­tu­nate sit­u­a­tion where they have to very open­ly and pub­licly choose between that base and That Swamp in big votes that the base is pay­ing atten­tion to and as this third attempt at Trump­care indi­cates the GOP Sen­a­tors are going to choose the donor class every time. The It’s only the McCain/Collins/Murkowski pack of hold­outs that’s pre­vent­ed Trump­care from becom­ing real­i­ty. And those donors have already indi­cat­ed to those Sen­a­tors the con­se­quences of not mak­ing Trum­care, an those tril­lions over the decades in Med­ic­aid cuts. The GOP­ers had bet­ter behave or else. The Swamp has spo­ken:

    ...
    One par­ty offi­cial not­ed that Sen­ate Repub­li­cans had a lucra­tive March, rais­ing $7 mil­lion — an off-year record for the orga­ni­za­tion. But in the after­math of the failed health repeal effort before the August recess and oth­er set­backs, the take dropped to $2 mil­lion in July and August — a poor show­ing for a major­i­ty par­ty with a decid­ed advan­tage on the midterm map.
    ...

    But The Swamp still isn’t look­ing like it’s going to get its way on the Gra­ham-Gas­sidy ver­sion of Trump­care because even this third attempt at Trump­care is so bad only The Swamp wants it.

    And note that while it might seem like we have stum­bled upon a great new way Trump is ‘drain­ing the swamp’ — by putting forth leg­is­la­tion so bad that only The Swamp could want it, Trump and the GOP are cre­at­ing leg­isla­tive no-win sit­u­a­tions where it’s a choice between dif­fer­ent form of polit­i­cal sui­cide and result­ing in a drop off in mega donor funds — don’t for­get that dry­ing up of big donor funds to the GOP isn’t a reflec­tion of a The Swamp’s giv­ing up on its attempt to wield its influ­ence influ­ence. Quite the oppo­site. Cut­ting off funds is the biggest pow­er play the Koch Net­work has because the GOP is large­ly built, owned and oper­at­ed by the Koch Net­work. There aren’t that many dif­fer­ent net­works of right-wing oli­garchs for the GOP to sell out to. The GOP is reliant on an oli­gop­oly monop­oly oth­er­wise known as The Swamp and the only thing stop­ping the imple­men­ta­tion The Swamp’s agen­da at this point is the polit­i­cal per­il asso­ci­at­ed with push­ing the kind of agen­da only The Swamp could love.

    #MAGA #Swamp­care

    Posted by Pterrafractyl | September 24, 2017, 10:03 pm
  12. So this hap­pened. Or rather, did­n’t hap­pen:

    Talk­ing Points Memo
    DC

    Which States Are Hit Hard­est By Fail­ure To Fund Children’s Health Pro­gram

    By Alice Oll­stein
    Pub­lished Octo­ber 2, 2017 2:36 pm

    Over the week­end, Con­gress allowed fund­ing for the Children’s Health Insur­ance Pro­gram (CHIP), which cov­ers near­ly 9 mil­lion chil­dren in low-income fam­i­lies, to lapse—failing to pass a reau­tho­riza­tion by Saturday’s dead­line after spend­ing most of the year attempt­ing to repeal the Afford­able Care Act.

    The expi­ra­tion of the pro­gram will not affect all states equal­ly. Some are already scram­bling to move mon­ey around to make sure no child sees their cov­er­age lapse while oth­ers have a healthy amount in reserves that will last them well into next year if Con­gress does not act.

    Though the Sen­ate will hold a markup on the reau­tho­riza­tion on Wednes­day, its pas­sage remains uncer­tain. The House has not yet unveiled its ver­sion of the bill, and a House Demo­c­ra­t­ic aide told TPM that while nego­ti­a­tions are ongo­ing, the par­ties are still fight­ing over whether to main­tain the same lev­el of the fed­er­al fund­ing match for CHIP and whether to require cuts to oth­er parts of the fed­er­al bud­get to off­set CHIP’s cost.

    “We have yet to reach an agree­ment,” the aide said. “It’s pret­ty upset­ting that the time trade­off has been an effort to repeal the Afford­able Care Act.”

    Accord­ing to an analy­sis by the Kaiser Fam­i­ly Foun­da­tion, 48 of 50 states, includ­ing DC, assumed Con­gress would reau­tho­rize CHIP when they wrote their 2018 state bud­gets. That mis­tak­en trust in Con­gress is already hav­ing major con­se­quences.

    At least 10 states are on track to run out of mon­ey by the end of 2017, and even those that can hold out into 2018 will pay a price.

    Joan Alk­er, the exec­u­tive direc­tor of the George­town Uni­ver­si­ty Cen­ter for Chil­dren and Fam­i­lies and an expert on CHIP, told TPM that the sever­i­ty depends on how long law­mak­ers drag their feet.

    “If Con­gress can get it done in the next cou­ple weeks, we could avoid some of the worst con­se­quences,” she said. “It’s hard to dis­en­tan­gle what the con­se­quences will be, but we will cer­tain­ly start see­ing them in Novem­ber.”

    Some states have laws on the books that would force them cap enroll­ment or end health cov­er­age for the CHIP pop­u­la­tion alto­geth­er if fed­er­al fund­ing laps­es. Oth­ers are antic­i­pat­ing cuts to oth­er CHIP-fund­ed pro­grams, includ­ing cov­er­age for low-income preg­nant women and chil­dren.

    With­out know­ing when Con­gress will act, Alk­er says sev­er­al states are torn about whether to send out notices to fam­i­lies warn­ing that cov­er­age could be cut off or enroll­ment frozen.

    ...

    Here are the states that may be hit the hard­est:

    Utah

    Utah’s senior Repub­li­can sen­a­tor Orrin Hatch (pic­tured above whis­per­ing with Sen­ate Major­i­ty Leader Mitch McConnell) chairs the com­mit­tee in charge of fund­ing CHIP. He told reporters last week that the pro­gram will be reau­tho­rized “short­ly,” but that will not be soon enough for his strug­gling state. Utah offi­cials have said that they will run out of fund­ing by the end of the year and are mak­ing plans to close the pro­gram, impact­ing upwards of 20,000 chil­dren.

    Min­neso­ta

    The com­mis­sion­er of Minnesota’s Depart­ment of Human Ser­vices, Emi­ly Piper, told her con­gres­sion­al del­e­ga­tion in Sep­tem­ber that with­out renewed fed­er­al fund­ing, she will have to take “extra­or­di­nary mea­sures” to pre­vent peo­ple from being kicked off of CHIP.

    “The preg­nant women cov­ered by CHIP would be at risk of los­ing cov­er­age alto­geth­er,” she wrote. “How­ev­er, we are explor­ing ways to con­tin­ue cov­er­age tem­porar­i­ly by car­ry­ing over FY 2017 CHIP funds so that their pre­na­tal and post­par­tum care con­tin­ues unin­ter­rupt­ed. This action, how­ev­er, comes with a sig­nif­i­cant finan­cial penal­ty.”

    That penal­ty, she esti­mates, will be a $10 mil­lion hit to the state’s gen­er­al fund.

    Ari­zona

    Arizona’s CHIP fund­ing, which pro­vides cov­er­age for more than 22,000 chil­dren, will run out by the end of the year if Con­gress does not pass a bill. Because the state passed a bill in 2016 that would force its CHIP pro­gram to halt new enroll­ment if the fed­er­al gov­ern­ment elim­i­nates fund­ing, the state is already warn­ing health insur­ers and fam­i­lies that they may imple­ment an enroll­ment freeze.

    The last time this hap­pened, dur­ing the Great Reces­sion in 2009, the rate of unin­sured chil­dren in Ari­zona climbed sharply.

    Texas

    Texas, which tem­porar­i­ly waived the fees fam­i­lies have to pay for CHIP in the wake of Hur­ri­cane Har­vey, could burn through its bud­get soon­er than pro­ject­ed, threat­en­ing health insur­ance for 390,000 chil­dren.

    West Vir­ginia

    State law requires West Vir­ginia to shut down its CHIP pro­gram if fed­er­al fund­ing lev­els drop by a cer­tain amount. They are cur­rent­ly scram­bling to get a legal inter­pre­ta­tion of whether that means this week or when the state exhausts its reserve fund­ing in ear­ly 2018.

    The state expects that about one-third of chil­dren enrolled in CHIP would become unin­sured with clo­sure of the pro­gram, unable to enroll either in a parent’s employ­ee insur­ance plan or on the indi­vid­ual mar­ket.

    Neva­da

    Should Con­gress’ inac­tion con­tin­ue, Neva­da is prepar­ing to freeze enroll­ment on Nov. 1 and end cov­er­age alto­geth­er on Nov. 30 for about 27,000 chil­dren.

    “We’d have to look at our options for lim­it­ing the ser­vices that are avail­able,” Nevada’s deputy admin­is­tra­tor for Med­ic­aid Cody Phin­ney told the Las Vegas Review-Jour­nal.

    “If Con­gress does not quick­ly reau­tho­rize CHIP, states like Neva­da will need to either send notices of ter­mi­na­tion to pro­gram ben­e­fi­cia­ries or devel­op alter­na­tive fund­ing,” Gov. Bri­an San­doval ® warned in a state­ment.

    The state leg­is­la­ture has not yet called a spe­cial ses­sion to plan for the poten­tial short­fall.

    ———-

    “Which States Are Hit Hard­est By Fail­ure To Fund Children’s Health Pro­gram” by Alice Oll­stein; Talk­ing Points Memo; 10/02/2017

    Though the Sen­ate will hold a markup on the reau­tho­riza­tion on Wednes­day, its pas­sage remains uncer­tain. The House has not yet unveiled its ver­sion of the bill, and a House Demo­c­ra­t­ic aide told TPM that while nego­ti­a­tions are ongo­ing, the par­ties are still fight­ing over whether to main­tain the same lev­el of the fed­er­al fund­ing match for CHIP and whether to require cuts to oth­er parts of the fed­er­al bud­get to off­set CHIP’s cost.”

    So the Sen­ate neglect­ed to reau­tho­rize the CHIP health care pro­gram for chil­dren but still might do it on Wednes­day. And then all that needs to hap­pen of for the House to unveil its ver­sion and pass it too. But then there’s still the debate over whether or not the reau­tho­riza­tion of the fed­er­al pro­gram for chil­dren’s health care will neces­si­tate cuts else­where. A ‘debate’ that looks strik­ing­ly like tak­ing health care for chil­dren hostage in order to extract fed­er­al bud­get cuts. And this ‘debate’ is hap­pen­ing at the same time the GOP is try­ing to ped­dling its bud­get-bust­ing tax cut for the mega-rich. It’s not the best look for the GOP.

    But who knows, maybe that reau­tho­riza­tion will all sud­den­ly fall into place and pass both cham­bers of Con­gress and states like Neva­da won’t be forced to drop cov­er­age for 27,000 chil­dren at the end of Novem­ber. Maybe. Or maybe not and all these bad things will hap­pen. To chil­dren. Don’t for­get, the GOP isn’t just try­ing to block grant Med­ic­aid. It’s try­ing to simul­ta­ne­ous­ly put into place a sched­ule to cut the fed­er­al gov­ern­men­t’s pay­ments into Med­ic­aid, year after year, for decades to come. That’s part of why it’s so dire. And if the GOP pre­vails on health care every state sin­gle state is going to be deal with “should we cut this health care pro­gram or cut spend­ing else­where?” ques­tions for all sorts of pro­grams year after year. For the fore­see­able future. In oth­er words, yes, the GOP appears to be on the verge of allow­ing the fed­er­al gov­ern­men­t’s chil­dren’s health pro­gram to lapse which would sud­den­ly thrust this bur­den onto states that typ­i­cal­ly can’t afford it, but don’t for­get that the total­i­ty of the cuts the GOP the has in mind for these kids includes their adult years too.

    When you’re try­ing to per­ma­nent­ly erode the gov­ern­men­t’s role in the health care safe­ty net the kids inevitably expe­ri­ence the deep­est cuts. Over the course of their entire lives.

    Posted by Pterrafractyl | October 2, 2017, 10:19 pm
  13. Heads up, US health insur­ance pre­mi­ums might be about to go up. A lot. Soon. And it’s all thanks to Pres­i­dent Trump’s sur­prise dou­ble shiv­ving deliv­ered against Oba­macare last week.

    The first blow came in the form of an exec­u­tive order signed on Thurs­day that imple­ments two strate­gies long demand­ed by the right-wing as a cure all solu­tion to ris­ing health care costs: let poli­cies be sold across state lines and let com­pa­nies form coop­er­a­tives across state lines and let states opt out of Oba­macare reg­u­la­tions that avoid cheap, use­less junk plans that hard­ly cov­ered any­thing and pre­cip­i­tat­ed med­ical bank­rupt­cies. By doing these two things at once this will will some­how mag­i­cal­ly unleash mar­ket forces that are sup­posed to cre­ate all sorts of cut­throat com­pe­ti­tion and super cheap that main­tain the qual­i­ty of the health care pro­vid­ed while low­er­ing costs for every­one. In the­o­ry. Specif­i­cal­ly, in crack­pot the­o­ry because this is almost cer­tain­ly going to desta­bi­lize insur­ance mar­kets and cause pre­mi­um spikes in real­i­ty:

    Talk­ing Points Memo
    DC

    If O’Care Exec­u­tive Order Does What Trump Hopes, It Will Cost Gov’t Mon­ey

    By Tier­ney Sneed
    Pub­lished Octo­ber 12, 2017 3:32 pm

    It’s hard to pre­dict the effect of an exec­u­tive order aimed at under­min­ing Oba­macare that Pres­i­dent Trump signed Thurs­day, as the order was vague and left most of the details to the rel­e­vant depart­ments writ­ing the reg­u­la­tions.

    But there’s at least one claim Trump made dur­ing the sign­ing cer­e­mo­ny that prob­a­bly won’t pan out: “This will cost the Unit­ed States gov­ern­ment vir­tu­al­ly noth­ing,” he promised, while vow­ing peo­ple “will have great, great health care.”

    Such a claim is at odds with the stat­ed goals of the order and how it would affect gov­ern­ment spend­ing relat­ed to the Afford­able Care Act.

    The key dynam­ic is that as the Trump admin­is­tra­tion seeks to make it eas­i­er for young, healthy peo­ple to access non-Oba­macare com­pli­ant plans, the pre­mi­ums for the sick­er peo­ple left in ACA exchanges will rise. And for a vast major­i­ty of those enrollees, the gov­ern­ment will be on the tab for pay­ing that increase, due to the Oba­macare tax cred­its that are pegged to growth in pre­mi­ums.

    “Effec­tive­ly by reduc­ing the num­ber of healthy peo­ple in the mar­ket­places, you’re increas­ing the lia­bil­i­ty for fed­er­al tax­pay­ers to pick up more of the cost of that pre­mi­um,” said Sab­ri­na Cor­lette, a researcher at George­town University’s Health Pol­i­cy Insti­tute.

    The order directs rel­e­vant agen­cies to con­sid­er rewrit­ing reg­u­la­tions relat­ed to three major issues: health asso­ci­a­tion plans, short-term lim­it­ed dura­tion insur­ance, and health sav­ings accounts.

    It’s hard to know exact­ly how the months-long rule-mak­ing process will shake out, but the gen­er­al goal is to make it eas­i­er for peo­ple to buy plans that don’t have to meet “very expan­sive and expen­sive Oba­macare cov­er­age man­dates and rules,” as Trump put it Thurs­day.

    For instance, Trump is direct­ing his admin­is­tra­tion to allow peo­ple to use short term insur­ance for longer than the three months allowed by Oba­ma-era reg­u­la­tions.

    “The real effect of this exec­u­tive order depends almost entire­ly on the details in reg­u­la­tions that are yet to come,” Lar­ry Levitt, vice pres­i­dent at Kaiser Fam­i­ly Foun­da­tion, said in an email to TPM. “But there’s no ques­tion the order could have an effect on gov­ern­ment costs. If short-term insur­ance plans expand, they’ll cher­ry pick healthy peo­ple and leave a sick­er pool of peo­ple in the ACA mar­ket­place. Pre­mi­ums in mar­ket­place plans would rise, and gov­ern­ment sub­si­dies would rise as well, since they’re tied to pre­mi­ums.”

    The White House seems to acknowl­edge the effect on pre­mi­ums — and how the tax cred­its will have to rise with them — in a fact sheet obtained by The Hill.

    “Near­ly nine-in-ten peo­ple with an exchange plan receive pre­mi­um tax cred­its and will large­ly be unaf­fect­ed by this EO,” it said. “Peo­ple who receive tax cred­its are insu­lat­ed from bear­ing the cost of the high­er pre­mi­um since the cred­it lim­its the amount of income they pay for a bench­mark plan.”

    The oth­er main areas of the order could exac­er­bate this trend. If indi­vid­u­als are allowed to par­tic­i­pate in health asso­ci­a­tion plans, the pre­mi­ums in the ACA exchanges stand to become more expen­sive for rea­sons akin to the effort to expand short term insur­ance. (The order, how­ev­er, only men­tions busi­ness’ abil­i­ty to access the asso­ci­a­tion health plans, which would allow employ­ers to band with sim­i­lar busi­ness­es across state lines to cre­ate their own poli­cies.)

    Even the push to expand health sav­ings accounts may cause pre­mi­ums to rise, accord­ing to Tim­o­thy Jost, a health care law spe­cial­ist at Wash­ing­ton and Lee Uni­ver­si­ty. That could incen­tivize “large employ­ers to dump unhealthy peo­ple into the exchanges,” he said, with the sim­i­lar effect of mak­ing the risk pool more cost­ly for insur­ers to cov­er.

    Unlike the var­i­ous leg­isla­tive Oba­macare repeal pro­pos­als, we don’t have a Con­gres­sion­al Bud­get Office score to ana­lyze the order’s cost to gov­ern­ment. How­ev­er, a CBO score of what would hap­pen if Trump stopped pay­ing cer­tain sub­si­dies to insur­ers — which would have a sim­i­lar effect of rais­ing pre­mi­ums, if by dif­fer­ent means — shows how such mea­sures end up being cost­ly to the gov­ern­ment. That move, and the 25 per­cent hike in pre­mi­ums it would cause, would add near­ly $200 bil­lion to the deficit over the next 10 years, the CBO found.

    Jost warned, how­ev­er, that the exec­u­tive order’s short-term cost to the gov­ern­ment could come with long-term chaos that could send insur­ers flee­ing from the mar­ket­places, sig­nif­i­cant­ly shrink­ing the total Oba­macare enroll­ment.

    ...

    ———-


    “If O’Care Exec­u­tive Order Does What Trump Hopes, It Will Cost Gov’t Mon­ey” by Tier­ney Sneed; Talk­ing Points Memo; 10/12/2017

    “The key dynam­ic is that as the Trump admin­is­tra­tion seeks to make it eas­i­er for young, healthy peo­ple to access non-Oba­macare com­pli­ant plans, the pre­mi­ums for the sick­er peo­ple left in ACA exchanges will rise. And for a vast major­i­ty of those enrollees, the gov­ern­ment will be on the tab for pay­ing that increase, due to the Oba­macare tax cred­its that are pegged to growth in pre­mi­ums.”

    Yep, it’s basi­cal­ly an exec­u­tive order designed to desta­bi­lize Oba­macare by siphon­ing the young and healthy into cheap non-Oba­macare-com­pli­ant junk plans, leav­ing just the old­er and less healthy pop­u­la­tions in the Oba­macare-com­pli­ant plans that will inevitably become more expen­sive when all the young and healthy peo­ple leave. It’s the kind of desta­bi­liza­tion that’s going to inevitably spike the pre­mi­ums of those Oba­macare-com­pli­ant plans, and because those plans also get tax cred­its that rise as pre­mi­ums rise that means we should expect gov­ern­ment pay­outs for these tax cred­its to spike along with the pre­mi­ums. So this exec­u­tive order is designed to effec­tive­ly sub­si­dize the desta­bi­liza­tion of the US health insur­ance mar­kets.

    What’s it going to cost? We don’t know, but to get a ball­park sense of the poten­tial costs, we can look at the CBO’s pro­jec­tions for the cost to the gov­ern­ment from high­er pre­mi­ums that would result from the cut­ting off of the cost-shar­ing reduc­tions (CSRs) sub­si­dies the gov­ern­ment pays to insur­ance com­pa­nies to sub­si­dize the pre­mi­ums for the poor. When the CBO exam­ined that back in August it point­ed to a very sim­i­lar dynam­ic: end­ing the sub­si­dies to the insur­ance com­pa­nies would just raise pre­mi­ums, which would sim­ply increase dif­fer­ent sub­si­dies Oba­macare pays to direct­ly to low income Oba­macare plan enrollees. So what did the CBO project the end of those CSR sub­si­dies would cost the gov­ern­ment?

    ...
    Unlike the var­i­ous leg­isla­tive Oba­macare repeal pro­pos­als, we don’t have a Con­gres­sion­al Bud­get Office score to ana­lyze the order’s cost to gov­ern­ment. How­ev­er, a CBO score of what would hap­pen if Trump stopped pay­ing cer­tain sub­si­dies to insur­ers — which would have a sim­i­lar effect of rais­ing pre­mi­ums, if by dif­fer­ent means — shows how such mea­sures end up being cost­ly to the gov­ern­ment. That move, and the 25 per­cent hike in pre­mi­ums it would cause, would add near­ly $200 bil­lion to the deficit over the next 10 years, the CBO found.
    ...

    $200 bil­lion over ten years more in sub­si­dies paid out direct­ly to low-income peo­ple as a result of the pro­ject­ed 25 per­cent pre­mi­um hikes that would be a con­se­quence of end­ing the sub­si­dies to the insur­ance com­pa­nies. That’s was the CBO’s pro­ject­ed cost to the gov­ern­ment if the Trump team stopped pay­ing sub­si­dies to insur­ers. So while we don’t have a CBO pro­jec­tion for the exec­u­tive order cut­ting off tax cred­its for peo­ple who earn too much for the direct sub­si­dies it’s still pret­ty clear that we’re talk­ing about pay­ing more mon­ey to desta­bi­lize the health insur­ance mar­kets.

    It’s also worth not­ing that we can also be con­fi­dent And how do we know pre­mi­ums will rise? Because that’s what keeps hap­pen­ing when the GOP pulled all the oth­er stunts designed to desta­bi­lize Oba­macare over the years. When Mar­co Rubio man­aged to get the “risk cor­ri­dor” cost-shar­ing plan elim­i­nat­ed at the end of 2015, insur­ance com­pa­nies raised pre­mi­ums in response. It was a gam­bit based on desta­bi­liz­ing Oba­macare, com­plain­ing about the result­ing pre­mi­um increase, and hop­ing the pub­lic does­n’t notice it was the GOP who caused it. And in the case of Mar­co Rubio that gam­bit appeared to com­plete­ly pay off. His suc­cess­ful act of sab­o­tage has large­ly remained unno­ticed by the broad­er pub­lic while Rubio got to qui­et­ly brag about “wip­ing out” the “bailouts” for insur­ance com­pa­nies. When the GOP desta­bi­lizes Oba­macare pre­mi­ums rise. It’s empir­i­cal.

    And all that mar­ket desta­bi­liza­tion will prob­a­bly emerge from just the first exec­u­tive order Trump signed that desta­bi­lized Oba­macare. Then there’s the sec­ond exec­u­tive order. And, of course, it’s an order to cut the do the very same thing that the CBO said would raise pre­mi­ums and cost the gov­ern­ment $200 bil­lion more in as a result of those raised pre­mi­ums: refus­ing to approve the cost-shar­ing reduc­tions (CSRs) sub­si­dies to insur­ance com­pa­nies designed to keep pre­mi­ums down for low-income indi­vid­u­als.

    Yes, Trump is seri­ous­ly hold­ing sub­si­dies for the poor hostage in order to force some sort of leg­isla­tive action on repeal­ing Oba­macare and replac­ing it with the wild­ly unpop­u­lar Trump­care. He even tweet­ed about it:

    The Democ­rats Oba­maCare is implod­ing. Mas­sive sub­sidy pay­ments to their pet insur­ance com­pa­nies has stopped. Dems should call me to fix!— Don­ald J. Trump (@realDonaldTrump) Octo­ber 13, 2017

    “Dems should call me to fix!”

    The pres­i­dent is pub­licly shak­ing down the pub­lic in the name of ‘pop­ulism’. This is hap­pen­ing.

    But it does­n’t hap­pen right away. The exec­u­tive order does­n’t imme­di­ate­ly end the sub­si­dies. Instead, it forces con­gress to autho­rize them instead. And that means the same dynam­ic that’s pre­vent­ed any sig­nif­i­cant leg­is­la­tion on health care from pass­ing con­gress so far this year is going to be in effect for this deci­sion too. As GOP Sen­a­tor John Cornyn recent­ly put it in the fol­low­ing arti­cle, if the Democ­rats want to see these sub­si­dies approved by the GOP-con­trolled con­gress, they’re going to have to give some real con­ces­sions. The way Cornyn sees it, even if the Democ­rats agree to give states more pow­er to issue waivers (allow­ing junk poli­cies to be sold), that con­ces­sion “seems pret­ty light.” Cornyn was much, much deep­er con­ces­sions. And he’s pre­sum­ably speak­ing for a num­ber of GOP­ers on this mat­ter. And that means if con­gress is actu­al­ly going to approve these sub­si­dies and avoid fur­ther mar­ket desta­bi­liza­tion, the Democ­rats are prob­a­bly going to have to agree to an array of oth­er GOP reforms that prob­a­bly desta­bi­lize Oba­macare too. Maybe not the same form of desta­bi­liza­tion as an end to the CSRs, but some type of desta­bi­liza­tion that inevitably ends up desta­bi­liz­ing the mar­kets and caus­ing pre­mi­ums to spike for any­one who isn’t young and/or healthy. Con­ces­sions that are so desta­bi­liz­ing it will be unclear what’s worse, accept­ing the com­pro­mise or turn­ing it down and los­ing the CSRs. That’s what we can expect if his­to­ry is our guide, which is why this sec­ond exec­u­tive order is such a huge prob­lem for con­gres­sion­al GOP­ers: they are unfit for han­dling this kind of respon­si­bil­i­ty. It’s empir­i­cal at this point:

    The Hill

    Trump hands Repub­li­cans a new Oba­maCare prob­lem

    By Peter Sul­li­van and Alexan­der Bolton
    10/14/17 06:00 AM EDT

    Key Repub­li­can mem­bers of Con­gress want to restore the Oba­maCare pay­ments, known as cost-shar­ing reduc­tions (CSRs), that Pres­i­dent Trump is end­ing, fear­ing the impact his move will have on the indi­vid­ual insur­ance mar­ket and their con­stituents. But there are obsta­cles ahead.

    Still, even if Democ­rats grant con­ces­sions, there’s no guar­an­tee a health-care deal can pass Con­gress. Con­ser­v­a­tives warn the pay­ments to insur­ers are cor­po­rate “bailouts,” a mes­sage echoed by Trump on Fri­day.

    “The Democ­rats Oba­maCare is implod­ing. Mas­sive sub­sidy pay­ments to their pet insur­ance com­pa­nies has stopped,” Trump tweet­ed.

    Trump warned Con­gress dur­ing the months-long debate over leg­is­la­tion to repeal and replace Oba­maCare that he would let the sys­tem implode if law­mak­ers failed to pass a bill. He made good on his vow this week.

    Sen­ate Repub­li­cans made clear before leav­ing Wash­ing­ton for a week­long Colum­bus Day recess that they were not fans of sim­ply let­ting Oba­maCare fall apart.

    “I’m not for fur­ther com­pli­cat­ing the lives of Tex­ans just to make a point,” Sen­ate Major­i­ty Whip John Cornyn (R‑Texas) said when asked before the recess about the argu­ment from some Repub­li­cans that Oba­maCare should be allowed to fail.

    Cornyn not­ed that Sen­ate Health Com­mit­tee Chair­man Lamar Alexan­der (R‑Tenn.) was in talks with Sen. Pat­ty Mur­ray (Wash.), the rank­ing Demo­c­rat on the com­mit­tee, over autho­riz­ing insur­ance mar­ket sta­bi­liza­tion pay­ments in exchange for mar­ket reforms, such as grant­i­ng states waivers from ObamaCare’s reg­u­la­to­ry require­ments.

    Yet Cornyn also said he wants real con­ces­sions from Democ­rats. Sim­ply giv­ing states more pow­er to waive ObamaCare’s insur­ance reg­u­la­tions, he said, “seems pret­ty light.”

    A spokesman for Cornyn said Fri­day that his boss had not yet weighed in on Trump’s deci­sion to end the Oba­maCare pay­ments, adding that his pre­vi­ous state­ment did not nec­es­sar­i­ly reflect his views of this week’s action.

    Con­gres­sion­al Repub­li­cans are split on whether they think Con­gress should act to fund the pay­ments. Some say they want to main­tain sta­bil­i­ty and pro­tect peo­ple who are enrolled.

    “[Trump] right­ful­ly put the bur­den where it belongs and that’s in Con­gress and Con­gress has to deal with this prob­lem,” Rep. Tom Reed (R‑N.Y.) told The Hill on Fri­day. Reed has pro­posed a bipar­ti­san pack­age in the House to fund the CSR pay­ments, as well as make right-lean­ing changes like repeal­ing ObamaCare’s med­ical device tax.

    “If Con­gress does­n’t get it done, the peo­ple who suf­fer are the peo­ple back home,” Reed added.

    Oth­er mod­er­ate House Repub­li­cans, like Reps. Leonard Lance (R‑N.J.) and Car­los Curbe­lo (R‑Fla.), who both face tough reelec­tion races, also called Fri­day for Con­gress to fund the pay­ments.

    The pay­ments reim­burse insur­ers for giv­ing dis­counts to low-income Oba­maCare enrollees. With­out the funds, insur­ers could drop out of the mar­ket or spike pre­mi­ums, caus­ing chaos.

    Some Repub­li­cans fear that their par­ty will be blamed for chaos in the mar­ket. Strate­gists warn that if health-care pre­mi­ums spike as a result of Trump end­ing the insur­ance pay­ments, can­di­dates will pay a price at the polls in 2018, when the House could be up for grabs.

    “What polit­i­cal par­ty would want to hold a bro­ken health-care sys­tem?” said John Weaver, a polit­i­cal strate­gist who advised Ohio Gov. John Kasich’s 2016 pres­i­den­tial cam­paign.

    “Trump took the health-care sys­tem hostage and shot it, so now Repub­li­cans are going to own this mov­ing for­ward. On top of every­thing else they’re fac­ing in the midterm [elec­tion], it’s an unmit­i­gat­ed polit­i­cal dis­as­ter,” he added.

    Democ­rats say Trump’s deci­sion will be “dev­as­tat­ing” and pre­dict pre­mi­ums will increase by 20 to 25 per­cent.

    On the oth­er side of the debate, con­ser­v­a­tive Rep. Jim Jor­dan (R‑Ohio) told The Hill that “heck no,” he doesn’t sup­port Con­gress fund­ing the pay­ments, which he called “a bailout to insur­ance com­pa­nies.”

    Jor­dan said the con­ser­v­a­tive House Free­dom Cau­cus has not yet dis­cussed the issue in depth, but “my guess is most mem­bers are going to have real prob­lems with these CSR pay­ments.”

    Mean­while, Alexan­der and Mur­ray are in the midst of bipar­ti­san nego­ti­a­tions over a bill to sta­bi­lize Oba­maCare, which would include fund­ing the CSR pay­ments. In exchange, Alexan­der is push­ing for giv­ing states more flex­i­bil­i­ty through expand­ing waivers to inno­vate and change Oba­maCare rules.

    Mur­ray said Fri­day she is “opti­mistic” about the nego­ti­a­tions and believes a deal could be reached “quick­ly.”

    A stick­ing point has been how much to expand the waivers for states. Alexan­der has been call­ing for more flex­i­bil­i­ty than Democ­rats, who wor­ry about main­tain­ing pro­tec­tions like min­i­mum stan­dards for what an insur­ance plan must cov­er. Repub­li­cans say sub­stan­tive changes to the waivers are need­ed, not just speed­ing up the process for states to be approved for a waiv­er.

    Still, Democ­rats expressed hope that a deal could be announced as soon as next week. Staff-lev­el dis­cus­sions have been ongo­ing.

    Sen. Mike Rounds (R‑S.D.), who worked for years in the insur­ance busi­ness before start­ing a sec­ond career in pol­i­tics, said before the recess that Con­gress couldn’t sim­ply let Oba­maCare fail with­out find­ing ways to pro­tect peo­ple from the fall­out.

    “When this fails, and it will fail, this is going to impact the lives of real peo­ple, and I think we should be doing every­thing we can to find an alter­na­tive so real peo­ple don’t get hurt,” he told The Hill.

    He dou­bled down on that posi­tion Fri­day.

    Pres­i­dent Trump’s deci­sion to end cost-shar­ing reduc­tion pay­ments has the poten­tial to impact 17,000 South Dakotans direct­ly and to cre­ate tur­bu­lence in the indi­vid­ual mar­ket. That is why I have been work­ing with a bipar­ti­san group of sen­a­tors to try to resolve this issue,” he said in a state­ment.

    Rounds has been talk­ing to Alexan­der, Mur­ray and Sen. Angus King (I‑Maine) about a deal to autho­rize the cost-shar­ing sub­si­dies in exchange for insur­ance mar­ket reforms.

    Trump on Thurs­day also signed an exec­u­tive order to allow Amer­i­cans to pur­chase insur­ance across state lines, a reform that con­ser­v­a­tive pol­i­cy experts have long espoused.

    But Rounds, based on his expe­ri­ence sell­ing insur­ance, doubts that will work in prac­tice. He says peo­ple liv­ing in New York City, which has high health-care costs, won’t be able to buy rel­a­tive­ly cheap plans from a state with low­er costs such as South Dako­ta because it won’t make eco­nom­ic sense for insur­ance com­pa­nies.

    Demo­c­ra­t­ic lead­ers are look­ing for a vehi­cle to get any poten­tial deal passed. House Demo­c­ra­t­ic Leader Nan­cy Pelosi (Calif.) on Fri­day float­ed attach­ing the pay­ments to a com­ing dis­as­ter spend­ing bill or the larg­er gov­ern­ment fund­ing bill, known as an omnibus, in Decem­ber.

    “I think we’re going to have a very good oppor­tu­ni­ty in the omnibus to get this done in a bipar­ti­san way if we can’t get it done soon­er,” Sen­ate Demo­c­ra­t­ic Leader Charles Schumer (N.Y.) told reporters Fri­day.

    Trump has indi­cat­ed that he sees the pay­ments as a bar­gain­ing chip.

    “I will say that the Democ­rats should come to me; I would even go to them,” Trump said Fri­day. “Because I’m only inter­est­ed in one thing: get­ting great health care for this coun­try.”

    ———-

    “Trump hands Repub­li­cans a new Oba­maCare prob­lem” by Peter Sul­li­van and Alexan­der Bolton; The Hill; 10/14/2017

    “Still, even if Democ­rats grant con­ces­sions, there’s no guar­an­tee a health-care deal can pass Con­gress. Con­ser­v­a­tives warn the pay­ments to insur­ers are cor­po­rate “bailouts,” a mes­sage echoed by Trump on Fri­day.”

    That’s right, some GOP­ers might not be open to any com­pro­mise at all. Because that’s how much they hate sub­si­dies intend­ed to help the poor.

    But even those that might be open to com­pro­mise might not be open to a rea­son­able com­pro­mise. As Sen­a­tor Cornyn not­ed, Demo­c­ra­t­ic Sen­a­tor Pat­ty Mur­ray was already in dis­cus­sions with GOP Sen­a­tor Lamar Alexan­der over autho­riz­ing insur­ance mar­ket sta­bi­liza­tion pay­ments in exchange for mak­ing state waivers (waivers designed to make junk plans avail­able, which will desta­bi­lize mar­kets) eas­i­er to obtain. So Democ­rats are appar­ent­ly will­ing to make a pret­ty mas­sive con­ces­sion since these state waivers are a means of severe­ly gut­ting the patient pro­tec­tions in Oba­macare on a state-by-state bases. But Cornyn see this con­ces­sion as “pret­ty light”:

    ...
    Sen­ate Repub­li­cans made clear before leav­ing Wash­ing­ton for a week­long Colum­bus Day recess that they were not fans of sim­ply let­ting Oba­maCare fall apart.

    “I’m not for fur­ther com­pli­cat­ing the lives of Tex­ans just to make a point,” Sen­ate Major­i­ty Whip John Cornyn (R‑Texas) said when asked before the recess about the argu­ment from some Repub­li­cans that Oba­maCare should be allowed to fail.

    Cornyn not­ed that Sen­ate Health Com­mit­tee Chair­man Lamar Alexan­der (R‑Tenn.) was in talks with Sen. Pat­ty Mur­ray (Wash.), the rank­ing Demo­c­rat on the com­mit­tee, over autho­riz­ing insur­ance mar­ket sta­bi­liza­tion pay­ments in exchange for mar­ket reforms, such as grant­i­ng states waivers from ObamaCare’s reg­u­la­to­ry require­ments.

    Yet Cornyn also said he wants real con­ces­sions from Democ­rats. Sim­ply giv­ing states more pow­er to waive ObamaCare’s insur­ance reg­u­la­tions, he said, “seems pret­ty light.”

    A spokesman for Cornyn said Fri­day that his boss had not yet weighed in on Trump’s deci­sion to end the Oba­maCare pay­ments, adding that his pre­vi­ous state­ment did not nec­es­sar­i­ly reflect his views of this week’s action.
    ...

    “Yet Cornyn also said he wants real con­ces­sions from Democ­rats. Sim­ply giv­ing states more pow­er to waive ObamaCare’s insur­ance reg­u­la­tions, he said, “seems pret­ty light.””

    Don’t for­get, with­in the GOP Cornyn sort of rep­re­sents the mod­er­ate fac­tion in this mess and he appears to want much more in terms of con­ces­sions that will desta­bi­lize mar­kets if he’ll sup­port financ­ing these cost-shar­ing sub­si­dies. It’s omi­nous.

    Although there’s still the GOP fac­tion work­ing with Lamar Alexan­der and Pat­ty Mur­ray on the bipar­ti­san ‘com­pro­mise (with more state waivers)’ deal and that includes Sen­a­tor Mike Rounds of South Dako­ta, who used to work in the insur­ance indus­try. As Rounds points out, along with vir­tu­al­ly all oth­er hon­est experts, if those sub­si­dies aren’t restored this is only going to harm US con­sumers:

    ...
    Sen. Mike Rounds (R‑S.D.), who worked for years in the insur­ance busi­ness before start­ing a sec­ond career in pol­i­tics, said before the recess that Con­gress couldn’t sim­ply let Oba­maCare fail with­out find­ing ways to pro­tect peo­ple from the fall­out.

    “When this fails, and it will fail, this is going to impact the lives of real peo­ple, and I think we should be doing every­thing we can to find an alter­na­tive so real peo­ple don’t get hurt,” he told The Hill.

    He dou­bled down on that posi­tion Fri­day.

    Pres­i­dent Trump’s deci­sion to end cost-shar­ing reduc­tion pay­ments has the poten­tial to impact 17,000 South Dakotans direct­ly and to cre­ate tur­bu­lence in the indi­vid­ual mar­ket. That is why I have been work­ing with a bipar­ti­san group of sen­a­tors to try to resolve this issue,” he said in a state­ment.

    Rounds has been talk­ing to Alexan­der, Mur­ray and Sen. Angus King (I‑Maine) about a deal to autho­rize the cost-shar­ing sub­si­dies in exchange for insur­ance mar­ket reforms.
    ...

    ““Pres­i­dent Trump’s deci­sion to end cost-shar­ing reduc­tion pay­ments has the poten­tial to impact 17,000 South Dakotans direct­ly and to cre­ate tur­bu­lence in the indi­vid­ual mar­ket. That is why I have been work­ing with a bipar­ti­san group of sen­a­tors to try to resolve this issue,” he said in a state­ment.”

    Tur­bu­lence in the indi­vid­ual mar­ket isn’t what most Trump vot­ers were prob­a­bly vot­ing for, but it’s what they’re going to get if Con­gress does­n’t approve those cost-shar­ing reduc­tion pay­ments for low-income Amer­i­cans and Sen­a­tor Rounds, who worked in this indus­try, is pub­licly point­ing this out. He’s def­i­nite­ly get­ting a Ban­non-select­ed pri­ma­ry chal­lenger in 2020. Espe­cial­ly since Rounds also point­ed out that Trump’s first exec­u­tive order, allow­ing (soon-to-be-junk) plans to be sold across state lines, is going to be desta­bi­liz­ing too...because insur­ance com­pa­nies in low-cost states aren’t going to offer low-cost plans in high-cost states like New York, where Rounds sold insur­ance because it’s not going to make eco­nom­ic sense for these com­pa­nies to do so (it’s not that easy to just move into a new state in the health care provider mar­ket):

    ...
    Trump on Thurs­day also signed an exec­u­tive order to allow Amer­i­cans to pur­chase insur­ance across state lines, a reform that con­ser­v­a­tive pol­i­cy experts have long espoused.

    But Rounds, based on his expe­ri­ence sell­ing insur­ance, doubts that will work in prac­tice. He says peo­ple liv­ing in New York City, which has high health-care costs, won’t be able to buy rel­a­tive­ly cheap plans from a state with low­er costs such as South Dako­ta because it won’t make eco­nom­ic sense for insur­ance com­pa­nies.
    ...

    Note that Sen­a­tor Rounds was elect­ed in 2014, so he’ll be up for reelec­tion in 2020 when Trump’s pop­u­lar­i­ty will be a huge deal for the reelec­tion chances of some­one like Rounds, so it will be inter­est­ing to watch how Rounds posi­tions him­self as a GOP­er who can pro­tect the pub­lic from Trump’s flights of destruc­tive fan­cy. The longer this night­mare goes, the more brand appeal the pro­tect-from-Trump brand is like­ly going to have. If trends con­tin­ue it’s going to be a great brand for 2020, at least in some states.

    Over­all, giv­en the num­ber of war­ring fac­tions with­in the GOP alone over whether or not to have con­gress autho­rize the pay­ments of those CSR sub­si­dies for the poor (the Free­dom Causus no com­pro­mise fac­tion, the Cornyn harsh desta­bi­liz­ing com­pro­mise fac­tion, and the Rounds less harsh com­pro­mise fac­tion), it’s look­ing quite pos­si­ble that those sub­si­dizes real­ly are going to go away. And mar­kets will just desta­bi­lize and Trump will call on the Democ­rats to join him in a bipar­ti­san hor­ri­ble right-wing bill. And there real­ly will be some sort of health care cri­sis of Trump’s own cre­ation.

    But if the con­gress does some­how find a way to finance these sub­si­dies and avoid fur­ther mar­ket desta­bi­liza­tion, nev­er fear, Steve Ban­non and Trump are here to ensure Oba­macare is blown up one way or anoth­er:

    Talk­ing Points Memo
    Livewire

    Ban­non: Trump End­ed Insur­er Sub­si­dies To ‘Blow Up’ Oba­macare

    By Esme Cribb
    Pub­lished Octo­ber 15, 2017 9:18 am

    Pres­i­dent Don­ald Trump’s for­mer strate­gist Steve Ban­non on Sat­ur­day said Trump end­ed cost-shar­ing reduc­tion (CSR) pay­ments, which sub­si­dize insur­ers for keep­ing out-of-pock­et costs down for low-income indi­vid­u­als, to “blow up” Oba­macare.

    “Gonna blow that thing up,” he said in a speech at the Val­ues Vot­er Sum­mit. “Gonna blow those exchanges up, right?”

    The White House on Thurs­day night claimed it was end­ing the pay­ments, a bla­tant move to sab­o­tage Oba­macare, because for­mer Pres­i­dent Barack Obama’s admin­is­tra­tion “over­stepped the legal bound­aries drawn by our Con­sti­tu­tion” by mak­ing the pay­ments.

    The Con­gres­sion­al Bud­get Office (CBO) esti­mat­ed in August that end­ing CSR pay­ments would dri­ve up pre­mi­ums for those who ben­e­fit from the sub­si­dies by 20 per­cent by 2018 and 25 per­cent by 2020.

    ———-

    “Ban­non: Trump End­ed Insur­er Sub­si­dies To ‘Blow Up’ Oba­macare” by Esme Cribb; Talk­ing Points Memo; 10/15/2017

    ““Gonna blow that thing up,” he said in a speech at the Val­ues Vot­er Sum­mit. “Gonna blow those exchanges up, right?””

    Yes, hav­ing failed thrice to pass Trump­care we now find Trump and Ban­non just plan­ning on sab­o­tag­ing and blow­ing up Oba­macare. And they’re doing it at the same time they’re enabling cheap crap plans to get set up so it’s very clear what the ‘replace’ is that Trump and Ban­non have in mind in order to keep their ‘repeal and replace’ pledge. The crap plans sold across state lines are the replace­ment for the Oba­macare plans they’re cur­rent­ly try­ing to blow up. They’re sup­posed to be the new nor­mal. Blow­ing up Oba­macare does­n’t just poten­tial­ly force con­gress to pass some­thing and force the Democ­rats to make com­pro­mis­es they might not oth­er­wise make. Blow­ing up Oba­macare also forces peo­ple into the crap plans because that’s all that will be avail­able that peo­ple will be able to afford with­out sub­si­dies.

    In oth­er words words, the exec­u­tive action assault on Oba­macare is the newest push to for pass Trump­care. IT just does­n’t involve votes this time. Just Trump’s vote. Because Trump­care was always just a plan for let­ting states to set up crap plans that are sold across state lines. The was basi­cal­ly Trump­care because that’s the GOP’s gen­er­al plan that the par­ty hwas been cham­pi­oning for years and Trump­care was basi­cal­ly the GOP con­gress’s baby. So blow­ing up Oba­macare while you enable crap plans is set­ting up Trump­care. It’s hap­pen­ing. Wel­come to Trump­care.

    Posted by Pterrafractyl | October 15, 2017, 11:17 pm
  14. Well that did­n’t take long: we’re learn­ing what the poten­tial impact will be from Pres­i­dent Trump’s sud­den deci­sion to cut off the Oba­macare sub­si­dies paid to insur­ance com­pa­nies to help keep costs down for low-income Amer­i­cans. It’s exact­ly the poten­tial impact vir­tu­al­ly all experts pre­dict­ed. Much, much high­er pre­mi­ums.

    Although, as the fol­low­ing arti­cle notes, the mas­sive pre­mi­um hikes aren’t being seen across the board. Why? Because a num­ber of insur­ance com­pa­nies were already hik­ing pre­mi­ums in antic­i­pa­tion of Trump doing exact­ly this move. And they weren’t psy­chic. Trump has been open­ly threat­en­ing to cut off these sub­si­dies for months and reports about how the uncer­tain­ty these threats cre­at­ed were lead­ing to pre­mi­um hikes or insur­ers leav­ing mar­kets have been report­ed on for months, with a study con­clud­ing that 2/3 of Oba­macare pre­mi­um hikes were due to uncer­tain­ty cre­at­ed by the Trump admin­is­tra­tion back in June.

    So while it’s already obvi­ous that Trump’s move to cut the cost-shar­ing reduc­tions (CSR) sub­si­dies for the poor was going to lead to pre­mi­um hikes, it’s impor­tant to keep in mind that the pre­mi­um hikes were see­ing are a lot low­er than they would have been had the insur­ance indus­try not been pre­emp­tive­ly hik­ing pre­mi­ums in antic­i­pa­tion of this exact sce­nario for months:

    Talk­ing Points Memo
    DC

    Trump’s Lat­est Oba­macare Attack Trig­gers Rate Hikes, Law­suits, Con­fu­sion

    By Alice Oll­stein
    Pub­lished Octo­ber 17, 2017 6:00 am

    Pres­i­dent Don­ald Trump’s deci­sion last week to pull the trig­ger on his oft-repeat­ed threat to cut off sub­si­dies to health insur­ance com­pa­nies is hav­ing wide­spread fall­out, with many states scram­bling to approve high­er insur­ance rates for 2018 to make up for the loss and keep insur­ers from flee­ing the mar­ket alto­geth­er.

    Because the insur­ance com­pa­nies are required by law to cov­er every­one regard­less of their health sta­tus and low­er the cost of care for low-income patients, and because many had assumed the gov­ern­ment would keep mak­ing the cost shar­ing reduc­tion (CSR) pay­ments, Trump’s move has thrown them into tur­moil.

    The vast major­i­ty either had raised their rates already in antic­i­pa­tion of the CSR cut or are fil­ing for emer­gency rate hikes now. And while these rate hikes will not impact the more than 80 per­cent of indi­vid­ual mar­ket enrollees who get gov­ern­ment tax cred­its, they will cost the gov­ern­ment bil­lions of dol­lars as those tax cred­its creep upward to cov­er the dif­fer­ence. The rate increas­es will also slam the mil­lions of mid­dle class Amer­i­cans whose indi­vid­ual health plans are unsub­si­dized.

    The tim­ing of the announcement—mere weeks before the start of open enroll­ment peri­od for 2018 and just after insur­ers had already signed con­tracts for par­tic­i­pat­ing —could not have been worse.

    “Poten­tial­ly the biggest effect of all this is just to cre­ate con­fu­sion,” warned Lar­ry Levitt, the vice pres­i­dent of the Kaiser Fam­i­ly Foun­da­tion. “It would be quite under­stand­able if con­sumers are per­plexed about whether sub­si­dies are still avail­able for them, which they are.”

    Rates on the rise

    Across the coun­try, the non-par­ti­san Con­gres­sion­al Bud­get Office has pre­dict­ed about a 25 per­cent increase in insur­ance rates over two years sole­ly due to the sub­sidy cuts. Already, in mar­kets where insur­ance com­pa­nies did not orig­i­nal­ly price for the yank­ing of the CSRs, that pre­dic­tion is com­ing true.

    On Fri­day, Oregon’s Depart­ment of Con­sumer and Busi­ness Ser­vices ordered health insur­ance com­pa­nies on the state’s indi­vid­ual mar­ket to hike their 2018 rates by 7.1 per­cent, “in order to ensure car­ri­ers can con­tin­ue to offer cov­er­age in Ore­gon.”

    “This increase will affect plans both on and off HealthCare.gov, and will com­pen­sate for the $49 mil­lion worth of cost-shar­ing reduc­tion pay­ments that the fed­er­al gov­ern­ment will no longer be mak­ing to Ore­gon insur­ance com­pa­nies in 2018.”

    Alas­ka ordered a sim­i­lar rate increase of 5 to 6 per­cent. In Arkansas, where insur­ers sub­mit­ted two sets of rates—one assum­ing Trump con­tin­ued fund­ing CSRs and one assum­ing last week’s cutoff—the state approved the much high­er rate, lead­ing to a 25 per­cent jump in costs for some non-sub­si­dized res­i­dents. In Penn­syl­va­nia, the increase will be near 30 per­cent, and in Flori­da, patients will pay between 26 and 72 per­cent more next year.

    Many states are only hik­ing the rate of their sil­ver-tier plans to cov­er the cost of the lost sub­si­dies, but oth­ers, like Indi­ana, are rais­ing rates across board. Accord­ing to an AP analy­sis, Repub­li­can-con­trolled states that did not expand Med­ic­aid, and that vot­ed for Trump, will be the hard­est hit.

    “Mid­dle class con­sumers will get hurt, but that’s not what’s hap­pen­ing in most places,” Levitt explained. “It’s real­ly hit­ting tax pay­ers, because the added cost of the increased tax cred­its will exceed the fed­er­al sav­ings from cut­ting CSRs.”

    Court­rooms and chaos

    On Fri­day, near­ly 20 state attor­neys gen­er­al sued the Trump admin­is­tra­tion over the abrupt sub­sidy with­draw­al, argu­ing the move vio­lat­ed the text of the Afford­able Care Act and the Admin­is­tra­tive Pro­ce­dure Act. The states aim to force the White House to make its Octo­ber pay­ment via a tem­po­rary restrain­ing order while the case is heard, and oth­er legal actions could be close behind.

    Because Trump ordered the pay­ments to cease imme­di­ate­ly and the rate hikes don’t go into effect until 2018, insur­ance com­pa­nies have to eat the loss of tens of mil­lions of dol­lars between now and the end of Decem­ber.

    ...

    Yet not only have insur­ers not filed law­suits yet, they have not fled the mar­kets en masse as many pre­dict­ed.

    Though some indi­vid­ual insur­ers, most vocal­ly in Mon­tana, have threat­ened to drop out of the mar­ket­place if their rate increas­es are not approved by reg­u­la­tors, the vast major­i­ty are grit­ting their teeth and stay­ing put.

    “For the most part, insur­ers had a sense this could be com­ing,” Levitt said. “Those that didn’t feel they could man­age it had already left. But because this was just one of sev­er­al actions the Trump admin­is­tra­tion has tak­en to under­mine the mar­ket­place, the ques­tion on insur­ers’ minds is: what might come next?

    ———-

    “Trump’s Lat­est Oba­macare Attack Trig­gers Rate Hikes, Law­suits, Con­fu­sion” by Alice Oll­stein; Talk­ing Points Memo; 10/17/2017

    “The vast major­i­ty either had raised their rates already in antic­i­pa­tion of the CSR cut or are fil­ing for emer­gency rate hikes now. And while these rate hikes will not impact the more than 80 per­cent of indi­vid­ual mar­ket enrollees who get gov­ern­ment tax cred­its, they will cost the gov­ern­ment bil­lions of dol­lars as those tax cred­its creep upward to cov­er the dif­fer­ence. The rate increas­es will also slam the mil­lions of mid­dle class Amer­i­cans whose indi­vid­ual health plans are unsub­si­dized.”

    As we can see, those insur­ance com­pa­nies that are present­ly forced to enact emer­gency rate yikes now are being pun­ished for not being cyn­i­cal enough back when Trump was threat­en­ing to cut off these sub­sidy pay­ments as some sort of spite-tantrum in the wake of the col­lapse of the Trump­care back in July. The insur­ance com­pa­nies that refused to believe Trump would actu­al­ly fol­low through on that threat just learned the les­son that when Trump threat­ens to sense­less­ly blow even some­thing as impor­tant as the health care sys­tem up in a fit of rage and revenge, he just might do it. In case it was­n’t already clear, it’s clear now (it real­ly should have already been clear).

    So what’s going to hap­pen to US indi­vid­ual health insur­ance mar­kets now that chaos has been inten­tion­al­ly cre­at­ed as some sort of last ditch attempt to force Con­gress to ‘repeal and replace’ Oba­macare with Trump­care? It’s very unclear, in part because there are mul­ti­ple jus­ti­fi­ca­tions Trump and the GOP have used to jus­ti­fy first hav­ing Trump cut off these sub­si­dies and demand Con­gress for­mal­ly fund them and now Con­gress refus­ing to rein­state them. When Trump first made these threats in late July he railed against the sub­si­dies as “bailouts” and his bud­get direc­tor, Mick Mul­vaney, argued that Oba­macare was pun­ish­ing peo­ple and there­fore insur­ance com­pa­nies should get pun­ished in retal­i­a­tion. And yet when you hear many of the jus­ti­fi­ca­tions for Trump’s move to cut the sub­si­dies and inject mas­sive uncer­tain­ty into the mar­kets the rea­son giv­en is typ­i­cal­ly that Trump had to do it because the pay­ments were being done by exec­u­tive order and not through Con­gress. And as we’ve already seen, some GOP­ers want to cre­ate a leg­isla­tive fix, some are say­ing they’re will­ing to do a fix but not with­out mas­sive con­ces­sions, and some have no inter­est in a fix at all.

    So it’s total­ly unclear whether or not the GOP is even going to allow Con­gress to fund these sub­si­dies. And as the fol­low­ing arti­cle makes clear, it’s still unclear even after the first group of GOP­ers just came to agree­ment with a group of Democ­rats on a bi-par­ti­san com­pro­mise that involves the Democ­rats mak­ing addi­tion­al con­ces­sions on the ero­sion of Oba­macare in exchange for extend­ing the sub­si­dies for two years. That deal isn’t good enough to a siz­able chunk of the con­gres­sion­al GOP­ers, in part because many of them oppose any exten­sion of the sub­si­dies at all. No mat­ter what. And the group of GOP­ers opposed to any con­gres­sion­al approval of these sub­si­dies at all includes House Speak­er Paul Ryan:

    Talk­ing Points Memo
    DC

    Sen­a­tors Announce Deal To Undo Trump’s Oba­macare Cuts

    By Alice Oll­stein
    Pub­lished Octo­ber 17, 2017 2:24 pm

    Pres­i­dent Don­ald Trump’s deci­sion last week to ter­mi­nate bil­lions in sub­si­dies to insur­ance com­pa­nies that are required under the Afford­able Care Act, lit a new fire under some mem­bers of Con­gress who have been work­ing for months to guar­an­tee the sub­sidy pay­ments and pro­tect the indi­vid­ual mar­ket from the White House’s whims.

    On Tues­day, Sens. Lamar Alexan­der (R‑TN) and Pat­ty Mur­ray (D‑WA) announced a deal that would fund the cost-shar­ing reduc­tion pay­ments for two years, make it eas­i­er for states to waive some health care reg­u­la­tions, and restore the bud­get for open enroll­ment out­reach Trump gut­ted ear­li­er this fall.

    A Demo­c­ra­t­ic aide con­firmed to TPM that the bill would restore $106 mil­lion in out­reach fund­ing for the Afford­able Care Act, more than was spent pro­mot­ing enroll­ment under the Oba­ma admin­is­tra­tion last year. But a GOP aide clar­i­fied that this out­reach bud­get would go to states as grants and would not be con­trolled by the fed­er­al gov­ern­ment.

    Alexan­der told reporters that the bill also amends the def­i­n­i­tion of afford­abil­i­ty in the rules for states seek­ing 1332 waivers to get out of some of Obamacare’s reg­u­la­tions. Exact text of the mea­sure has not yet been released, but Alexan­der described the broad out­lines: “It does not change essen­tial health ben­e­fits,” he said. “It does not change the require­ment for pre-exist­ing con­di­tions. There are pro­tec­tions there that pro­tect peo­ple, but at the same time we give sig­nif­i­cant flex­i­bil­i­ty to states.”

    After attempt­ing to sell the deal to his col­leagues in a Repub­li­can lun­cheon on Tues­day, Alexan­der told reporter he is “encour­aged by the con­sen­sus of sup­port I’ve received, includ­ing from Pres­i­dent Trump,” but warned that reach­ing a bipar­ti­san deal was the first step of many.

    Sen. Mike Rounds (R‑SD), a sup­port­er of the mea­sure, told reporters that there is not yet a com­mit­ment from GOP lead­ers in the Sen­ate or House to sup­port the bill or even hold a vote on it. “If we get enough co-spon­sors on the bill, we can present it to lead­er­ship and move for­ward,” he said. “This is an oppor­tu­ni­ty to actu­al­ly take care of a prob­lem.”

    Alexan­der name-checked the three Repub­li­cans who brought down Oba­macare repeal bills this year—Sens. John McCain (R‑AZ), Lisa Murkows­ki (R‑AK) and Susan Collins (R‑ME)—as being on board. Demo­c­ra­t­ic Sen­ate lead­ers also voiced full-throat­ed sup­port for the deal on Tues­day, say­ing it includes “some very sig­nif­i­cant anti-sab­o­tage pro­vi­sions.”

    “The pres­i­dent has been sab­o­tag­ing [the ACA], and the agree­ment would undo much of that sab­o­tage,” said Sen­ate Major­i­ty Leader Chuck Schumer. “So over­all we are very pleased with this agree­ment.”

    Pres­i­dent Trump, who was in the mid­dle of a Rose Gar­den press con­fer­ence when news of the deal broke, also seemed to sig­nal his sup­port when asked about it by reporters: “It is a short term solu­tion so that we don’t have this very dan­ger­ous lit­tle peri­od, includ­ing dan­ger­ous peri­od for insur­ance com­pa­nies, by the way,” he said. “For a peri­od of one year, two years, we will have a very good solu­tion.”

    But despite sup­port on both sides of the aisle and poten­tial­ly in the White House, the deal still faces an uphill bat­tle.

    On Mon­day, House Speak­er Paul Ryan dumped cold water on the idea of restor­ing CSR pay­ments, telling reporters: “Prop­ping up Oba­macare and just giv­ing insur­ance sub­si­dies to insur­ance car­ri­ers to keep a fail­ing sys­tem propped up is not the answer.”

    The influ­en­tial Repub­li­can Study Com­mit­tee issued its own neg­a­tive assess­ment on Tues­day fol­low­ing Alexander’s announce­ment, fur­ther imper­il­ing the deal’s change of pass­ing the House.

    Chair­man @repmarkwalker: “The GOP should focus on repeal­ing & replac­ing Oba­macare, not try­ing to save it. This bailout is unac­cept­able.” https://t.co/Sjooq9ituF— RSC (@RepublicanStudy) Octo­ber 17, 2017

    “I’m hop­ing every­body under­stands how much resis­tance there is for fund­ing these Oba­macare mar­kets that will nev­er be self-sus­tain­ing,” said Sen. Ron John­son (R‑WI), who has been talk­ing with House Repub­li­cans about an alter­na­tive plan. “It’s a very legit­i­mate point of view from con­ser­v­a­tives.”

    John­son and oth­er con­ser­v­a­tives did rec­og­nize, how­ev­er, that Trump’s sud­den ter­mi­na­tion of the CSR pay­ments last week, just before open enroll­ment, is wreak­ing hav­oc in the health care sys­tem.

    “Not fund­ing CSRs cause pre­mi­ums to increase and is lit­er­al­ly cost­ing Amer­i­can tax­pay­ers more mon­ey,” he said. “That’s a hard lit­tle real­i­ty to get every­body to acknowl­edge, but it’s the truth.”

    Nego­ti­a­tions between Alexan­der (R‑TN) and Sen. Pat­ty Mur­ray (D‑WA) on CSRs began months ago, with the goal of pass­ing a bill by the end of Sep­tem­ber to pre­vent the Trump-fueled uncer­tain­ty from trig­ger­ing mas­sive insur­ance rate increas­es in 2018. But after the talks were side­lined for weeks as GOP lead­ers launched yet anoth­er failed bid to repeal Oba­macare, Con­gress blew past that dead­line, Trump cut off the CSR pay­ments, and insur­ers sig­nif­i­cant­ly hiked their rates and threat­ened to drop out of the mar­ket alto­geth­er.

    ...

    ———-

    “Sen­a­tors Announce Deal To Undo Trump’s Oba­macare Cuts” by Alice Oll­stein; Talk­ing Points Memo; 10/17/2017

    “On Mon­day, House Speak­er Paul Ryan dumped cold water on the idea of restor­ing CSR pay­ments, telling reporters: “Prop­ping up Oba­macare and just giv­ing insur­ance sub­si­dies to insur­ance car­ri­ers to keep a fail­ing sys­tem propped up is not the answer.””

    The Speak­er of the House came out against any exten­sion of the sub­si­dies by Con­gress at all. That was a day before the bi-par­ti­san com­pro­mise was announced. And after it was announced was got to hear from the Repub­li­can Study Com­mit­tee, say­ing the “bailouts” (sub­si­dies to low­er costs to low-income Amer­i­cans) were unac­cept­able:

    ...
    The influ­en­tial Repub­li­can Study Com­mit­tee issued its own neg­a­tive assess­ment on Tues­day ollow­ing Alexander’s announce­ment, fur­ther imper­il­ing the deal’s change of pass­ing the House.

    Chair­man @repmarkwalker: “The GOP should focus on repeal­ing & replac­ing Oba­macare, not try­ing to save it. This bailout is unac­cept­able.” https://t.co/Sjooq9ituF— RSC (@RepublicanStudy) Octo­ber 17, 2017

    “I’m hop­ing every­body under­stands how much resis­tance there is for fund­ing these Oba­macare mar­kets that will nev­er be self-sus­tain­ing,” said Sen. Ron John­son (R‑WI), who has been talk­ing with House Repub­li­cans about an alter­na­tive plan. “It’s a very legit­i­mate point of view from con­ser­v­a­tives.”

    John­son and oth­er con­ser­v­a­tives did rec­og­nize, how­ev­er, that Trump’s sud­den ter­mi­na­tion of the CSR pay­ments last week, just before open enroll­ment, is wreak­ing hav­oc in the health care sys­tem.

    “Not fund­ing CSRs cause pre­mi­ums to increase and is lit­er­al­ly cost­ing Amer­i­can tax­pay­ers more mon­ey,” he said. “That’s a hard lit­tle real­i­ty to get every­body to acknowl­edge, but it’s the truth.”
    ...

    ““I’m hop­ing every­body under­stands how much resis­tance there is for fund­ing these Oba­macare mar­kets that will nev­er be self-sus­tain­ing,” said Sen. Ron John­son (R‑WI), who has been talk­ing with House Repub­li­cans about an alter­na­tive plan. “It’s a very legit­i­mate point of view from con­ser­v­a­tives.””

    Notice the lan­guage used by Sen­a­tor Ron John­son to describe the nature of the oppo­si­tion to fund­ing these sub­si­dies: the GOP resis­tance is specif­i­cal­ly resis­tance to the idea of “fund­ing these Oba­macare mar­kets that will nev­er be self-sus­tain­ing.” Which is a resis­tance to the idea of sub­si­dies for the poor.

    Yes, once again, after you look past all the obfus­ca­tion and fas­cist the­atrics, we learn that the fun­da­men­tal thing the GOP oppos­es is gov­ern­ment finan­cial help for the poor. And the bi-par­ti­san pro­pos­al to finance does­n’t fix that prob­lem.

    And notice how the bi-par­ti­san com­pro­mise deal is actu­al­ly a pret­ty big con­ces­sion towards the GOP/Trumpcare (real­ly Kochcare) goal of mak­ing health care a state, instead of fed­er­al, issue: the sub­sidy mon­ey to indi­vid­ual states as block grants to dole out instead of the fed­er­al gov­ern­ment admin­is­ter­ing it. And the deal would also weak­en rules on the waivers states can issue that water-down Oba­macare rules in gen­er­al even fur­ther. So if a par­tic­u­lar right-wing state gov­ern­ment want­ed to with­hold the sub­si­dies for the poor under the GOP prin­ci­ple that sub­si­dies for the poor are harm­ful, that state could come up with all sorts of sadis­tic rules intend­ed to with­hold as much mon­ey as pos­si­ble from the sub­si­dies for the poor:

    ...
    On Tues­day, Sens. Lamar Alexan­der (R‑TN) and Pat­ty Mur­ray (D‑WA) announced a deal that would fund the cost-shar­ing reduc­tion pay­ments for two years, make it eas­i­er for states to waive some health care reg­u­la­tions, and restore the bud­get for open enroll­ment out­reach Trump gut­ted ear­li­er this fall.

    A Demo­c­ra­t­ic aide con­firmed to TPM that the bill would restore $106 mil­lion in out­reach fund­ing for the Afford­able Care Act, more than was spent pro­mot­ing enroll­ment under the Oba­ma admin­is­tra­tion last year. But a GOP aide clar­i­fied that this out­reach bud­get would go to states as grants and would not be con­trolled by the fed­er­al gov­ern­ment.

    Alexan­der told reporters that the bill also amends the def­i­n­i­tion of afford­abil­i­ty in the rules for states seek­ing 1332 waivers to get out of some of Obamacare’s reg­u­la­tions. Exact text of the mea­sure has not yet been released, but Alexan­der described the broad out­lines: “It does not change essen­tial health ben­e­fits,” he said. “It does not change the require­ment for pre-exist­ing con­di­tions. There are pro­tec­tions there that pro­tect peo­ple, but at the same time we give sig­nif­i­cant flex­i­bil­i­ty to states.”
    ...

    “A Demo­c­ra­t­ic aide con­firmed to TPM that the bill would restore $106 mil­lion in out­reach fund­ing for the Afford­able Care Act, more than was spent pro­mot­ing enroll­ment under the Oba­ma admin­is­tra­tion last year. But a GOP aide clar­i­fied that this out­reach bud­get would go to states as grants and would not be con­trolled by the fed­er­al gov­ern­ment

    “Alexan­der told reporters that the bill also amends the def­i­n­i­tion of afford­abil­i­ty in the rules for states seek­ing 1332 waivers to get out of some of Obamacare’s reg­u­la­tions. Exact text of the mea­sure has not yet been released, but Alexan­der described the broad out­lines: “It does not change essen­tial health ben­e­fits,” he said. “It does not change the require­ment for pre-exist­ing con­di­tions. There are pro­tec­tions there that pro­tect peo­ple, but at the same time we give sig­nif­i­cant flex­i­bil­i­ty to states.””

    “Sig­nif­i­cant flex­i­bil­i­ty to states.” And block grant­i­ng the sub­si­dies. If that isn’t enough to pla­cate the GOP hard­lin­ers then it’s look­ing like Trump and the GOP are seri­ous­ly just going to let the chaos they are inject­ing into the mar­ket­place cat­alyze an Oba­macare pre­mi­um explo­sion as part of a deeply cyn­i­cal strat­e­gy to implode the Oba­macare and replace it with Trump­care. And they’re going to do it under the pre­text of ‘prin­ci­ple’. The prin­ci­ple of oppos­ing help for the poor when­ev­er pos­si­ble.

    But let’s note the irony of it all. Once of the pur­port­ed jus­ti­fi­ca­tions for all this is that it’s uncon­sti­tu­tion­al for the pres­i­dent to approve these sub­si­dies through exec­u­tive orders and that’s why this need­ed to be kicked back to Con­gress. And this appears to be part of a broad­er strat­e­gy and stop both­er­ing try­ing to pass Trump­care leg­isla­tive­ly. Instead, Trump an the GOP can just keep hack­ing away and under­min­ing Oba­macare one exec­u­tive order at a time, wait for the cri­sis to unfold, and then imple­ment Trump­care fur­ther with the var­i­ous exec­u­tive orders and emer­gency mea­sures that need to be passed to hold Oba­macare togeth­er. That way, as Oba­macare morphs into the Trump­care and the pub­lic mar­vels at its grow­ing hideous­ness it will in effect be Trump­care, but still be called Oba­macare.

    Might that be part of the plan? A plan to not ever off­i­cal­ly pass Trump­care but just force it slow­ly into exis­tence bit by bit as Oba­macare is forcibly impl­doed? Per­haps, although this plan would involve Trump aban­don­ing the lega­cy of hav­ing “Trump­care” offi­cial­ly replace “Oba­macare”, and it’s unclear if Trump is capa­ble of that kind of sac­ri­fice. And even if he’s capa­ble of a such non-ego-cen­tric strat­e­gy — leav­ing Oba­macare in place while fun­da­men­tal­ly trans­form­ing it into Trumpcare/Kochcare bit by bit — it does­n’t like he’s plan­ning on pur­su­ing that strat­e­gy. Yes, in the above arti­cle it was not­ed that Trump’s ini­tial response to news of the bi-par­ti­san deal was one of sup­port:

    ...
    Pres­i­dent Trump, who was in the mid­dle of a Rose Gar­den press con­fer­ence when news of the deal broke, also seemed to sig­nal his sup­port when asked about it by reporters: “It is a short term solu­tion so that we don’t have this very dan­ger­ous lit­tle peri­od, includ­ing dan­ger­ous peri­od for insur­ance com­pa­nies, by the way,” he said. “For a peri­od of one year, two years, we will have a very good solu­tion.”
    ...

    But then Trump changed his tune. To a tune that sounds a lot like what Paul Ryan has been whistling:

    Talk­ing Points Memo
    Edi­tor’s Blog

    Pres­i­dent Com­ments on Alexan­der-Mur­ray Pro­pos­al

    By Josh Mar­shall Pub­lished Octo­ber 17, 2017 10:19 pm

    Here’s the President’s com­ment on the Alexan­der-Mur­ray Oba­macare sta­bi­liza­tion pro­pos­al from his speech this evening at the Her­itage Foun­da­tion.

    “And I’m pleased the Democ­rats have final­ly respond­ed to my call for them to take respon­si­bil­i­ty for their Oba­macare dis­as­ter and work with Repub­li­cans to pro­vide much-need­ed relief to the Amer­i­can peo­ple. While I com­mend the bipar­ti­san work done by Sen­a­tors Alexan­der and Mur­ray — and I do com­mend it — I con­tin­ue to believe Con­gress must find a solu­tion to the Oba­macare mess instead of pro­vid­ing bailouts to insur­ance com­pa­nies.”

    … per the White House pool report.

    ———-

    Pres­i­dent Com­ments on Alexan­der-Mur­ray Pro­pos­al” by Josh Mar­shall; Talk­ing Points Memo; 10/17/2017

    ““And I’m pleased the Democ­rats have final­ly respond­ed to my call for them to take respon­si­bil­i­ty for their Oba­macare dis­as­ter and work with Repub­li­cans to pro­vide much-need­ed relief to the Amer­i­can peo­ple. While I com­mend the bipar­ti­san work done by Sen­a­tors Alexan­der and Mur­ray — and I do com­mend it — I con­tin­ue to believe Con­gress must find a solu­tion to the Oba­macare mess instead of pro­vid­ing bailouts to insur­ance com­pa­nies.”

    “I con­tin­ue to believe Con­gress must find a solu­tion to the Oba­macare mess instead of pro­vid­ing bailouts to insur­ance com­pa­nies.” It sure sounds like Trump is on ‘Team Ryan’ here. The team that says the only way to fix Oba­macare is to cause it to implode in order to force Con­gress into pass­ing Trump­care. Under the ban­ner of “no sub­si­dies for insur­ance com­pa­nies”, which is, of course, the cov­er-ban­ner for the real “no sub­si­dies for the poor” ban­ner that tru­ly ani­mates the par­ty. But since the GOP is deter­mined to pre­tend like they’re actu­al­ly con­cerned about cor­po­rate sub­si­dies it’s prob­a­bly worth keep­ing in mind that the pri­ma­ry bailout to insur­ance com­pa­nies in the US comes in the form of not hav­ing a nation­al health care sys­tem despite the obvi­ous pub­lic ben­e­fits a nation­al health care sys­tem would pro­vide for almost all Amer­i­cans and deep con­flicts of inter­est the for-prof­it mod­el has for some­thing like gen­er­al health care. The fact that some­thing like Medicare for All remains a polit­i­cal pipe dream due to Amer­i­ca’s pro­found polit­i­cal con­fu­sion and dys­func­tion is the ulti­mate insur­ance com­pa­ny sub­sidy.

    Posted by Pterrafractyl | October 17, 2017, 11:14 pm
  15. The good news: we’re final­ly get­ting some clar­i­ty from the GOP on its plans for the US health care sys­tem. The bad news: it’s exact­ly what you would expect from the GOP.

    In the lat­est attempt to kill Oba­macare via death by a thou­sand cuts, the Depart­ment of Jus­tice just made the high­ly unusu­al move of refus­ing to defend US pol­i­cy in the courts. Specif­i­cal­ly, the DOJ just decid­ed to agree with the plain­tiffs in a law­suit brought against Oba­macare by 20 GOP-con­trolled states. Although not entire­ly. The DOJ’s new stance on the case isn’t that Oba­macare is uncon­sti­tu­tion­al like the GOP state plain­tiffs are argu­ing. Instead, the DOJ is argu­ing that the pro­tec­tions for pre-exist­ing con­di­tions and pro­tec­tions against high pre­mi­ums for seniors is uncon­sti­tu­tion­al and needs to be elim­i­nat­ed next year. These are two high­ly pop­u­lar pro­vi­sions of Oba­macare.

    The GOP states are try­ing to argue what amounts to a legal­is­tic ‘gotcha’ tech­ni­cal­i­ty:

    1. The 2012 Supreme Court deci­sion in the case over the con­sti­tu­tion­al­i­ty of the Oba­macare indi­vid­ual man­date found the man­date to be con­sti­tu­tion­al because it was a tax (as opposed to a man­dat­ed pur­chase of a ser­vice).

    2. The GOP repealed the indi­vid­ual man­date last year as part of the giant tax cut scam.

    3. The GOP states argue that there­fore Oba­macare as a whole is uncon­sti­tu­tion­al. The DOJ more nar­row­ly argues that, there­fore, the ACA’s ban on dis­crim­i­na­tion based on pre-exist­ing con­di­tions and lim­its on charg­ing old­er patients high­er pre­mi­ums are invalid.

    The repeal of the indi­vid­ual man­date — which the GOP focused on as uncon­sti­tu­tion­al — means the rest of Oba­macare is uncon­sti­tu­tion­al. That’s lit­er­al­ly the legal log­ic behind the GOP’s law­suit.

    As one might expect, many legal experts find the case to be ridicu­lous, but not the DOJ! Although it sounds like that’s lim­it­ed to the DOJ lead­er­ship because three DOJ’s career lawyers work­ing on the case with­drew from the case and were replaced by a polit­i­cal appointee.

    It’s real­ly quite a remark­able. This is an elec­tion year, after all. You’d think Trump would be more inter­est­ing in not throw­ing away con­trol of the House, and pos­si­bly even the Sen­ate, giv­en the whole ‘might be impeached’ thing. And that’s why this move cre­ates real clar­i­ty from the GOP regard­ing their health care plans: they’re so seri­ous­ly about get­ting rid of the pro­tec­tions for pre-exist­ing con­di­tions and pro­tec­tions for old­er peo­ple that they’re will­ing to do some­thing this polit­i­cal­ly tox­ic this year with con­trol of the con­gress hangs in the bal­ance. It’s a sign GOP pri­or­i­ties. A deeply trou­bling sign of deeply trou­bling pri­or­i­ties:

    Talk­ing Points Memo
    DC

    Trump’s Jus­tice Depart­ment Refus­es To Defend Oba­macare In Court

    By Alice Oll­stein
    June 7, 2018 7:37 pm

    In a dra­mat­ic move, the Trump admin­is­tra­tion declared its inten­tion to refuse to defend the Afford­able Care Act from a fed­er­al law­suit by 20 GOP-con­trolled states who are argu­ing that Con­gress’ repeal of the indi­vid­ual man­date ren­ders parts of the rest of the health care law uncon­sti­tu­tion­al, accord­ing to a fil­ing from the Depart­ment of Jus­tice Thurs­day evening.

    In par­tic­u­lar, the admin­is­tra­tion is argu­ing that the ACA’s ban on dis­crim­i­na­tion based on pre-exist­ing con­di­tions and lim­its on charg­ing old­er patients high­er pre­mi­ums are invalid, and they are request­ing that the court put a halt to those pro­vi­sions in Jan­u­ary of 2019, when enforce­ment of the indi­vid­ual man­date is set to be ter­mi­nat­ed.

    The change was sig­naled ear­li­er on Thurs­day when three career DOJ attor­neys with­drew from the law­suit and a polit­i­cal appointee signed on to rep­re­sent the admin­is­tra­tion in the case, which is pend­ing before the Dis­trict Court for the North­ern Dis­trict of Texas.

    ...

    The Trump admin­is­tra­tion and the GOP-con­trolled House and Sen­ate made sev­er­al attempts to repeal the ACA in 2017. Fol­low­ing the fail­ure of those leg­isla­tive salvos — save for the suc­cess­ful repeal of the indi­vid­ual man­date as part of a mas­sive pack­age of tax cuts — the admin­is­tra­tion set about chip­ping away at the health care law piece by piece using exec­u­tive orders and Depart­ment of Health and Human Ser­vices reg­u­la­tions. Those moves, par­tic­u­lar­ly the antic­i­pat­ed intro­duc­tion of cheap, skimpy, short-term and lim­it­ed-ben­e­fit health care plans, are expect­ed to drain healthy con­sumers from the ACA mar­ket and dri­ve up pre­mi­ums for those who remain.

    Thursday’s legal brief is a new phase of the administration’s cru­sade against the ACA. It is extreme­ly rare, but not unprece­dent­ed, for the Jus­tice Depart­ment to refuse to defend a fed­er­al law, as the agency is gen­er­al­ly duty-bound to argue in defense of any cur­rent laws or poli­cies that come under legal chal­lenge. Most recent­ly, Pres­i­dent Oba­ma direct­ed his DOJ not to defend the Defense of Mar­riage Act, which was lat­er struck down by the Supreme Court.

    In this case, even though the DOJ is refus­ing to defend the ACA, sev­er­al attor­neys gen­er­al rep­re­sent­ing blue states, led by Cal­i­for­nia, have inter­vened in defense of the law and will argue that it should be pre­served in its entire­ty.

    The red states seek­ing to inval­i­date the ACA argue that the Supreme Court only upheld the con­sti­tu­tion­al­i­ty of the law in 2012 because the indi­vid­ual man­date was con­sid­ered a tax. Because Con­gress repealed that tax — the penal­ty for not pur­chas­ing health insur­ance — as part of the tax reform bill ear­li­er this year, they argue that the require­ment to buy health cov­er­age is now uncon­sti­tu­tion­al. On Thurs­day, the DOJ agreed with this inter­pre­ta­tion.

    “The rea­son­ing is worse than ridicu­lous,” a source involved in the law­suit on behalf of groups defend­ing the ACA. “And the con­se­quence is that start­ing next year – sick and old peo­ple will have to pay much more for cov­er­age – the key ele­ment of the Oba­ma reforms.”

    Read the fil­ing below:
    [see fil­ing]

    In a let­ter to House Minor­i­ty Leader Nan­cy Pelosi, Attor­ney Gen­er­al Jeff Ses­sions out­lined his rea­son­ing for the move, say­ing that key piece of the ACA are “insev­er­able” from the indi­vid­ual man­date and thus must be abol­ished fol­low­ing its repeal.

    [see let­ter from Attor­ney Gen­er­al Jeff Ses­sions to House Minor­i­ty Leader Nan­cy Pelosi]

    ———-

    “Trump’s Jus­tice Depart­ment Refus­es To Defend Oba­macare In Court” by Alice Oll­stein; Talk­ing Points Memo; 06/07/2018

    “In a dra­mat­ic move, the Trump admin­is­tra­tion declared its inten­tion to refuse to defend the Afford­able Care Act from a fed­er­al law­suit by 20 GOP-con­trolled states who are argu­ing that Con­gress’ repeal of the indi­vid­ual man­date ren­ders parts of the rest of the health care law uncon­sti­tu­tion­al, accord­ing to a fil­ing from the Depart­ment of Jus­tice Thurs­day evening.”

    The repeal of the indi­vid­ual man­date, the thing the GOP fix­at­ed on for years as uncon­sti­tu­tion­al, makes the remain­ing parts of Oba­macare uncon­sti­tu­tion­al. Death by a thou­sand stu­pid and cru­el cuts. That’s the GOP’s Oba­macare repeal strat­e­gy at this point. And this par­tic­u­lar cut is par­tic­u­lar­ly stu­pid and cru­el: the ban on dis­crim­i­na­tion based on pre-exist­ing con­di­tions and lim­its on charg­ing old­er patients high­er pre­mi­ums are invalid and should be repealed next year. That’s the GOP’s stance at both the state and fed­er­al lev­el at this point. Dur­ing an elec­tion year. No one does stu­pid and cru­el like the GOP:

    ...
    In par­tic­u­lar, the admin­is­tra­tion is argu­ing that the ACA’s ban on dis­crim­i­na­tion based on pre-exist­ing con­di­tions and lim­its on charg­ing old­er patients high­er pre­mi­ums are invalid, and they are request­ing that the court put a halt to those pro­vi­sions in Jan­u­ary of 2019, when enforce­ment of the indi­vid­ual man­date is set to be ter­mi­nat­ed.

    ...

    The red states seek­ing to inval­i­date the ACA argue that the Supreme Court only upheld the con­sti­tu­tion­al­i­ty of the law in 2012 because the indi­vid­ual man­date was con­sid­ered a tax. Because Con­gress repealed that tax — the penal­ty for not pur­chas­ing health insur­ance — as part of the tax reform bill ear­li­er this year, they argue that the require­ment to buy health cov­er­age is now uncon­sti­tu­tion­al. On Thurs­day, the DOJ agreed with this inter­pre­ta­tion.

    “The rea­son­ing is worse than ridicu­lous,” a source involved in the law­suit on behalf of groups defend­ing the ACA. “And the con­se­quence is that start­ing next year – sick and old peo­ple will have to pay much more for cov­er­age – the key ele­ment of the Oba­ma reforms.”
    ...

    This is what hap­pens when the Stu­pid and Cru­el Par­ty has all the pow­er. So you have to feel for the DOJ employ­ees oper­at­ing under stu­pid and cru­el orders. Or get replaced with a polit­i­cal appointee when the orders get too stu­pid and cru­el for career employ­ees to car­ry out:

    ...
    The change was sig­naled ear­li­er on Thurs­day when three career DOJ attor­neys with­drew from the law­suit and a polit­i­cal appointee signed on to rep­re­sent the admin­is­tra­tion in the case, which is pend­ing before the Dis­trict Court for the North­ern Dis­trict of Texas.
    ...

    And, of course, this is just the lat­est move to desta­bi­lize the US health insur­ance mar­kets and then cyn­i­cal­ly blame it on Democ­rats in the hopes that pub­lic out­rage will give them cov­er to under­mine health pro­tec­tions even more. The repeal of the indi­vid­ual man­date itself that trig­gered this law­suit is an exam­ple of that strat­e­gy and, as expect­ed, its repeal is already start­ing to cause a hike in pre­mi­ums. The Stu­pid and Cru­el Par­ty is cun­ning­ly stu­pid and cru­el at times:

    ...
    The Trump admin­is­tra­tion and the GOP-con­trolled House and Sen­ate made sev­er­al attempts to repeal the ACA in 2017. Fol­low­ing the fail­ure of those leg­isla­tive salvos — save for the suc­cess­ful repeal of the indi­vid­ual man­date as part of a mas­sive pack­age of tax cuts — the admin­is­tra­tion set about chip­ping away at the health care law piece by piece using exec­u­tive orders and Depart­ment of Health and Human Ser­vices reg­u­la­tions. Those moves, par­tic­u­lar­ly the antic­i­pat­ed intro­duc­tion of cheap, skimpy, short-term and lim­it­ed-ben­e­fit health care plans, are expect­ed to drain healthy con­sumers from the ACA mar­ket and dri­ve up pre­mi­ums for those who remain.
    ...

    So will the Stu­pid and Cru­el Par­ty man­age to cun­ning­ly spin their gut­ting of the most pop­u­lar pro­vi­sions of Oba­macare into a polit­i­cal vic­to­ry by pin­ning the blame on Democ­rats? We’ll see but that’s the plan. And as the fol­low­ing arti­cle makes clear, part the GOP plan for spin­ning this into a polit­i­cal lia­bil­i­ty for the Democ­rats appears to be to focus on the grow­ing the Demo­c­ra­t­ic calls for a sin­gle pay­er sys­tem like Medicare for all. Which is polit­i­cal­ly fas­ci­nat­ing. Because mak­ing that argue in response to ques­tions about why the GOP is dis­man­tling Oba­macare makes an implic­it argu­ment to the Amer­i­can vot­ers: the only options are sin­gle pay­er, or going back to the wild west of lit­tle to no pro­tec­tions that the GOP wants. Because Oba­macare, the pri­vate-sec­tor ori­ent­ed com­pro­mise to sin­gle-pay­er, is allowed. The GOP has made it clear they will under­mine that pri­vate mar­ket if it’s attempt­ed. So it’s either sin­gle-pay­er or noth­ing. That’s the GOP’s implic­it argu­ment

    The New York Times

    Trump’s New Plan to Dis­man­tle Oba­macare Comes With Polit­i­cal Risks

    By Abby Good­nough, Robert Pear and Char­lie Sav­age
    June 8, 2018

    WASHINGTON — After fail­ing to repeal the Afford­able Care Act with a Repub­li­can-con­trolled Con­gress, the Trump admin­is­tra­tion is seiz­ing on a dif­fer­ent strat­e­gy for dis­man­tling the law, one fraught with polit­i­cal risk. It is ask­ing a court to throw out major ele­ments, includ­ing huge­ly pop­u­lar pro­vi­sions that pro­tect sick peo­ple from being denied health insur­ance or charged high­er rates.

    Democ­rats swift­ly por­trayed the sur­prise move by the Jus­tice Depart­ment, out­lined Thurs­day in a brief sup­port­ing a court case filed by Texas and 19 oth­er states, as a harsh blow to Amer­i­cans with frag­ile health and their fam­i­lies. Already, Demo­c­ra­t­ic can­di­dates in the midterm elec­tions had been play­ing up their party’s role in block­ing last year’s repeal efforts and their recent suc­cess in push­ing for the expan­sion of Med­ic­aid in two more states. Now they have a new talk­ing point, and they lost no time test­ing it.

    Repub­li­cans are divid­ed between con­ser­v­a­tives who had vowed to elim­i­nate the law and mod­er­ates, some in tough races, who want to pre­serve the pop­u­lar pro­tec­tions for peo­ple who are sick.

    Asked about the Jus­tice Depart­ment move, Jesse Hunt, a spokesman for the Nation­al Repub­li­can Con­gres­sion­al Com­mit­tee, spoke instead about the Democ­rats.

    “Democ­rats destroyed the health care sys­tem as we knew when they rammed Oba­macare down our throats,” he said in an email, “and now all they can talk about is mov­ing to a sin­gle-pay­er health care sys­tem.”

    The Afford­able Care Act has already sur­vived sev­er­al court chal­lenges, and this lat­est test of its dura­bil­i­ty could take months or years to go through the legal sys­tem. But the uncer­tain­ty it cre­ates in the mean­time could rat­tle the law’s insur­ance mar­ket­places just as insur­ers are start­ing to file rate requests for next year. The com­pa­nies were already ner­vous because of Congress’s deci­sion last year to elim­i­nate the penal­ty for going with­out health cov­er­age.

    Recent polling has found that health care is a cru­cial issue for vot­ers this year. In an NBC News/Wall Street Jour­nal poll released this week, 22 per­cent of respon­dents said it would be the most impor­tant fac­tor in decid­ing their vote, ahead of the econ­o­my, guns, tax­es and immi­gra­tion.

    In the past, polls have found that both Repub­li­cans and Democ­rats favor pro­tect­ing cov­er­age for the tens of mil­lions of Amer­i­cans with pre-exist­ing con­di­tions. A Decem­ber 2016 poll by the non­par­ti­san Kaiser Fam­i­ly Foun­da­tion found that 75 per­cent of Democ­rats and 63 per­cent of Repub­li­cans approved of the law’s pro­vi­sion pro­hibit­ing insur­ance com­pa­nies from deny­ing cov­er­age based on a person’s health sta­tus or med­ical his­to­ry. Even Pres­i­dent Trump called it one of the law’s “strongest assets” dur­ing an inter­view with “60 Min­utes” short­ly after he won the elec­tion.

    The issue became a flash point that helped derail Repub­li­can efforts to repeal the law last year, with oppo­nents of the party’s health bills speak­ing loud­ly against weak­en­ing pro­tec­tions for the sick and vul­ner­a­ble.

    Sen­a­tor Bri­an Schatz, Demo­c­rat of Hawaii, pre­dict­ed that the res­ur­rec­tion of the issue would mobi­lize vot­ers, say­ing, “There’s noth­ing quite like the admin­is­tra­tion tak­ing an action in court to illus­trate the sim­ple fact that they are still com­ing after your health care.”

    Democ­rats around the coun­try were already work­ing hard on Fri­day to get that mes­sage across. In Penn­syl­va­nia, where Repub­li­cans last month nom­i­nat­ed Rep­re­sen­ta­tive Lou Bar­let­ta for Sen­ate, the state Demo­c­ra­t­ic Par­ty issued a state­ment that warned, “Don­ald Trump’s lap­dog Lou Bar­let­ta will throw his full sup­port behind this attempt to end cov­er­age for peo­ple with pre-exist­ing con­di­tions.”

    Sen­a­tor Susan Collins, Repub­li­can of Maine, who vot­ed against the Repub­li­can repeal bills in the Sen­ate last year, also expressed con­cern about the administration’s new push, say­ing it “cre­ates fur­ther uncer­tain­ty that could ulti­mate­ly result in high­er costs for mil­lions of Amer­i­cans and under­mine essen­tial pro­tec­tions for peo­ple with pre-exist­ing con­di­tions, such as asth­ma, can­cer, heart dis­ease, arthri­tis and dia­betes.”

    But that was not the talk­ing point of the party’s elec­tion arm. Mr. Hunt shift­ed the focus to Demo­c­ra­t­ic calls for a sin­gle-pay­er sys­tem, say­ing, “Mas­sive tax increas­es and reduced qual­i­ty of care are about as pop­u­lar as its archi­tect: Nan­cy Pelosi.”

    Repub­li­cans have been try­ing to dis­man­tle the Afford­able Care Act, a cen­ter­piece of Pres­i­dent Barack Obama’s lega­cy, since it was enact­ed in 2010 with­out any Repub­li­can votes. Attempts to repeal it in Con­gress have failed, but oppo­nents of the law have also filed scores of law­suits chal­leng­ing var­i­ous pro­vi­sions.

    The Supreme Court in 2012 upheld a major pro­vi­sion of the law that required most Amer­i­cans to have health insur­ance or pay a tax penal­ty. The court said that while this “indi­vid­ual man­date” exceed­ed Congress’s pow­er to reg­u­late com­merce, it could be upheld as an exer­cise of Congress’s tax­ing pow­er. But last year the Repub­li­can-con­trolled Con­gress elim­i­nat­ed those penal­ties as part of the $1.5 tril­lion tax over­haul that Mr. Trump signed in Decem­ber.

    Two months lat­er, Texas and the 19 oth­er states filed suit in the Fed­er­al Dis­trict Court in Fort Worth, assert­ing that the man­date could no longer be jus­ti­fied as a tax and should there­fore be struck down — and argu­ing that as a result, the rest of the law must be inval­i­dat­ed, too.

    The Jus­tice Depart­ment brief did not go so far, but it said that Judge Reed O’Connor should void both the man­date and the pro­tec­tions for peo­ple with pre-exist­ing med­ical con­di­tions, while leav­ing in place the expan­sion of Med­ic­aid in more than 30 states.

    Attor­ney Gen­er­al Jeff Ses­sions said that it is “a rare case” for the Jus­tice Depart­ment not to defend pro­vi­sions of a law but added that he could not find any “rea­son­able argu­ments” to sup­port their con­sti­tu­tion­al­i­ty.

    If the admin­is­tra­tion pre­vails in the case, the full force of the deci­sion would not hit until after the midterm elec­tions on Nov. 6. But insur­ers said the legal debate alone could cause tur­moil in insur­ance mar­kets this sum­mer.

    “At the very least it adds uncer­tain­ty at exact­ly the moment when plans are try­ing to set rates for next year,” said Ceci Con­nol­ly, the chief exec­u­tive of the Alliance of Com­mu­ni­ty Health Plans. “At the worst it could strip away guar­an­teed cov­er­age for those with pre-exist­ing con­di­tions.”

    The main trade asso­ci­a­tion for health insur­ers came out strong­ly against the administration’s posi­tion.

    “Remov­ing those pro­vi­sions will result in renewed uncer­tain­ty in the indi­vid­ual mar­ket, cre­ate a patch­work of require­ments in the states, cause rates to go even high­er for old­er Amer­i­cans and sick­er patients, and make it chal­leng­ing to intro­duce prod­ucts and rates for 2019,” said Matt Eyles, the pres­i­dent and chief exec­u­tive of America’s Health Insur­ance Plans, a trade group for insur­ers.

    The Trump administration’s move fueled accu­sa­tions that it was politi­ciz­ing the Jus­tice Depart­ment, which is sup­posed to defend the con­sti­tu­tion­al­i­ty of fed­er­al statutes in court — even if the admin­is­tra­tion in pow­er does not like them — if rea­son­able argu­ments can be made.

    Don­ald B. Ver­ril­li Jr., a solic­i­tor gen­er­al in the Oba­ma admin­is­tra­tion, said there were obvi­ous­ly rea­son­able argu­ments that could be made in defense of the Afford­able Care Act in the Texas case, point­ing to those in a brief filed Thurs­day by Cal­i­for­nia and 15 oth­er states.

    “Just read the brief of the states that inter­vened to defend the law,” Mr. Ver­ril­li said in a state­ment. “A com­pelling defense of the law is right there in black and white. This is a sad moment.”

    Three career lawyers in the department’s civ­il divi­sion with­drew from the case ear­li­er on Thurs­day and did not sign the brief. A Jus­tice Depart­ment spokes­woman said the lawyers’ with­draw­al had been a depart­ment deci­sion, declin­ing to spec­i­fy whether the lawyers had per­son­al­ly object­ed to con­tin­u­ing on the case. But Mar­tin S. Led­er­man, a George­town Uni­ver­si­ty law pro­fes­sor who was a Jus­tice Depart­ment offi­cial in the Oba­ma admin­is­tra­tion, called the mass with­draw­al a like­ly sign of dis­tress.

    “Jus­tice Depart­ment attor­neys don’t with­draw from cas­es sim­ply because the gov­ern­ment is mak­ing an argu­ment the lawyers think the courts should or would reject,” he said. “Such with­drawals are exceed­ing­ly rare — typ­i­cal­ly only when the argu­ment is inde­fen­si­ble, as they are here.”

    ...

    ———-

    “Trump’s New Plan to Dis­man­tle Oba­macare Comes With Polit­i­cal Risks” by Abby Good­nough, Robert Pear and Char­lie Sav­age; The New York Times; 06/08/23018

    “After fail­ing to repeal the Afford­able Care Act with a Repub­li­can-con­trolled Con­gress, the Trump admin­is­tra­tion is seiz­ing on a dif­fer­ent strat­e­gy for dis­man­tling the law, one fraught with polit­i­cal risk. It is ask­ing a court to throw out major ele­ments, includ­ing huge­ly pop­u­lar pro­vi­sions that pro­tect sick peo­ple from being denied health insur­ance or charged high­er rates.

    Yes, gut­ting the most pop­u­lar pro­vi­sions of Oba­macare dur­ing an elec­tion year does seem fraught with risk. But the GOP has a plan: talk about Demo­c­ra­t­ic calls for a sin­gle pay­er sys­tem when­ev­er some­one brings up their sab­o­tage of Oba­macare:

    ...
    Repub­li­cans are divid­ed between con­ser­v­a­tives who had vowed to elim­i­nate the law and mod­er­ates, some in tough races, who want to pre­serve the pop­u­lar pro­tec­tions for peo­ple who are sick.

    Asked about the Jus­tice Depart­ment move, Jesse Hunt, a spokesman for the Nation­al Repub­li­can Con­gres­sion­al Com­mit­tee, spoke instead about the Democ­rats.

    “Democ­rats destroyed the health care sys­tem as we knew when they rammed Oba­macare down our throats,” he said in an email, “and now all they can talk about is mov­ing to a sin­gle-pay­er health care sys­tem.”

    ...

    Sen­a­tor Susan Collins, Repub­li­can of Maine, who vot­ed against the Repub­li­can repeal bills in the Sen­ate last year, also expressed con­cern about the administration’s new push, say­ing it “cre­ates fur­ther uncer­tain­ty that could ulti­mate­ly result in high­er costs for mil­lions of Amer­i­cans and under­mine essen­tial pro­tec­tions for peo­ple with pre-exist­ing con­di­tions, such as asth­ma, can­cer, heart dis­ease, arthri­tis and dia­betes.”

    But that was not the talk­ing point of the party’s elec­tion arm. Mr. Hunt shift­ed the focus to Demo­c­ra­t­ic calls for a sin­gle-pay­er sys­tem, say­ing, “Mas­sive tax increas­es and reduced qual­i­ty of care are about as pop­u­lar as its archi­tect: Nan­cy Pelosi.”
    ...

    When some­one brings up the GOP take down of Oba­macare, scare­mon­ger about Medicare for all. It’s a fas­ci­nat­ing strat­e­gy, but it seems fraught with per­il. Because it’s mak­ing it clear that a pri­vate-sec­tor ori­ent­ed health care solu­tion intend­ed to pro­vide guar­an­teed access to afford­able health care in Amer­i­ca, like Oba­macare which was based on Mitt Rom­ney’s plan and was sup­posed to be a cap­i­tal­ist com­pro­mise, isn’t pos­si­ble in Amer­i­ca because the GOP will strip any mar­ket ori­ent­ed sys­tem of the reg­u­la­tions that con­fer the patient pro­tec­tions and desta­bi­lize the mar­kets spik­ing pre­mi­ums. The GOP won’t allow pri­vate sec­tor pro­tec­tions to remain in place so Medicare for all real­ly is the only option left. Is that some­thing the GOP wants to make clear as it attacks the most pop­u­lar pro­tec­tions in Oba­macare? That seems polit­i­cal­ly risky.

    Adding to the polit­i­cal risk of this strat­e­gy is that mere­ly talk­ing about it desta­bi­lizes the insur­ance mar­kets. So even though the suc­cess of the GOP law­suit won’t remove pro­tec­tions until next year, the rates for next year are get­ting set this year by the health insur­ance indus­try. So there’s enor­mous uncer­tain­ty intro­duced by this sud­den move by the DOJ right at the wrong time:

    ...
    The Afford­able Care Act has already sur­vived sev­er­al court chal­lenges, and this lat­est test of its dura­bil­i­ty could take months or years to go through the legal sys­tem. But the uncer­tain­ty it cre­ates in the mean­time could rat­tle the law’s insur­ance mar­ket­places just as insur­ers are start­ing to file rate requests for next year. The com­pa­nies were already ner­vous because of Congress’s deci­sion last year to elim­i­nate the penal­ty for going with­out health cov­er­age.

    ...

    If the admin­is­tra­tion pre­vails in the case, the full force of the deci­sion would not hit until after the midterm elec­tions on Nov. 6. But insur­ers said the legal debate alone could cause tur­moil in insur­ance mar­kets this sum­mer.

    “At the very least it adds uncer­tain­ty at exact­ly the moment when plans are try­ing to set rates for next year,” said Ceci Con­nol­ly, the chief exec­u­tive of the Alliance of Com­mu­ni­ty Health Plans. “At the worst it could strip away guar­an­teed cov­er­age for those with pre-exist­ing con­di­tions.”

    The main trade asso­ci­a­tion for health insur­ers came out strong­ly against the administration’s posi­tion.

    “Remov­ing those pro­vi­sions will result in renewed uncer­tain­ty in the indi­vid­ual mar­ket, cre­ate a patch­work of require­ments in the states, cause rates to go even high­er for old­er Amer­i­cans and sick­er patients, and make it chal­leng­ing to intro­duce prod­ucts and rates for 2019,” said Matt Eyles, the pres­i­dent and chief exec­u­tive of America’s Health Insur­ance Plans, a trade group for insur­ers.
    ...

    Yes, the GOP is choos­ing one of the least polit­i­cal­ly pop­u­lar paths it could on one of the most impor­tant issues to vot­ers dur­ing an elec­tion year. The vast right-wing media com­plex’s mighty pro­pa­gan­da pow­ers are going to be put to the test:

    ...
    Recent polling has found that health care is a cru­cial issue for vot­ers this year. In an NBC News/Wall Street Jour­nal poll released this week, 22 per­cent of respon­dents said it would be the most impor­tant fac­tor in decid­ing their vote, ahead of the econ­o­my, guns, tax­es and immi­gra­tion.

    In the past, polls have found that both Repub­li­cans and Democ­rats favor pro­tect­ing cov­er­age for the tens of mil­lions of Amer­i­cans with pre-exist­ing con­di­tions. A Decem­ber 2016 poll by the non­par­ti­san Kaiser Fam­i­ly Foun­da­tion found that 75 per­cent of Democ­rats and 63 per­cent of Repub­li­cans approved of the law’s pro­vi­sion pro­hibit­ing insur­ance com­pa­nies from deny­ing cov­er­age based on a person’s health sta­tus or med­ical his­to­ry. Even Pres­i­dent Trump called it one of the law’s “strongest assets” dur­ing an inter­view with “60 Min­utes” short­ly after he won the elec­tion.

    The issue became a flash point that helped derail Repub­li­can efforts to repeal the law last year, with oppo­nents of the party’s health bills speak­ing loud­ly against weak­en­ing pro­tec­tions for the sick and vul­ner­a­ble.
    ...

    And we can’t for­get that this lat­est GOP assault on health care pro­tec­tions was made pos­si­ble by the GOP giant tax cut scam that’s going make vir­tu­al­ly all enti­tle­ment and safe­ty-net pro­grams unaf­ford­able in the long-run. It’s a fit­ting cause and effect pol­i­cy night­mare, the­mat­i­cal­ly:

    ...
    Repub­li­cans have been try­ing to dis­man­tle the Afford­able Care Act, a cen­ter­piece of Pres­i­dent Barack Obama’s lega­cy, since it was enact­ed in 2010 with­out any Repub­li­can votes. Attempts to repeal it in Con­gress have failed, but oppo­nents of the law have also filed scores of law­suits chal­leng­ing var­i­ous pro­vi­sions.

    The Supreme Court in 2012 upheld a major pro­vi­sion of the law that required most Amer­i­cans to have health insur­ance or pay a tax penal­ty. The court said that while this “indi­vid­ual man­date” exceed­ed Congress’s pow­er to reg­u­late com­merce, it could be upheld as an exer­cise of Congress’s tax­ing pow­er. But last year the Repub­li­can-con­trolled Con­gress elim­i­nat­ed those penal­ties as part of the $1.5 tril­lion tax over­haul that Mr. Trump signed in Decem­ber.

    Two months lat­er, Texas and the 19 oth­er states filed suit in the Fed­er­al Dis­trict Court in Fort Worth, assert­ing that the man­date could no longer be jus­ti­fied as a tax and should there­fore be struck down — and argu­ing that as a result, the rest of the law must be inval­i­dat­ed, too.

    The Jus­tice Depart­ment brief did not go so far, but it said that Judge Reed O’Connor should void both the man­date and the pro­tec­tions for peo­ple with pre-exist­ing med­ical con­di­tions, while leav­ing in place the expan­sion of Med­ic­aid in more than 30 states.
    ...

    And when you have career lawyers leav­ing the case and get­ting replaced with a polit­i­cal appointee, that’s not just a bad look. It’s a inde­fen­si­ble look which is extra bad pol­i­tics. It just looks crooked:

    ...
    Three career lawyers in the department’s civ­il divi­sion with­drew from the case ear­li­er on Thurs­day and did not sign the brief. A Jus­tice Depart­ment spokes­woman said the lawyers’ with­draw­al had been a depart­ment deci­sion, declin­ing to spec­i­fy whether the lawyers had per­son­al­ly object­ed to con­tin­u­ing on the case. But Mar­tin S. Led­er­man, a George­town Uni­ver­si­ty law pro­fes­sor who was a Jus­tice Depart­ment offi­cial in the Oba­ma admin­is­tra­tion, called the mass with­draw­al a like­ly sign of dis­tress.

    “Jus­tice Depart­ment attor­neys don’t with­draw from cas­es sim­ply because the gov­ern­ment is mak­ing an argu­ment the lawyers think the courts should or would reject,” he said. “Such with­drawals are exceed­ing­ly rare — typ­i­cal­ly only when the argu­ment is inde­fen­si­ble, as they are here.”
    ...

    So will the GOP’s plans to deflect atten­tion away from its attempts to gut pop­u­lar pro­tec­tions by talk­ing about Demo­c­ra­t­ic sin­gle-pay­er dreams work? Well, that, in part depends on how the Amer­i­can vot­ing pub­lic responds when giv­en a choice between Medicare for all vs low reg­u­la­tion pri­vate mar­kets with few pro­tec­tions. Because that’s the choice the GOP is impos­ing by under­min­ing all the pop­u­lar pro­tec­tions in Oba­macare. A sin­gle-pay­er health care sys­tem, one designed to be resis­tant to GOP sab­o­tage, has sim­ply become a logis­ti­cal neces­si­ty in Amer­i­ca. The GOP has made that clear. What isn’t clear is if the par­ty will pay a polit­i­cal price for it.

    So if it seemed like the GOP’s polit­i­cal risks could­n’t get any riski­er in the age of Trump, they found a new way to do it: gut the most pop­u­lar pro­vi­sions in Oba­macare and desta­bi­lize the insur­ance mar­kets right before the mid-terms. Based on flim­sy legal argu­ments.

    The risks for all the old and sick peo­ple about to get priced out of health care are also about to increase dra­mat­i­cal­ly.

    Posted by Pterrafractyl | June 10, 2018, 10:06 pm
  16. It’s that time again. Time for the Repub­li­can Par­ty to demon­strate to the Amer­i­can pub­lic that the par­ty is utter­ly inca­pable of deal­ing with health care pol­i­cy. That’s what the Trump admin­is­tra­tion just sig­naled this week when the Jus­tice Depart­ment declared that the Trump admin­is­tra­tion just switched its legal stance on the ongo­ing Repub­li­can law­suit to kill Oba­macare.

    Recall that this is the law­suit brought for­ward by 20 GOP state attor­neys gen­er­al that is argu­ing that when the Repub­li­can tax bill of 2017 elim­i­nat­ed the IRS penal­ty on peo­ple who don’t get health insur­ance that means that indi­vid­ual man­date in Oba­macare can no longer be con­sid­ered a tax. The law­suit then argues that because the man­date could no longer be con­sid­ered a tax the man­date is there­fore uncon­sti­tu­tion­al. It then argues that because the man­date is required for Oba­macare to func­tion the entire law should be con­sid­ered uncon­sti­tu­tion­al and thrown out.

    Also recall how this law­suit is tech­ni­cal­ly suing the fed­er­al gov­ern­ment which placed the Trump’s own jus­tice depart­ment in the posi­tion of defend­ing Oba­macare. So the Trump admin­is­tra­tion was left in the posi­tion of decid­ing which, if any, parts of Oba­macare it would defend. And in June of last year the DOJ announced that it was no longer defend­ing the bans on insur­ers dis­crim­i­nat­ing against pre-exist­ing con­di­tions and bans on charg­ing old­er peo­ple high­er pre­mi­ums. The DOJ was still defend­ing oth­er parts of the law at that, like the Med­ic­aid expan­sion, but specif­i­cal­ly want­ed to get rid of pro­tec­tions for pre-exist­ing con­di­tions and the elder­ly. It was a remark­able elec­tion year deci­sion and a reminder of the the polit­i­cal per­il health care pos­es for the Repub­li­can Par­ty but also a reminder of how intense the desire is with­in the par­ty to strip the Amer­i­can pub­lic of any mean­ing­ful health care rights.

    And then, in Decem­ber, the fed­er­al judge in Texas hear­ing the case made a stun­ning rul­ing: the judge agreed with the plain­tiffs, argu­ing that, yes, the removal of the tax penal­ty for the indi­vid­ual man­date real­ly does inval­i­date the entire law and the whole thing should be thrown out. It was­n’t the kind of rul­ing that legal experts expect­ed to hold up in the Supreme Court but it kept the law­suit in play.

    And just this week, the Trump admin­is­tra­tion’s jus­tice depart­ment announced a new pol­i­cy on this law­suit: the admin­is­tra­tion agrees with the argu­ments behind the law­suit and wants to see the entire law be ruled invalid. Giv­en the real­i­ty that the Repub­li­can par­ty failed at repeal­ing Oba­macare in 2017 and has nev­er demon­strat­ed a capac­i­ty to come up with a replace­ment that would­n’t be broad­ly loathed by Amer­i­can vot­ers, the sud­den deci­sion of the Trump admin­is­tra­tion to place the Repub­li­cans in a posi­tion where they would once again be oblig­at­ed to come up with a viable replace­ment plan raised ques­tions about the polit­i­cal cal­cu­lus behind this deci­sion.

    And those ques­tions over the polit­i­cal log­ic behind this only got big­ger after reports that Trump’s admin­is­tra­tion made this deci­sion with­out the back­ing of the Repub­li­can lead­er­ship in con­gress. Sen­ate Major­i­ty Leader Mitch McConnell has even announced that he’s not going to be par­tic­i­pat­ing in com­ing up with a Repub­li­can replace­ment plan and will be entire­ly leav­ing that up to the Trump admin­is­tra­tion. And as the fol­low­ing arti­cle notes, House Minor­i­ty Leader Kevin McCarthy tried and failed to talk Trump out of it. As the arti­cle also notes, the real rea­son the Repub­li­cans are so exas­per­at­ed about the admin­is­tra­tion’s offi­cial embrace of the Repub­li­can law­suit is because over­turn­ing Oba­macare and get­ting rid of all of those pop­u­lar pro­tec­tions, like pre-exist­ing con­di­tions, and replac­ing them with basi­cal­ly noth­ing has actu­al­ly the been par­ty’s stance all along. So by embrac­ing the Repub­li­can state attor­neys gen­er­al law­suit, the Trump admin­is­tra­tion just made it a lot hard­er for the Repub­li­cans in con­gress to lie to the pub­lic about the real­i­ty that agen­da because now they have to come up with a replace­ment plan that does­n’t exist and can’t exist because a plan with those pop­u­lar pro­tec­tions is anti­thet­i­cal to the real Repub­li­can health care agen­da:

    The Wash­ing­ton Post

    Repub­li­cans furi­ous with Trump for mak­ing it hard­er to lie about health care

    By Greg Sar­gent
    Opin­ion writer
    March 27, 2019

    As we’ve been dis­cussing here, the Trump admin­is­tra­tion has ful­ly embraced a law­suit that seeks to over­turn the Afford­able Care Act entire­ly based on a legal the­o­ry that is being wide­ly dis­missed by com­men­ta­tors across the spec­trum as noth­ing but a bad joke.

    The prob­lem is that a Texas judge has decid­ed that this joke is good law, and has struck down the entire ACA as uncon­sti­tu­tion­al, using log­ic that is baf­fling­ly dif­fi­cult to fol­low. That’s up on appeal, how­ev­er, and no doubt many Repub­li­cans have qui­et­ly been hop­ing against hope that the law­suit — which was brought by a group of Repub­li­can attor­neys gen­er­al — ulti­mate­ly fails.

    Yet the Trump admin­is­tra­tion embraced the law­suit. This appar­ent­ly sur­prised many Repub­li­cans, who didn’t see it com­ing. And now Axios reports that Rep. Kevin McCarthy, the House minor­i­ty leader, has pri­vate­ly vent­ed his dis­plea­sure to Trump him­self over the administration’s new stance:

    McCarthy told Trump over the phone that the deci­sion made no sense — espe­cial­ly after Democ­rats killed Repub­li­cans in the midterms in part over the issue of pre-exist­ing con­di­tions, accord­ing to two sources famil­iar with their recent con­ver­sa­tion. ...

    McCarthy is far from alone in his view. Repub­li­can law­mak­ers and offi­cials are exas­per­at­ed about the Jus­tice Department’s posi­tion ...

    Mul­ti­ple GOP sources — from the most con­ser­v­a­tive to the most mod­er­ate wing of the par­ty — have told Axios that they can’t fath­om why the pres­i­dent would want to re-lit­i­gate an issue that has been a clear los­er for Repub­li­cans.

    Trump, how­ev­er, is uncon­cerned. He blithe­ly assert­ed: “The Repub­li­can Par­ty will soon be known as the par­ty of health care.”

    But Axios reports that this “sub­stance-free dec­la­ra­tion” from Trump has left Repub­li­can law­mak­ers and offi­cials “exas­per­at­ed.”

    Yet it’s worth get­ting at why this exas­per­ates them. As the Axios report notes, Repub­li­cans know this is a los­er for them, because the issue just cost them the House. As Sahil Kapur points out, in 2018 health care was the top issue for midterm vot­ers, and those who cit­ed it as their num­ber one issue went for the Demo­c­ra­t­ic can­di­dates by more than 50 points. This came after they had just tried and failed to repeal Oba­macare.

    Now Trump pub­licly recom­mit­ted his par­ty to total repeal, which has got Repub­li­cans angry with him. But what’s amus­ing is that this actu­al­ly is the GOP’s cur­rent stance. Sure, Repub­li­cans are rhetor­i­cal­ly com­mit­ted to keep­ing some form of pro­tec­tions for pre­ex­ist­ing con­di­tions (just not the ones Oba­macare has put in place). But as Peter Sud­er­man notes, there’s still no seri­ous GOP plan for actu­al­ly doing this, pre­cise­ly because Repub­li­cans won’t make the hard pol­i­cy choic­es nec­es­sary to cre­ate such a plan.

    So their posi­tion, func­tion­al­ly, is still full repeal. Repub­li­cans just want to be able to say they’re also for pro­tect­ing pre­ex­ist­ing con­di­tions, with­out say­ing how.

    If this sounds famil­iar, that’s because we’ve seen this before, and this his­to­ry makes the Repub­li­can anger over this even more com­i­cal. Dur­ing the 2018 elec­tions, Demo­c­ra­t­ic can­di­dates relent­less­ly pum­meled Repub­li­cans for vot­ing to do away with those pro­tec­tions. Untold num­bers of GOP incum­bents and can­di­dates respond­ed by lying about their true inten­tions, claim­ing that they want­ed to keep those pro­tec­tions.

    ...

    So this lie failed for Repub­li­cans. And so, when McCarthy rips into Trump for embrac­ing this law­suit as a proven los­er for them, what he real­ly means is that being too close­ly asso­ci­at­ed with actu­al repeal is a los­er. Repub­li­cans would like to keep say­ing they sup­port repeal while also claim­ing to want to pro­tect peo­ple with pre­ex­ist­ing con­di­tions. Tying Repub­li­cans too close­ly to a law­suit that would wipe all of it away incon­ve­nient­ly puts pres­sure on them to say how they would do that.

    Trump, though, didn’t get the memo, or doesn’t under­stand the memo. He thinks he and Repub­li­cans are sup­posed to actu­al­ly sup­port repeal. Or he’s still so gung-ho about destroy­ing Barack Obama’s sig­na­ture domes­tic achieve­ment that he doesn’t care what this means for the rest of his par­ty.

    Or per­haps Trump actu­al­ly thinks that if the courts ulti­mate­ly do strike down the ACA, he and the GOP can this time mag­i­cal­ly hatch a replace­ment and get the Demo­c­ra­t­ic House to go along with it. Per­haps Trump doesn’t under­stand that you’re mere­ly sup­posed to say that you have a way to replace the ACA. You’re not sup­posed to actu­al­ly believe it!

    What­ev­er is dri­ving this, it will bad­ly com­pli­cate Repub­li­cans’ efforts to pre­tend to be for pro­tect­ing peo­ple with pre­ex­ist­ing con­di­tions. No won­der McCarthy is so angry.

    ———-

    “Repub­li­cans furi­ous with Trump for mak­ing it hard­er to lie about health care” by Greg Sar­gent; The Wash­ing­ton Post; 03/27/2019

    “Yet the Trump admin­is­tra­tion embraced the law­suit. This appar­ent­ly sur­prised many Repub­li­cans, who didn’t see it com­ing. And now Axios reports that Rep. Kevin McCarthy, the House minor­i­ty leader, has pri­vate­ly vent­ed his dis­plea­sure to Trump him­self over the administration’s new stance

    “Don’t do it!” That was the advice to Trump from the House minor­i­ty leader about the deci­sion to ful­ly back the law­suit. Which was prob­a­bly pret­ty good advice giv­en that health care was the top issue in 2018 and vot­ers who pri­or­i­tize it favored Democ­rats by a 50 point mar­gin. And yet Trump con­fi­dent­ly declared that “The Repub­li­can Par­ty will soon be known as the par­ty of health care.” The Trump admin­is­tra­tion’s polit­i­cal strat­e­gy is so divorced from real­i­ty that Kevin McCarthy has become a voice a rea­son:

    ...
    Trump, how­ev­er, is uncon­cerned. He blithe­ly assert­ed: “The Repub­li­can Par­ty will soon be known as the par­ty of health care.”

    ...

    Yet it’s worth get­ting at why this exas­per­ates them. As the Axios report notes, Repub­li­cans know this is a los­er for them, because the issue just cost them the House. As Sahil Kapur points out, in 2018 health care was the top issue for midterm vot­ers, and those who cit­ed it as their num­ber one issue went for the Demo­c­ra­t­ic can­di­dates by more than 50 points. This came after they had just tried and failed to repeal Oba­macare.
    ...

    And as the arti­cle notes, what makes this move such a big risk for the Repub­li­cans run­ning for office is that full repeal of Oba­macare real­ly has always been the GOP’s plan but the par­ty can’t admit it pub­licly because that’s such a wild­ly unpop­u­lar stance. So the GOP has been steadi­ly wag­ing a cam­paign of lies to con­vince vot­ers that the par­ty real­ly does sup­port things like pre-exist­ing con­di­tions pro­tec­tions despite the fact that the par­ty does not at all sup­port those pro­tec­tions. And main­tain­ing that cru­cial lie is going to be a lot hard­er going for­ward:

    ...
    Now Trump pub­licly recom­mit­ted his par­ty to total repeal, which has got Repub­li­cans angry with him. But what’s amus­ing is that this actu­al­ly is the GOP’s cur­rent stance. Sure, Repub­li­cans are rhetor­i­cal­ly com­mit­ted to keep­ing some form of pro­tec­tions for pre­ex­ist­ing con­di­tions (just not the ones Oba­macare has put in place). But as Peter Sud­er­man notes, there’s still no seri­ous GOP plan for actu­al­ly doing this, pre­cise­ly because Repub­li­cans won’t make the hard pol­i­cy choic­es nec­es­sary to cre­ate such a plan.

    So their posi­tion, func­tion­al­ly, is still full repeal. Repub­li­cans just want to be able to say they’re also for pro­tect­ing pre­ex­ist­ing con­di­tions, with­out say­ing how.

    If this sounds famil­iar, that’s because we’ve seen this before, and this his­to­ry makes the Repub­li­can anger over this even more com­i­cal. Dur­ing the 2018 elec­tions, Demo­c­ra­t­ic can­di­dates relent­less­ly pum­meled Repub­li­cans for vot­ing to do away with those pro­tec­tions. Untold num­bers of GOP incum­bents and can­di­dates respond­ed by lying about their true inten­tions, claim­ing that they want­ed to keep those pro­tec­tions.

    ...

    So this lie failed for Repub­li­cans. And so, when McCarthy rips into Trump for embrac­ing this law­suit as a proven los­er for them, what he real­ly means is that being too close­ly asso­ci­at­ed with actu­al repeal is a los­er. Repub­li­cans would like to keep say­ing they sup­port repeal while also claim­ing to want to pro­tect peo­ple with pre­ex­ist­ing con­di­tions. Tying Repub­li­cans too close­ly to a law­suit that would wipe all of it away incon­ve­nient­ly puts pres­sure on them to say how they would do that.
    ...

    So how on earth did the Trump admin­is­tra­tion arrive at the deci­sion to make a wild polit­i­cal gam­ble like this? Well, accord­ing to the fol­low­ing arti­cle, it appears that Mick Mul­vaney was the dri­ving behind this.

    Recall how Mul­vaney was one of the GOP’s extreme­ly con­ser­v­a­tive mem­bers of the House who was rou­tine­ly in favor of extrem­ist stances on things like gov­ern­ment shut­downs before being tapped by the Trump admin­is­tra­tion. In oth­er words, he was a ‘burn is down’ House GOP­er before being select­ed as the direc­tor of the Office of Man­age­ment and Bud­get and lat­er also select­ed by Trump to be the act­ing head of the Con­sumer Finan­cial Pro­tec­tion Bureau. And now he’s the act­ing chief of staff in addi­tion to his OMB job. So Trump clear­ly views Mul­vaney as a fig­ure he can trust.

    And as the fol­low­ing arti­cle notes, one of the most sig­nif­i­cant staffing changes under Mul­vaney’s term as act­ing chief of staff has involved Mul­vaney bring­ing into the White House a num­ber of key ‘burn is down’ allies. Allies who are going into key pol­i­cy-mak­ing posi­tions that shape the Trump admin­is­tra­tion’s pol­i­cy agen­da like Joe Gro­gan, who became the head of the White House’s Domes­tic Pol­i­cy Coun­cil in late Jan­u­ary fol­low­ing Mul­vaney’s appoint­ment as act­ing Chief of Staff. And both Mul­vaney and Gro­gan appear to have suc­cess­ful­ly con­vinced Trump that back­ing the entire repeal of Oba­macare in that law­suit is good pol­i­tics because it appeals to Trump’s base.

    So it appears that the new Mul­vaney fac­tion with­in the Trump admin­is­tra­tion has con­vinced Trump that threat­en­ing to sud­den­ly take away health care pro­tec­tions from mil­lions is good pol­i­tics. Whether or not they are cor­rect or delu­sion­al it’s not the best com­men­tary on the state of Amer­i­can pol­i­tics:

    Slate

    Mick Mul­vaney Has Con­sol­i­dat­ed His Influ­ence in the White House to Everyone’s Detri­ment

    By Jor­dan Weiss­mann
    March 27, 20198:11 PM

    The Trump admin­is­tra­tion shocked much of Wash­ing­ton on Mon­day when it reversed legal course and urged a fed­er­al appeals court to strike down the entire Afford­able Care Act, includ­ing its pop­u­lar Med­ic­aid expan­sion. The move has flus­tered con­gres­sion­al Repub­li­cans, who have been forced to qui­et their gloat­ing about the Mueller report and talk about health care, which they gen­er­al­ly regard these days as polit­i­cal kryp­tonite.

    And now we know whom they can blame: Mick Mul­vaney. Both Politi­co and the New York Times report that the White House chief of staff, along with one of his pro­teges, was the main dri­ver behind the president’s deci­sion, which was opposed by the attor­ney gen­er­al, vice pres­i­dent, and sec­re­tary of health and human ser­vices.

    Mulvaney’s pow­er move prob­a­bly does not mean much for the future of Oba­macare. But it does con­firm that the man has acquired a great deal of influ­ence in the White House—which, giv­en his venal pol­i­cy instincts and tin ear for pol­i­tics, can’t pos­si­bly bode well for any­body, least of all Repub­li­can law­mak­ers.

    Late last year, a fed­er­al court judge in Texas hand­ed down a far­ci­cal­ly rea­soned opin­ion inval­i­dat­ing all of Oba­macare, because Repub­li­cans had zeroed out the tax penal­ty asso­ci­at­ed with the law’s indi­vid­ual man­date. He argued that the Supreme Court had pre­vi­ous­ly upheld the man­date as a tax, and now that the tax was gone, the require­ment that Amer­i­cans must buy health insur­ance was now uncon­sti­tu­tion­al, and—this is the absurd bit—the rest of the law must also fall as well.

    In doing so, he sided with a group of Repub­li­can state attor­neys gen­er­al who had sued to void the entire ACA. In a con­tro­ver­sial move, the Trump admin­is­tra­tion chose not to defend against the suit, and agreed that the man­date was uncon­sti­tu­tion­al. But it argued that parts of the law, such as the Med­ic­aid expan­sion, could exist with­out the man­date and should be left to stand.

    On Mon­day, the Jus­tice Depart­ment appeared to change its mind. It filed a four-line let­ter with the 5th Cir­cuit Court of Appeals, where the case is now on appeal, urg­ing it to uphold the low­er court’s entire rul­ing. It’s no longer split­ting the baby.

    Chances are, this will not affect the final out­come of the suit a great deal. The states lead­ing the case were already press­ing to undo the entire health law. The fact that Team Trump now agrees in full with them doesn’t change the facts of the case or legal cal­cu­la­tions involved. It’s also worth keep­ing in mind that, pre­vi­ous­ly, the admin­is­tra­tion argued that the court should strike down Obamacare’s pro­tec­tions for patients with pre-exist­ing con­di­tions, gut­ting a key piece of the law and like­ly spark­ing a mas­sive fight in Con­gress over health care any­way.

    So why both­er ratch­et­ing things up for min­i­mal gain? Mul­vaney believed it would make good pol­i­tics, as did the White House’s Domes­tic Pol­i­cy Coun­cil head Joe Gro­gan, an ally Mul­vaney picked for his job. Vice Pres­i­dent Mike Pence, Sec­re­tary of Health and Human Ser­vices Alex Azar, and Attor­ney Gen­er­al William Barr all pushed back, but the Mul­vaney argu­ment pre­vailed any­way. Here’s how the Times described it:

    Mr. Trump has tout­ed that he has kept his promis­es, Mr. Mul­vaney and Mr. Gro­gan argued, and as a can­di­date, they said, he cam­paigned on repeal­ing the health law. His base of vot­ers would love it. Besides, they argued, Democ­rats have been cam­paign­ing suc­cess­ful­ly on health care, and Repub­li­cans should try to take it over them­selves. This could force the issue.

    This think­ing is bizarre. Repub­li­cans tried and failed mul­ti­ple times to repeal and replace the Afford­able Care Act while they con­trolled both hous­es of Con­gress. After­ward, they were smashed in the midterms, los­ing their House major­i­ty in the process as Democ­rats ham­mered them for attack­ing pro­tec­tions for patients with pre-exist­ing con­di­tions. It is unclear what, if any­thing, they could pass now if mil­lions sud­den­ly lost their health cov­er­age. There is almost cer­tain­ly no issue they would less like to “force,” espe­cial­ly head­ing into 2020, which is why House Minor­i­ty Leader Kevin McCarthy report­ed­ly told Trump his deci­sion on the law­suit made zero sense. For Repub­li­cans run­ning for re-elec­tion, putting health care on their plate would be a bit like mak­ing a bunch of vam­pires chow down on a bas­ket of gar­lic bread.

    But the log­ic is also clas­sic Mul­vaney, who, as a Tea Par­ty con­gress­man from a deep red South Car­oli­na dis­trict, con­sis­tent­ly backed polit­i­cal­ly unpop­u­lar and often fruit­less con­fronta­tions with the Oba­ma admin­is­tra­tion. Dur­ing the debt ceil­ing bat­tle in 2011, he sug­gest­ed that a gov­ern­ment default wouldn’t be too dev­as­tat­ing (almost nobody agreed). He also sup­port­ed the 2013 gov­ern­ment shut­down over Oba­macare. Dur­ing his time as Trump’s bud­get direc­tor, he became known for propos­ing extreme spend­ing cuts even Repub­li­cans blanched at and let­ting loose with car­toon­ish­ly cold­heart­ed sound bites, like the time he came down on Meals on Wheels. It’s no sur­prise he’s urg­ing yet anoth­er scheme that seems bound to back­fire.

    It is also easy to see how the think­ing appealed to Trump, who is mono­ma­ni­a­cal­ly focused on the desires of his base and has repeat­ed­ly tried to engi­neer crises that would force his par­ty to pass some sort of health care leg­is­la­tion, even though it is appar­ent to just about every­one else that they are inca­pable of it.

    This speaks to why Mul­vaney has been such a suc­cess­ful behind-the-scenes oper­a­tor with­in the Trump admin­is­tra­tion: He knows what makes the pres­i­dent tick. They share a sin­gle-mind­ed focus on con­ser­v­a­tive vot­ers. And he’s put in enough hours golf­ing with Trump to solid­i­fy their per­son­al rela­tion­ship, while avoid­ing the mis­takes that brought down his pre­de­ces­sors as chief of staff. As Politi­co notes:

    While Mul­vaney has been a low-key pres­ence in Trump’s fre­net­ic White House, the deci­sion to take direct aim at Oba­macare after the administration’s fail­ure to repeal the law in 2017 offers a glimpse into how he wields his influ­ence. Instead of focus­ing on lim­it­ing the access of oth­er West Wing staffers to the president—something his pre­de­ces­sor John Kel­ly tried and failed to do—he has steadi­ly built his own oper­a­tion inside the White House and giv­en his allies a direct line to Trump. They include Gro­gan, who took the reins of the Domes­tic Pol­i­cy Coun­cil in late Jan­u­ary.

    ...

    ———-

    “Mick Mul­vaney Has Con­sol­i­dat­ed His Influ­ence in the White House to Everyone’s Detri­ment” by Jor­dan Weiss­mann; Slate; 03/27/2019

    And now we know whom they can blame: Mick Mul­vaney. Both Politi­co and the New York Times report that the White House chief of staff, along with one of his pro­teges, was the main dri­ver behind the president’s deci­sion, which was opposed by the attor­ney gen­er­al, vice pres­i­dent, and sec­re­tary of health and human ser­vices.”

    Blame Mick. That’s prob­a­bly going to be a famil­iar say­ing for the Repub­li­cans going for­ward. But it’s not just Mick. It’s all his friends he brought into the White House like Joe Gro­gan. A fac­tion of Repub­li­cans who thought gov­ern­ment shut­downs and the sud­den repeal of Oba­macare are good pol­i­tics for the par­ty are now in key pol­i­cy-mak­ing posi­tions in the White House:

    ...
    So why both­er ratch­et­ing things up for min­i­mal gain? Mul­vaney believed it would make good pol­i­tics, as did the White House’s Domes­tic Pol­i­cy Coun­cil head Joe Gro­gan, an ally Mul­vaney picked for his job. Vice Pres­i­dent Mike Pence, Sec­re­tary of Health and Human Ser­vices Alex Azar, and Attor­ney Gen­er­al William Barr all pushed back, but the Mul­vaney argu­ment pre­vailed any­way. Here’s how the Times described it:

    Mr. Trump has tout­ed that he has kept his promis­es, Mr. Mul­vaney and Mr. Gro­gan argued, and as a can­di­date, they said, he cam­paigned on repeal­ing the health law. His base of vot­ers would love it. Besides, they argued, Democ­rats have been cam­paign­ing suc­cess­ful­ly on health care, and Repub­li­cans should try to take it over them­selves. This could force the issue.

    This think­ing is bizarre. Repub­li­cans tried and failed mul­ti­ple times to repeal and replace the Afford­able Care Act while they con­trolled both hous­es of Con­gress. After­ward, they were smashed in the midterms, los­ing their House major­i­ty in the process as Democ­rats ham­mered them for attack­ing pro­tec­tions for patients with pre-exist­ing con­di­tions. It is unclear what, if any­thing, they could pass now if mil­lions sud­den­ly lost their health cov­er­age. There is almost cer­tain­ly no issue they would less like to “force,” espe­cial­ly head­ing into 2020, which is why House Minor­i­ty Leader Kevin McCarthy report­ed­ly told Trump his deci­sion on the law­suit made zero sense. For Repub­li­cans run­ning for re-elec­tion, putting health care on their plate would be a bit like mak­ing a bunch of vam­pires chow down on a bas­ket of gar­lic bread.

    But the log­ic is also clas­sic Mul­vaney, who, as a Tea Par­ty con­gress­man from a deep red South Car­oli­na dis­trict, con­sis­tent­ly backed polit­i­cal­ly unpop­u­lar and often fruit­less con­fronta­tions with the Oba­ma admin­is­tra­tion. Dur­ing the debt ceil­ing bat­tle in 2011, he sug­gest­ed that a gov­ern­ment default wouldn’t be too dev­as­tat­ing (almost nobody agreed). He also sup­port­ed the 2013 gov­ern­ment shut­down over Oba­macare. Dur­ing his time as Trump’s bud­get direc­tor, he became known for propos­ing extreme spend­ing cuts even Repub­li­cans blanched at and let­ting loose with car­toon­ish­ly cold­heart­ed sound bites, like the time he came down on Meals on Wheels. It’s no sur­prise he’s urg­ing yet anoth­er scheme that seems bound to back­fire.
    ...

    And don’t for­get, the Trump admin­is­tra­tion decid­ed last year to advo­cate that the pro­tec­tions for pre-exist­ing con­di­tions and charg­ing the elder­ly more should be elim­i­nat­ed as part of this law­suit. This was right before the 2018 mid-terms. So to some extent this lat­est move should come as no sur­prise at all because its almost worse rhetor­i­cal­ly to specif­i­cal­ly advo­cate for just get­ting rid of the pro­tec­tions for pre-exist­ing con­di­tions and charg­ing the elder­ly more as opposed to get­ting rid of the entire law. In oth­er words, as polit­i­cal­ly insane as this lat­est move is it might actu­al­ly be a rhetor­i­cal improve­ment from the admin­is­tra­tion’s pre­vi­ous stance on this law­suit:

    ...
    On Mon­day, the Jus­tice Depart­ment appeared to change its mind. It filed a four-line let­ter with the 5th Cir­cuit Court of Appeals, where the case is now on appeal, urg­ing it to uphold the low­er court’s entire rul­ing. It’s no longer split­ting the baby.

    Chances are, this will not affect the final out­come of the suit a great deal. The states lead­ing the case were already press­ing to undo the entire health law. The fact that Team Trump now agrees in full with them doesn’t change the facts of the case or legal cal­cu­la­tions involved. It’s also worth keep­ing in mind that, pre­vi­ous­ly, the admin­is­tra­tion argued that the court should strike down Obamacare’s pro­tec­tions for patients with pre-exist­ing con­di­tions, gut­ting a key piece of the law and like­ly spark­ing a mas­sive fight in Con­gress over health care any­way.
    ...

    And as the arti­cle notes, both Mul­vaney and Trump share the same polit­i­cal instinct: cater to the hard core base at all costs:

    ...
    It is also easy to see how the think­ing appealed to Trump, who is mono­ma­ni­a­cal­ly focused on the desires of his base and has repeat­ed­ly tried to engi­neer crises that would force his par­ty to pass some sort of health care leg­is­la­tion, even though it is appar­ent to just about every­one else that they are inca­pable of it.

    This speaks to why Mul­vaney has been such a suc­cess­ful behind-the-scenes oper­a­tor with­in the Trump admin­is­tra­tion: He knows what makes the pres­i­dent tick. They share a sin­gle-mind­ed focus on con­ser­v­a­tive vot­ers. And he’s put in enough hours golf­ing with Trump to solid­i­fy their per­son­al rela­tion­ship, while avoid­ing the mis­takes that brought down his pre­de­ces­sors as chief of staff. As Politi­co notes:
    ...

    So giv­en their shared views on the need to con­stant­ly keep the hard core Trump base sati­at­ed it’s not at all sur­pris­ing that Trump would find Mul­vaney’s argu­ments on the pol­i­tics of this per­sua­sive. It was no doubt extreme­ly pop­u­lar with the base. Except it’s so unpop­u­lar over­all that the GOP does­n’t want to talk about it so it’s unclear how much of Trump’s base even knows about it. And it’s still some­what sur­pris­ing that Mul­vaney, him­self pre­vi­ous­ly a con­gress­man, would be so cav­a­lier about plac­ing his fel­low GOP­ers still in con­gress in such a pre­car­i­ous polit­i­cal posi­tion. But that’s what he appears to think.

    What could Trump and Mul­vaney be think­ing? Well, it’s worth keep­ing in mind the obser­va­tion in the fol­low­ing arti­cle by Jor­dan Weiss­man, author of the above arti­cle, from Decem­ber right after the fed­er­al judge made the rul­ing: it still looks like this case is going to ulti­mate­ly lose at the Supreme Court if it makes it through the appeals process. Because the argu­ments are pret­ty bad.

    So while it’s true that the GOP has no real replace­ment for Oba­macare and it would be a polit­i­cal dis­as­ter for GOP if this is law­suit pro­ceeds and wins, it’s very pos­si­ble the GOP is assum­ing it’s not going to win the law­suit so it does­n’t ulti­mate­ly have to wor­ry about pro­vid­ing a replace­ment for Oba­macare. It’s just an oppor­tu­ni­ty to pos­ture.

    As Weiss­man points out, the fed­er­al judges rul­ing was pred­i­cat­ed in part on what the GOP neglect­ed to do in its 2017 tax bill that got rid of the man­date. When the tax bill they left it a com­plete mys­tery as to whether or not law­mak­ers changed their mind about whether or not the man­date is “non-sev­er­able” (nec­es­sary) for Oba­macare to func­tion. The fact that they did­n’t clar­i­fy this in the tax bill means we have to default to the “non-sev­er­abil­i­ty” of the indi­vid­ual man­date that was part of the orig­i­nal pas­sage of Oba­macare. The removal of the man­date vio­lat­ed the “non-sev­er­abil­i­ty” of the man­date to Oba­macare and that’s why the whole law has to be thrown out. That was part of the judge’s log­ic behind the rul­ing. It does­n’t sound like legal experts were impressed.

    So it’s impor­tant to keep in mind that it’s very pos­si­ble the Trump admin­is­tra­tion and rest of the GOP is assum­ing that this is going to lose at the Supreme Court because the Decem­ber rul­ing was kind of a joke. This lat­est move by the Trump DOJ could sim­ply be a cyn­i­cal ploy where they assume few peo­ple out­side of Trump’s base will hear about the admin­is­tra­tion’s new stance on this case because it’s going to lose in the end and hard­ly any unde­cid­ed vot­ers are pay­ing atten­tion. It could just be crass polit­i­cal virtue sig­nal­ing because they know the legal argu­ment is garbage.

    Then again, as the arti­cle notes, we’re assum­ing John Roberts won’t decide that this is the time to go ahead and kill Oba­macare and that seems like an assump­tion we should­n’t make in the Trump era. You nev­er know with Roberts.

    Still, giv­en how legal­ly flim­sy the Texas judge’s rul­ing was it at least appears that it’s not a legal­ly strong case and there’s a good chance Roberts will once again rule in favor of keep­ing Oba­macare intact. Then again, let’s not for­get that when Roberts ruled in favor of the indi­vid­ual man­date in the 2012 case about the con­sti­tu­tion­al­i­ty of the man­date, he also did enor­mous dam­age and vot­ed in favor of let­ting states opt out of the Med­ic­aid expan­sion. It was a severe blow to the law and pre­dictably dam­aged the health care of mil­lions of peo­ple in states that did­n’t accept the expan­sion.

    So there’s a prece­dent that Roberts will uphold the con­sti­tu­tion­al­i­ty of law while still inflict­ing a new blow. Maybe it will be let­ting states opt out of pre-exist­ing con­di­tions man­dates. Or maybe Roberts will let states opt out of the rules against insur­ance com­pa­nies charg­ing seniors more. Or maybe it will nev­er make it to the Supreme Court. We’ll find out. But it’s very pos­si­ble the GOP is view­ing this law­suit as unlike­ly to win there­fore safe for ‘red meat’ pos­tur­ing. And if it does go to the Supreme Court even if Roberts rules in favor of Oba­macare he might strike anoth­er blow against the law in some way like he did in 2012 as part of the GOP’s larg­er ‘death by a thou­sand cuts’ strat­e­gy.

    So the law­suit should lose based on its legal mer­its and prob­a­bly will lose. It’s basi­cal­ly legal trolling. And the GOP has to hope the law­suit los­es because if there’s one thing we know at this point it’s that the Repub­li­can Par­ty can’t do health care and they real­ly don’t want this to blow up on them before 2020. If Oba­macare was sud­den­ly elim­i­nat­ed thanks to this GOP law­suit that would be polit­i­cal dis­as­ter for the GOP. Not only would that be high­ly dis­rup­tive to mil­lions but it would force a GOP replace­ment plan and Repub­li­can Par­ty is the par­ty of health care sab­o­tage and deba­cles. Not health care plans. The GOP has no replace­ment that the pub­lic won’t hate. So pret­ty much every­one, includ­ing Trump, has an incen­tive to see this law­suit fail. That’s how irre­spon­si­ble it is:

    Slate

    The Afford­able Care Act Is Not Dead Yet

    By Jor­dan Weiss­mann
    Dec 15, 201812:48 AM

    Once again, the fate of Oba­macare could soon be in the hands of one John G. Roberts.

    On Fri­day night, a fed­er­al tri­al court judge in Texas bal by the tax bill Repub­li­cans passed in 2017. The deci­sion was wide­ly antic­i­pat­ed and will cer­tain­ly be appealed, poten­tial­ly set­ting up a final show­down at the Supreme Court, where the health law has already been test­ed twice before.

    Is this the begin­ning of the end of the Afford­able Care Act? The cool­head­ed ana­lyt­i­cal part of me would like to say absolute­ly not. After all, the chief jus­tice has already turned down two pre­vi­ous oppor­tu­ni­ties to dri­ve a legal stake into the health law. And this case is, by many accounts, even more ten­u­ous than the ones that came before it.

    On the oth­er hand, it’s 2018. Log­ic no longer applies, every­thing is per­mit­ted, and for all I know Roberts might have decid­ed it’s a good time to strip health care from a few mil­lion of his fel­low Amer­i­cans. So let’s talk about the case.

    The suit was filed by a group of 20 GOP-led states argu­ing that Obamacare’s indi­vid­ual man­date, which required Amer­i­cans to buy health insur­ance or pay a fine, had been left uncon­sti­tu­tion­al after Repub­li­cans reduced the IRS penal­ty to zero as part of their tax bill last year. Their argu­ment had three parts:

    1) In 2012, the Supreme Court upheld the man­date on the grounds that it was a tax.

    2) Now that there’s no more tax asso­ci­at­ed with the man­date, it can’t pos­si­bly be con­sti­tu­tion­al.

    3) Because the man­date was con­sid­ered essen­tial to mak­ing the rest of Oba­macare function—in legal terms, it was “non-severable”—the court should junk the rest of the health law too, includ­ing its expan­sion of Med­ic­aid and pro­tec­tions for patients with pre-exist­ing con­di­tions.

    In his tedious­ly lengthy opin­ion Fri­day, Judge Reed O’Connor, a George W. Bush appointee who pre­sides in Fort Worth, con­clud­ed that the red states were right: The man­date was uncon­sti­tu­tion­al, and the rest of Oba­macare had to go.

    Now, as Uni­ver­si­ty of Michi­gan pro­fes­sor Nicholas Bagley has point­ed out, the ques­tion of whether or not the man­date is still con­sti­tu­tion­al actu­al­ly isn’t all that impor­tant in the scheme of things. I mean, it’s fas­ci­nat­ing in a dorm room bull ses­sion sense—is a $0 tax still a tax? We can debate that all day. But back in the real world, Repub­li­cans have func­tion­al­ly killed off the man­date, and Oba­macare is man­ag­ing to lope along with­out it. The real­ly impor­tant ques­tion, from a legal and pol­i­cy stand­point, is whether the rest of Oba­macare can still stand if the man­date is ruled uncon­sti­tu­tion­al.

    The answer to that key ques­tion should be: Yes. Con­gress may have thought that the insur­ance-buy­ing require­ment was essen­tial to Oba­macare when the law passed in 2010. But Repub­li­cans pret­ty clear­ly decid­ed oth­er­wise in 2017, when they tried and failed to repeal the Afford­able Care Act, then decid­ed to kill the man­date alone as a con­ve­nient way to help fund their tax bill. Not a sin­gle Repub­li­can mem­ber of Con­gress got up at the time and said: “We just repealed all of Oba­macare.” They said, “We repealed the indi­vid­ual man­date.”

    O’Connor, how­ev­er, did not see things that way. He con­cludes that Con­gress believed the man­date was essen­tial to all of Oba­macare in 2010, and that the man­date can­not be sev­ered from the rest of Oba­macare, in part because Con­gress’ intent in 2017 was a com­plete and utter mys­tery:

    Look­ing for any sev­er­abil­i­ty-relat­ed intent in the 2017 Con­gress is a fool’s errand because the 2017 “Con­gress did not repeal any part of the ACA, includ­ing the shared respon­si­bil­i­ty pay­ment. In fact, it could not do so through the bud­get rec­on­cil­i­a­tion pro­ce­dures that it used.” (“The only thing that we know for sure about Con­gress’ intent in 2017 … is that Con­gress want­ed to pass a tax cut.”). So, ask­ing what the 2017 Con­gress intend­ed with respect to the ACA qua the ACA is unhelp­ful. There is no answer.

    One notable thing about this para­graph from O’Connor is that it’s fac­tu­al­ly incor­rect. As Demo­c­ra­t­ic Bud­get Com­mit­tee staffer Bob­by Kogan points out, Repub­li­cans could have repealed large parts of Oba­macare, includ­ing the Med­ic­aid expan­sion, under the rec­on­cil­i­a­tion process they used to pass their tax bill. Some con­ser­v­a­tives, such as for­mer Repub­li­can Sen­ate staffer Chris Jacobs, are equal­ly unim­pressed with O’Connor’s rea­son­ing on the sev­er­abil­i­ty issue.

    It’s good pol­i­cy — but awful law. Con­gress act­ed last year to repeal the man­date, but leave every­thing else in place, and the courts should have deferred to that. The rea­son­ing behind the rul­ing is FROM A DISSENT in #NFIB­vSe­be­lius, for Pete’s sake... https://t.co/68dUBFfobG
    — Chris Jacobs (@chrisjacobsHC) Decem­ber 15, 2018

    ...

    ———-

    “The Afford­able Care Act Is Not Dead Yet” by Jor­dan Weiss­mann; Slate; 12/15/2018

    Is this the begin­ning of the end of the Afford­able Care Act? The cool­head­ed ana­lyt­i­cal part of me would like to say absolute­ly not. After all, the chief jus­tice has already turned down two pre­vi­ous oppor­tu­ni­ties to dri­ve a legal stake into the health law. And this case is, by many accounts, even more ten­u­ous than the ones that came before it.”

    The law­suit should fail at the Supreme Court based on prece­dent. But it’s the Trump era so we should assume Roberts won’t decide now is a good time to kill Oba­macare. That was how Weiss­mann framed the dan­gers this law­suit pos­es. Oba­macare is prob­a­bly ulti­mate­ly safe, but Roberts just might decide today is the day Oba­macare goes:

    ...
    On the oth­er hand, it’s 2018. Log­ic no longer applies, every­thing is per­mit­ted, and for all I know Roberts might have decid­ed it’s a good time to strip health care from a few mil­lion of his fel­low Amer­i­cans. So let’s talk about the case.
    ...

    But, again, that seems unlike­ly that Roberts will throw out Oba­macare with this law­suit because it just does­n’t seem like the law­suit has much mer­it. And then there’s the fact that, as the just point­ed out, the GOP’s argu­ment is based the fact that the GOP’s tax bill did­n’t clar­i­fy Oba­macare on the issue of the “non-sev­er­able” nature of the man­date when it got rid of the tax penal­ty. So the GOP cre­at­ed the prob­lem it’s suing over to kill Oba­macare:

    ...
    Now, as Uni­ver­si­ty of Michi­gan pro­fes­sor Nicholas Bagley has point­ed out, the ques­tion of whether or not the man­date is still con­sti­tu­tion­al actu­al­ly isn’t all that impor­tant in the scheme of things. I mean, it’s fas­ci­nat­ing in a dorm room bull ses­sion sense—is a $0 tax still a tax? We can debate that all day. But back in the real world, Repub­li­cans have func­tion­al­ly killed off the man­date, and Oba­macare is man­ag­ing to lope along with­out it. The real­ly impor­tant ques­tion, from a legal and pol­i­cy stand­point, is whether the rest of Oba­macare can still stand if the man­date is ruled uncon­sti­tu­tion­al.

    The answer to that key ques­tion should be: Yes. Con­gress may have thought that the insur­ance-buy­ing require­ment was essen­tial to Oba­macare when the law passed in 2010. But Repub­li­cans pret­ty clear­ly decid­ed oth­er­wise in 2017, when they tried and failed to repeal the Afford­able Care Act, then decid­ed to kill the man­date alone as a con­ve­nient way to help fund their tax bill. Not a sin­gle Repub­li­can mem­ber of Con­gress got up at the time and said: “We just repealed all of Oba­macare.” They said, “We repealed the indi­vid­ual man­date.”

    O’Connor, how­ev­er, did not see things that way. He con­cludes that Con­gress believed the man­date was essen­tial to all of Oba­macare in 2010, and that the man­date can­not be sev­ered from the rest of Oba­macare, in part because Con­gress’ intent in 2017 was a com­plete and utter mys­tery:

    Look­ing for any sev­er­abil­i­ty-relat­ed intent in the 2017 Con­gress is a fool’s errand because the 2017 “Con­gress did not repeal any part of the ACA, includ­ing the shared respon­si­bil­i­ty pay­ment. In fact, it could not do so through the bud­get rec­on­cil­i­a­tion pro­ce­dures that it used.” (“The only thing that we know for sure about Con­gress’ intent in 2017 … is that Con­gress want­ed to pass a tax cut.”). So, ask­ing what the 2017 Con­gress intend­ed with respect to the ACA qua the ACA is unhelp­ful. There is no answer.

    ...

    “So, ask­ing what the 2017 Con­gress intend­ed with respect to the ACA qua the ACA is unhelp­ful. There is no answer.”

    That’s right, the GOP neglects to clar­i­fy in the 2017 tax bill the impact that get­ting rid of the man­date’s tax penal­ty would have on the sev­er­abil­i­ty of the man­date to Oba­macare and then the GOP wages a law­suit that uses that lack of clar­i­ty as a legal open­ing. It’s quite a rack­et.

    That’s what the GOP did and now this law­suit got through the Texas fed­er­al court judge and if it makes it through the appeals courts it’s going to be at the Supreme Court where Chief Jus­tice Roberts will more or less be the decider. The law­suit should­n’t suc­ceed but in these Trumpian times we can’t dis­miss the pos­si­bil­i­ty. This is John Roberts we’re talk­ing about.

    But giv­en that even Trump and the GOP can’t pos­si­bly want to actu­al­ly see this law­suit suc­ceed, at least note before the 2020 elec­tion, it seems like a pret­ty safe bet that it won’t. Nobody wants to actu­al­ly see the law­suit suc­ceed. Except for parts of Trump’s hard core base. The law­suit is legal trolling to impress the base and that’s large­ly it unless John Roberts is feel­ing frisky. Legal trolling in the form of threat­en­ing to take away the health care of mil­lions while pre­tend­ing to have a replace­ment plan that does­n’t exist and can’t exist. Legal trolling that won’t have a cost because the case does­n’t have a chance. Or at least should­n’t have a chance.

    So it’s going to be worth keep­ing in mind that the fact that GOP elect­ed offi­cials are exas­per­at­ed with Trump for sud­den­ly mak­ing health care an issue the GOP has to deal with is no excuse for the fact that these GOP­ers not answer­ing ques­tions about what the GOP’s replace­ment plan is for Oba­macare. If the par­ty is going to legal­ly and leg­isla­tive­ly sab­o­tage Oba­macare and sue it out of exis­tence it should real­ly be forced to explain what its replace­ment plan would be dur­ing that whole suing-out-of-exis­tence peri­od. The pub­lic should­n’t have to wait for the law­suit to suc­ceed before it demands details on the pro­posed replace­ments.

    And that’s per­haps the most inter­est­ing part of this law­suit: it puts the onus on the GOP of what its Oba­macare replace­ment is going to be going into the 2020 elec­tions. Trump may want to focus on immi­gra­tion issues for his reelec­tion strat­e­gy but as long as the GOP is wag­ing this law­suit and the Trump jus­tice depart­ment is sup­port­ing it the ques­tion of what the GOP’s health care replace­ment is becomes an impor­tant and rather urgent ques­tion. The GOP is lit­er­al­ly try­ing to sud­den­ly break Oba­macare. That rais­es a lot of urgent ques­tions.

    So while the GOP may have want­ed to use this law­suit to qui­et­ly legal­ly troll Oba­macare’s sup­port­ers and send ‘red meat’ sig­nals to the base, keep in mind that this law­suit actu­al­ly makes health care an urgent front and cen­ter issue head­ing into the 2020 elec­tion. Urgent because the GOP is try­ing to break it for polit­i­cal gain, which makes this law­suit an extra urgent polit­i­cal issue in a way. And also kind of meta at this point.

    Posted by Pterrafractyl | March 31, 2019, 12:06 am
  17. Here’s a series of arti­cles that point towards the impor­tance high drug prices could have not just in the 2020 elec­tion but more fun­da­men­tal­ly in Amer­i­can pol­i­tics. They also tie into the inevitable attempts by Pres­i­dent Trump and the GOP to por­tray the Demo­c­ra­t­ic nom­i­nee as some sort of wild eyed social­ist out to dis­man­tle the Amer­i­can Dream:

    First, it’s worth not­ing some­thing that was report­ed last week, around the same time we got news that the Trump admin­is­tra­tion’s jus­tice depart­ment decid­ed to ful­ly back the law­suit being brought by 20 Repub­li­can state attor­neys gen­er­al argu­ing that Oba­macare was made uncon­sti­tu­tion­al after the Repub­li­cans elim­i­nat­ed the IRS tax penal­ty for adults who did­n’t get insur­ance. It appears that high phar­ma­ceu­ti­cal prices is an area that the Trump White House sees as an oppor­tu­ni­ty for bipar­ti­san coop­er­a­tion. Yep, at pret­ty much the same time we learned about the Trump admin­is­tra­tion get­ting behind the GOP’s lat­est attempt to uni­lat­er­al­ly destroy Oba­macare we also learned that the Trump team sees an open­ing for bipar­ti­san health care reform:

    CNBC

    White House and Pelosi’s staff in ear­ly talks about leg­is­la­tion to cut high drug costs

    * The Trump admin­is­tra­tion is in ear­ly talks with House Speak­er Nan­cy Pelosi’s staff about leg­is­la­tion to low­er pre­scrip­tion drug costs, a White House offi­cial tells CNBC.
    * The offi­cial wouldn’t offer details on what’s under con­sid­er­a­tion or the tim­ing of a bill being intro­duced. Politi­co first report­ed the news.

    Berke­ley Lovelace Jr.
    Eamon Javers
    Pub­lished Tue, Mar 26 2019 • 12:51 PM EDT | Updat­ed Tue, Mar 26 2019 • 2:19 PM EDT

    The Trump admin­is­tra­tion is in ear­ly talks with House Speak­er Nan­cy Pelosi about pos­si­ble leg­is­la­tion to low­er pre­scrip­tion drug costs, a White House offi­cial con­firmed.

    “Low­er­ing the cost of pre­scrip­tion drugs is a shared com­mon inter­est, and those con­ver­sa­tions will con­tin­ue,” the per­son said, ask­ing not to be iden­ti­fied because the dis­cus­sions aren’t pub­lic.

    The offi­cial wouldn’t say what the leg­is­la­tion might look like or when a bill might be intro­duced. Politi­co first report­ed the news.

    High drug costs have become a rare bipar­ti­san issue, with law­mak­ers on both sides of the aisle demand­ing some­thing be done. Pres­i­dent Don­ald Trump has made low­er­ing prices one of his key issues ahead of the 2020 elec­tion. Democ­rats are also jock­ey­ing to prove they can lead reform.

    ...

    Drug com­pa­nies argue that price increas­es have been mod­est, and have instead point­ed the blame at phar­ma­cy ben­e­fit man­agers, some­times called mid­dle­men. They say that PBMs should pass the rebates nego­ti­at­ed with man­u­fac­tur­ers along to patients. Drug­mak­ers applaud­ed the administration’s pur­suit to change the nation’s rebate sys­tem.

    White House Domes­tic Pol­i­cy Coun­cil Direc­tor Joe Gro­gan and leg­isla­tive direc­tor Shahi­ra Knight are lead­ing the talks for the Trump admin­is­tra­tion. Wen­dell Primus, Pelosi’s health pol­i­cy staffer, is lead­ing the talks for the House Democ­rats.

    “We’ve been hav­ing some staff-lev­el dis­cus­sions with the admin­is­tra­tion about low­er­ing pre­scrip­tion drug prices, but they aren’t nego­ti­a­tions,” Pelosi spokesman Hen­ry Con­nel­ly told CNBC.

    “House Democ­rats promised the Amer­i­can peo­ple we’d take bold action to low­er pre­scrip­tion drug prices, and that’s what we’re going to do,” he added.

    ———–

    “White House and Pelosi’s staff in ear­ly talks about leg­is­la­tion to cut high drug costs” by Berke­ley Lovelace Jr. and Eamon Javers; CNBC; 03/26/2019

    “High drug costs have become a rare bipar­ti­san issue, with law­mak­ers on both sides of the aisle demand­ing some­thing be done. Pres­i­dent Don­ald Trump has made low­er­ing prices one of his key issues ahead of the 2020 elec­tion. Democ­rats are also jock­ey­ing to prove they can lead reform.”

    It’s worth not­ing that the Democ­rats appear to be down­play­ing these dis­cus­sions, so it’s very unclear if there is actu­al­ly any real bipar­ti­san push on drug prices hap­pen­ing:

    ...
    “We’ve been hav­ing some staff-lev­el dis­cus­sions with the admin­is­tra­tion about low­er­ing pre­scrip­tion drug prices, but they aren’t nego­ti­a­tions,” Pelosi spokesman Hen­ry Con­nel­ly told CNBC.

    “House Democ­rats promised the Amer­i­can peo­ple we’d take bold action to low­er pre­scrip­tion drug prices, and that’s what we’re going to do,” he added.
    ...

    So Pelosi’s office is char­ac­ter­iz­ing it as less than nego­ti­a­tions. That’ does­n’t exact­ly sound promis­ing.

    It’s also worth not­ing that point per­son in the White House for these nego­ti­a­tions is Joe Gro­gan, the new Domes­tic Pol­i­cy Coun­cil who was brought in for that job in Jan­u­ary by Mick Mul­vaney. Before join­ing the Trump admin­is­tra­tion Gro­gan was the lead lob­by­ist for drug giant Gilead Sci­ences:

    Politi­co

    White House to name Gro­gan top pol­i­cy aide

    By ADAM CANCRYN and DAN DIAMOND

    01/22/2019 01:36 PM EST

    The White House is expect­ed to soon name Joe Gro­gan as the next head of its Domes­tic Pol­i­cy Coun­cil, two sources with knowl­edge of the deci­sion told POLITICO.

    The move would ele­vate Gro­gan, a top Office of Man­age­ment and Bud­get health care offi­cial and ally of act­ing White House Chief of Staff Mick Mul­vaney, to a role that could give him broad new influ­ence over the Trump administration’s major pol­i­cy pri­or­i­ties, includ­ing low­er­ing drug prices and efforts to unwind Oba­macare.

    Gro­gan has worked exten­sive­ly on those issues at OMB along­side Mul­vaney and HHS Sec­re­tary Alex Azar. Gro­gan, a for­mer lob­by­ist for drug giant Gilead Sci­ences before join­ing OMB in 2017, has advanced plans rolling back parts of the Afford­able Care Act through reg­u­la­tion and helped push through an ini­tial series of reforms tar­get­ing phar­ma­ceu­ti­cal costs.

    A spokesper­son for Mul­vaney did not imme­di­ate­ly respond to a request for com­ment.

    Gro­gan has forged strong rela­tion­ships with top Trump health care appointees, includ­ing CMS Admin­is­tra­tor Seema Ver­ma and FDA Com­mis­sion­er Scott Got­tlieb. He’s like­ly to play an even big­ger role on health care at the Domes­tic Pol­i­cy Coun­cil, which Mul­vaney is eager to reestab­lish as a dri­ver of con­ser­v­a­tive pol­i­cy ideas. Gro­gan could espe­cial­ly help pur­sue bipar­ti­san drug pric­ing leg­is­la­tion, one source famil­iar with mat­ter said, in hopes of nego­ti­at­ing a pack­age that could pass a divid­ed Con­gress.

    Any leg­isla­tive effort would face long odds. House Democ­rats insist any major drug price bill must empow­er Medicare to direct­ly nego­ti­ate drug prices, a pro­pos­al Azar has pub­licly ruled out and that Repub­li­cans in Con­gress vehe­ment­ly oppose.

    Trump health offi­cials have so far large­ly bypassed Con­gress in favor of try­ing to crack down on drug costs through a series of reg­u­la­to­ry changes. But the admin­is­tra­tion has expressed renewed open­ness to leg­is­la­tion, amid Trump’s frus­tra­tion over the lack of progress on what he con­sid­ers a key cam­paign pledge.

    Gro­gan has joined oth­er top admin­is­tra­tion health offi­cials like Azar and Got­tlieb in tak­ing a hard­er line against the phar­ma­ceu­ti­cal indus­try’s efforts to pro­tect mar­ket share.

    ...

    ———–

    “White House to name Gro­gan top pol­i­cy aide” by ADAM CANCRYN and DAN DIAMOND; Politi­co; 01/22/2019

    “The move would ele­vate Gro­gan, a top Office of Man­age­ment and Bud­get health care offi­cial and ally of act­ing White House Chief of Staff Mick Mul­vaney, to a role that could give him broad new influ­ence over the Trump administration’s major pol­i­cy pri­or­i­ties, includ­ing low­er­ing drug prices and efforts to unwind Oba­macare.”

    So when Joe Gro­gan was ele­vat­ed to the posi­tion of head of White House Domes­tic Pol­i­cy Coun­cil that put him in a lead posi­tion on the Trump admin­is­tra­tion’s efforts to low­er drug prices with some sort of bipar­ti­san leg­is­la­tion in Con­gress. And, of course, Gro­gan was a drug lob­by­ist before join­ing the Trump admin­is­tra­tion in 2017:

    ...
    Gro­gan has worked exten­sive­ly on those issues at OMB along­side Mul­vaney and HHS Sec­re­tary Alex Azar. Gro­gan, a for­mer lob­by­ist for drug giant Gilead Sci­ences before join­ing OMB in 2017, has advanced plans rolling back parts of the Afford­able Care Act through reg­u­la­tion and helped push through an ini­tial series of reforms tar­get­ing phar­ma­ceu­ti­cal costs.
    ...

    Adding to the com­pli­ca­tions is the fact that Democ­rats are demand­ing that part of the solu­tion to high drug prices involve Medicare being allowed to use its immense mar­ket pow­er to direct­ly nego­ti­ate low­er drug prices, which Repub­li­cans are vehe­ment­ly opposed to. That leaves few real solu­tions and like­ly means the nego­ti­a­tions will some­how revolve around ‘increas­ing com­pe­ti­tion’ and ‘tak­ing a hard­er line against the phar­ma­ceu­ti­cal indus­try’s efforts to pro­tect mar­ket share’. In oth­er words, a ‘let the mar­kets fix it’ solu­tion:

    ...
    Any leg­isla­tive effort would face long odds. House Democ­rats insist any major drug price bill must empow­er Medicare to direct­ly nego­ti­ate drug prices, a pro­pos­al Azar has pub­licly ruled out and that Repub­li­cans in Con­gress vehe­ment­ly oppose.

    ...

    Gro­gan has joined oth­er top admin­is­tra­tion health offi­cials like Azar and Got­tlieb in tak­ing a hard­er line against the phar­ma­ceu­ti­cal indus­try’s efforts to pro­tect mar­ket share.
    ...

    So giv­en that it’s look­ing like the only solu­tions to high drug prices that the Repub­li­cans will allow will be some­thing along the lines of ‘increas­ing com­pe­ti­tion’, it’s worth not­ing a study put out in Feb­ru­ary by the Kaiser Health Net­work on the impact that increas­ing approvals for gener­ic drugs had on drug prices. So what did the study find? Well, it turns out that the gener­ic drug man­u­fac­tur­ing indus­try is already so con­sol­i­dat­ed that even after approvals for new gener­ic drugs were increased sig­nif­i­cant­ly large num­bers of those new­ly approved drugs weren’t actu­al­ly com­ing to the Amer­i­can mar­ket due to the anti-com­pet­i­tive incen­tives that arise from a hyper-con­sol­i­dat­ed mar­ket. In oth­er words, the gener­ic drug man­u­fac­tur­ing sec­tor is so con­cen­trat­ed in the US that ‘more com­pe­ti­tion’ basi­cal­ly can’t work to low­er prices:

    Kaiser Health News

    Trump Admin­is­tra­tion Salutes Parade Of Gener­ic Drug Approvals, But Hun­dreds Aren’t For Sale

    By Syd­ney Lup­kin and Jay Han­cock
    Feb­ru­ary 7, 2019

    The Trump admin­is­tra­tion has been trum­pet­ing a huge increase in FDA gener­ic drug approvals the past two years, the result of its actions to stream­line a cum­ber­some process and com­bat anti-com­pet­i­tive prac­tices. But near­ly half of those new­ly approved drugs aren’t being sold in the Unit­ed States, Kaiser Health News has found, mean­ing that many patients are deriv­ing lit­tle prac­ti­cal ben­e­fit from the administration’s efforts.

    The administration’s aggres­sive push to approve more gener­ics is designed to spur more com­pe­ti­tion with expen­sive brand-name drugs, and dri­ve prices low­er, Pres­i­dent Don­ald Trump not­ed at a White House event last month. The Food and Drug Admin­is­tra­tion has approved more than 1,600 gener­ic drug appli­ca­tions since Jan­u­ary 2017 — about a third more than it did in the last two years of the Oba­ma admin­is­tra­tion.

    But more than 700, or about 43 per­cent, of those gener­ics still weren’t on the mar­ket as of ear­ly Jan­u­ary, a KHN data analy­sis of FDA and drug list price records shows. Even more note­wor­thy: 36 per­cent of gener­ics that would be the first to com­pete against a brand­ed drug are not yet for sale. That means thou­sands or even mil­lions of patients have no option beyond buy­ing brand­ed drugs that can cost thou­sands of dol­lars per month.

    “That’s shock­ing­ly high,” said for­mer con­gress­man Hen­ry Wax­man, who co-spon­sored the 1984 law that paved the way for the gener­ic approval process as we know it today. He said he’d like to know more, but sus­pects anti-com­pet­i­tive behav­ior is at least part­ly to blame and that revi­sions to the so-called Hatch-Wax­man Act might be need­ed.

    The approved gener­ics that haven’t made it to Amer­i­can med­i­cine cab­i­nets include gener­ic ver­sions of expen­sive med­i­cines like the blood thin­ner Bril­in­ta and HIV med­ica­tion Tru­va­da. They also include six dif­fer­ent gener­ic ver­sions of Nitro­press, a heart fail­ure drug, whose price spiked 310 per­cent in 2015.

    Experts say a vari­ety of fac­tors are to blame. Gener­ics sell­ers have fought for years against patent lit­i­ga­tion and oth­er delay tac­tics that pro­tect brand-name drugs from com­pe­ti­tion. In recent years, vast indus­try con­sol­i­da­tion has reduced the ranks of com­pa­nies will­ing to pur­chase and dis­trib­ute gener­ics. And, in some cas­es, mak­ers of gener­ics obtain approvals and ulti­mate­ly make a busi­ness deci­sion to sit on them.

    “It’s a real prob­lem because we’re not get­ting all the expect­ed com­pe­ti­tion,” FDA Com­mis­sion­er Scott Got­tlieb said in an inter­view, adding that it will be dif­fi­cult to solve because it has so many caus­es. It takes five gener­ics on the mar­ket to dri­ve prices down to 33 per­cent of the orig­i­nal brand-name price, accord­ing to an FDA analy­sis.

    With­out gener­ics to low­er drug costs, brand­ed man­u­fac­tur­ers can con­tin­ue to increase their prices, at a rate of rough­ly 10 per­cent a year, said Scott Kno­er, chief phar­ma­cy offi­cer at the Cleve­land Clin­ic. “It makes health care costs go up across the board.”

    Even if hos­pi­tal patients don’t direct­ly see high drug prices in their bills, the high­er costs get passed to insur­ers, who pass them on as high­er pre­mi­ums, Kno­er said. They also get passed to tax­pay­ers, who pay for drugs cov­ered by Medicare and Med­ic­aid.

    Con­sol­i­da­tion on mul­ti­ple tiers of the drug sup­ply chain have changed the face of the gener­ic drug mar­ket, warp­ing sup­ply and demand.

    In some cas­es, key phar­ma­ceu­ti­cal ingre­di­ents are unavail­able or a man­u­fac­tur­er doesn’t have the capac­i­ty to launch a prod­uct because it’s hav­ing dif­fi­cul­ty meet­ing demand for exist­ing prod­ucts.

    Man­u­fac­tur­ing con­sol­i­da­tion has dra­mat­i­cal­ly reduced the pro­duc­tion of injectable drugs, which are typ­i­cal­ly admin­is­tered in a doctor’s office. This may be why 157 injectable gener­ics that were approved in the past two years haven’t been brought to mar­ket.

    Erin Fox, a phar­ma­cist at the Uni­ver­si­ty of Utah who tracks drug short­ages, said the KHN analy­sis of stalled gener­ics “high­lights that com­pa­nies often have a lot of prod­ucts ‘on the books’ but aren’t real­ly mak­ing them.” A few gener­ics on the list — like dex­trose 10 per­cent injec­tion, to treat patients with low blood sug­ar — would have been help­ful to com­bat short­ages the past few years. “This comes up with short­ages a lot — it looks like there are more sup­pli­ers than there real­ly are,” Fox said.

    A lot can change between the time a drug­mak­er files a gener­ic appli­ca­tion with the FDA and the time it’s approved.

    Some drug­mak­ers that applied for gener­ic approval years ago switched their atten­tion to more prof­itable prod­ucts. Novar­tis, for instance, recent­ly sold a gener­ics divi­sion run by San­doz so San­doz could focus on oth­er drugs, includ­ing biosim­i­lars, which com­pete with expen­sive bio­log­ic drugs made from liv­ing organ­isms.

    “Some of these [gener­ic] drug appli­ca­tions have been sit­ting six, sev­en, eight years,” said Robert Pol­lock, a for­mer act­ing deputy direc­tor of the FDA’s Office of Gener­ic Drugs who now works for Lach­man Con­sul­tants. By the time it’s approved, a gener­ic can fall out of favor because patients tak­ing the brand­ed ver­sion report­ed new side effects, or because a more effec­tive brand­ed drug was approved.

    For some gener­ic man­u­fac­tur­ers, there’s mon­ey to be made by wait­ing. Brand-name drug­mak­ers will pay them to keep their prod­ucts off the mar­ket as part of a tac­tic some­times called “pay for delay.” The Fed­er­al Trade Com­mis­sion esti­mates that such deals cost con­sumers and tax­pay­ers $3.5 bil­lion a year.

    The num­ber of these poten­tial­ly anti-com­pet­i­tive set­tle­ments decreased from fis­cal 2014 to fis­cal 2015, accord­ing to the lat­est FTC report. Still, Got­tlieb said he hopes to crack down on such tac­tics. The first gener­ic to take on a brand­ed drug is grant­ed 180 days of exclu­siv­i­ty before the sec­ond and third gener­ics can be approved, giv­ing those prod­ucts a clear advan­tage.

    “We don’t like that com­pa­nies are able to just park [a gener­ic for] 180 days while they cut a deal not to come to mar­ket,” Got­tlieb said, adding that with help from Con­gress he hopes to force com­pa­nies to for­feit exclu­siv­i­ty if they don’t launch on time.

    In some cas­es, Got­tlieb said, gener­ic drug­mak­ers wait until they’ve stock­piled a num­ber of new­ly approved gener­ics and have land­ed a con­tract with a pur­chas­er before bring­ing their med­i­cines to mar­ket.

    These bun­dled con­tracts are secre­tive, so not much is known about them, but it means com­pa­nies are fil­ing gener­ic appli­ca­tions just for the option of intro­duc­ing gener­ics, said health care econ­o­mist Rena Con­ti, an asso­ciate pro­fes­sor at Boston Uni­ver­si­ty. They’ll wait until the most strate­gic time to launch, which could be after the com­pe­ti­tion shakes out, leav­ing them as “the last man stand­ing,” Con­ti said. Then they can launch and hike the price.

    To be sure, the FDA under Gottlieb’s lead­er­ship has tak­en steps to increase gener­ic com­pe­ti­tion, from sham­ing brand-name drug­mak­ers for block­ing gener­ics to pub­lish­ing doc­u­ments to help man­u­fac­tur­ers win approval more eas­i­ly. But approval doesn’t nec­es­sar­i­ly spur com­pe­ti­tion.

    “We used to say it was all about get­ting in — once you got approval from the FDA, then you could go to mar­ket,” said Chip Davis, CEO of the Asso­ci­a­tion for Acces­si­ble Med­i­cines, the trade group for mak­ers of gener­ic drugs. The biggest chal­lenges his mem­bers face is that there aren’t enough com­pa­nies pur­chas­ing drugs, Davis said. Con­sol­i­da­tion has led to three large buy­ing groups cov­er­ing 90 per­cent of the mar­ket, accord­ing to a Drug Chan­nels Insti­tute report. So, if you’re the fourth or fifth gener­ic, you may have no one left to sell to.

    Yet anoth­er bar­ri­er relates to how drug mid­dle­men select the drugs they’ll cov­er under indus­try for­mu­la­ries, which deter­mine what prod­ucts insur­ance plans will cov­er. In some cas­es, mid­dle­men known as “phar­ma­cy ben­e­fit man­agers” have made it clear they don’t have room on their for­mu­la­ries for anoth­er gener­ic. Or they do, but they give brand­ed drugs pref­er­en­tial treat­ment with low­er copays, hurt­ing the generic’s mar­ket share.

    ...

    ———-

    “Trump Admin­is­tra­tion Salutes Parade Of Gener­ic Drug Approvals, But Hun­dreds Aren’t For Sale” by Syd­ney Lup­kin and Jay Han­cock; Kaiser Health News; 02/07/2019

    “The Trump admin­is­tra­tion has been trum­pet­ing a huge increase in FDA gener­ic drug approvals the past two years, the result of its actions to stream­line a cum­ber­some process and com­bat anti-com­pet­i­tive prac­tices. But near­ly half of those new­ly approved drugs aren’t being sold in the Unit­ed States, Kaiser Health News has found, mean­ing that many patients are deriv­ing lit­tle prac­ti­cal ben­e­fit from the administration’s efforts.

    Near­ly half (43 per­cent) of the gener­ic drugs new­ly approved for sale in the US don’t actu­al­ly end up for sale. Includ­ing 36 per­cent of the gener­ics that would be the first to com­pete against an expen­sive brand­ed drug. It’s quite a find­ing:

    ...
    The administration’s aggres­sive push to approve more gener­ics is designed to spur more com­pe­ti­tion with expen­sive brand-name drugs, and dri­ve prices low­er, Pres­i­dent Don­ald Trump not­ed at a White House event last month. The Food and Drug Admin­is­tra­tion has approved more than 1,600 gener­ic drug appli­ca­tions since Jan­u­ary 2017 — about a third more than it did in the last two years of the Oba­ma admin­is­tra­tion.

    But more than 700, or about 43 per­cent, of those gener­ics still weren’t on the mar­ket as of ear­ly Jan­u­ary, a KHN data analy­sis of FDA and drug list price records shows. Even more note­wor­thy: 36 per­cent of gener­ics that would be the first to com­pete against a brand­ed drug are not yet for sale. That means thou­sands or even mil­lions of patients have no option beyond buy­ing brand­ed drugs that can cost thou­sands of dol­lars per month.
    ...

    What’s behind this stun­ning behav­ior by the gener­ics mar­ket? Well, that appears to require more inves­ti­ga­tion, but the fact that the gener­ics indus­try has under­gone vast con­sol­i­da­tion in recent years is one of those fun facts that’s going to loom large when­ev­er there’s a mys­tery as to why an indus­try does­n’t appear t o be com­pet­ing with itself:

    ...
    “That’s shock­ing­ly high,” said for­mer con­gress­man Hen­ry Wax­man, who co-spon­sored the 1984 law that paved the way for the gener­ic approval process as we know it today. He said he’d like to know more, but sus­pects anti-com­pet­i­tive behav­ior is at least part­ly to blame and that revi­sions to the so-called Hatch-Wax­man Act might be need­ed.

    The approved gener­ics that haven’t made it to Amer­i­can med­i­cine cab­i­nets include gener­ic ver­sions of expen­sive med­i­cines like the blood thin­ner Bril­in­ta and HIV med­ica­tion Tru­va­da. They also include six dif­fer­ent gener­ic ver­sions of Nitro­press, a heart fail­ure drug, whose price spiked 310 per­cent in 2015.

    Experts say a vari­ety of fac­tors are to blame. Gener­ics sell­ers have fought for years against patent lit­i­ga­tion and oth­er delay tac­tics that pro­tect brand-name drugs from com­pe­ti­tion. In recent years, vast indus­try con­sol­i­da­tion has reduced the ranks of com­pa­nies will­ing to pur­chase and dis­trib­ute gener­ics. And, in some cas­es, mak­ers of gener­ics obtain approvals and ulti­mate­ly make a busi­ness deci­sion to sit on them.

    “It’s a real prob­lem because we’re not get­ting all the expect­ed com­pe­ti­tion,” FDA Com­mis­sion­er Scott Got­tlieb said in an inter­view, adding that it will be dif­fi­cult to solve because it has so many caus­es. It takes five gener­ics on the mar­ket to dri­ve prices down to 33 per­cent of the orig­i­nal brand-name price, accord­ing to an FDA analy­sis.

    ...

    Con­sol­i­da­tion on mul­ti­ple tiers of the drug sup­ply chain have changed the face of the gener­ic drug mar­ket, warp­ing sup­ply and demand.

    In some cas­es, key phar­ma­ceu­ti­cal ingre­di­ents are unavail­able or a man­u­fac­tur­er doesn’t have the capac­i­ty to launch a prod­uct because it’s hav­ing dif­fi­cul­ty meet­ing demand for exist­ing prod­ucts.

    Man­u­fac­tur­ing con­sol­i­da­tion has dra­mat­i­cal­ly reduced the pro­duc­tion of injectable drugs, which are typ­i­cal­ly admin­is­tered in a doctor’s office. This may be why 157 injectable gener­ics that were approved in the past two years haven’t been brought to mar­ket.
    ...

    In some cas­es, brand-name drug­mak­ers actu­al­ly pay gener­ic man­u­fac­tur­ers to not pro­duce a drug in what are called “pay for delay” schemes. Law­mak­ers just put for­ward leg­is­la­tion in the House that would ban these “pay for delay” deals so this appears to be a legal prac­tice at this point:

    ...
    Erin Fox, a phar­ma­cist at the Uni­ver­si­ty of Utah who tracks drug short­ages, said the KHN analy­sis of stalled gener­ics “high­lights that com­pa­nies often have a lot of prod­ucts ‘on the books’ but aren’t real­ly mak­ing them.” A few gener­ics on the list — like dex­trose 10 per­cent injec­tion, to treat patients with low blood sug­ar — would have been help­ful to com­bat short­ages the past few years. “This comes up with short­ages a lot — it looks like there are more sup­pli­ers than there real­ly are,” Fox said.

    A lot can change between the time a drug­mak­er files a gener­ic appli­ca­tion with the FDA and the time it’s approved.

    ...

    For some gener­ic man­u­fac­tur­ers, there’s mon­ey to be made by wait­ing. Brand-name drug­mak­ers will pay them to keep their prod­ucts off the mar­ket as part of a tac­tic some­times called “pay for delay.” The Fed­er­al Trade Com­mis­sion esti­mates that such deals cost con­sumers and tax­pay­ers $3.5 bil­lion a year.

    The num­ber of these poten­tial­ly anti-com­pet­i­tive set­tle­ments decreased from fis­cal 2014 to fis­cal 2015, accord­ing to the lat­est FTC report. Still, Got­tlieb said he hopes to crack down on such tac­tics. The first gener­ic to take on a brand­ed drug is grant­ed 180 days of exclu­siv­i­ty before the sec­ond and third gener­ics can be approved, giv­ing those prod­ucts a clear advan­tage.
    ...

    And in some cas­es, gener­ic drug­mak­ers lit­er­al­ly sit on a drug and wait for all of the oth­er com­pe­ti­tion to shake out before they start man­u­fac­tur­ing:

    ...
    In some cas­es, Got­tlieb said, gener­ic drug­mak­ers wait until they’ve stock­piled a num­ber of new­ly approved gener­ics and have land­ed a con­tract with a pur­chas­er before bring­ing their med­i­cines to mar­ket.

    These bun­dled con­tracts are secre­tive, so not much is known about them, but it means com­pa­nies are fil­ing gener­ic appli­ca­tions just for the option of intro­duc­ing gener­ics, said health care econ­o­mist Rena Con­ti, an asso­ciate pro­fes­sor at Boston Uni­ver­si­ty. They’ll wait until the most strate­gic time to launch, which could be after the com­pe­ti­tion shakes out, leav­ing them as “the last man stand­ing,” Con­ti said. Then they can launch and hike the price.

    To be sure, the FDA under Gottlieb’s lead­er­ship has tak­en steps to increase gener­ic com­pe­ti­tion, from sham­ing brand-name drug­mak­ers for block­ing gener­ics to pub­lish­ing doc­u­ments to help man­u­fac­tur­ers win approval more eas­i­ly. But approval doesn’t nec­es­sar­i­ly spur com­pe­ti­tion.

    “We used to say it was all about get­ting in — once you got approval from the FDA, then you could go to mar­ket,” said Chip Davis, CEO of the Asso­ci­a­tion for Acces­si­ble Med­i­cines, the trade group for mak­ers of gener­ic drugs. The biggest chal­lenges his mem­bers face is that there aren’t enough com­pa­nies pur­chas­ing drugs, Davis said. Con­sol­i­da­tion has led to three large buy­ing groups cov­er­ing 90 per­cent of the mar­ket, accord­ing to a Drug Chan­nels Insti­tute report. So, if you’re the fourth or fifth gener­ic, you may have no one left to sell to.
    ...

    And as the arti­cle notes, with­out the com­pe­ti­tion of gener­ics, the brand­ed man­u­fac­tur­ers can con­tin­ue rais­ing prices around 10 per­cent a year:

    ...
    With­out gener­ics to low­er drug costs, brand­ed man­u­fac­tur­ers can con­tin­ue to increase their prices, at a rate of rough­ly 10 per­cent a year, said Scott Kno­er, chief phar­ma­cy offi­cer at the Cleve­land Clin­ic. “It makes health care costs go up across the board.”

    Even if hos­pi­tal patients don’t direct­ly see high drug prices in their bills, the high­er costs get passed to insur­ers, who pass them on as high­er pre­mi­ums, Kno­er said. They also get passed to tax­pay­ers, who pay for drugs cov­ered by Medicare and Med­ic­aid.
    ...

    So it appears that the gener­ics mar­ket­place is so con­cen­trat­ed that basic com­pe­ti­tion does­n’t work. Democ­rats are look­ing to counter this bro­ken mar­ket­place with approach­es like let­ting Medicare use its enor­mous clout to direct­ly nego­ti­ate low­er prices. But Repub­li­cans are com­plete­ly opposed, as is pre­sum­ably the phar­ma­ceu­ti­cal lob­by.

    What are the alter­na­tives? Well, Eliz­a­beth War­ren, the Sen­a­tor from Mass­a­chu­setts and 2020 pres­i­den­tial con­tender, has an alter­na­tive solu­tion for high drug prices. And it’s the kind of pro­pos­al that could shape how Amer­i­cans view the word “social­ism” head­ing into the 2020. War­ren has already made waves with her calls to break up the big tech giants. Giv­en the con­sol­i­da­tion in the gener­ic drug sec­tor it might be tempt­ing to assume War­ren pro­posed break­ing up that sec­tor too in order to increase com­pe­ti­tion. Instead, War­ren is propos­ing kind of the flip side to that: get­ting the gov­ern­ment involved in gener­ics man­u­fac­tur­ing.

    It’s worth not­ing that it’s when the right-wing media calls this pro­pos­al ‘social­ist’ it’s going to be refresh­ing­ly apt giv­en that pret­ty much any pol­i­cy the Democ­rats pro­pose that isn’t based in mar­ket fun­da­men­tal­ism gets framed as ‘social­ist’ by the right-wing.

    And from a polit­i­cal stand­point the gener­ic drug mar­ket is the kind of mar­ket where there’s no good excuse for mar­ket fail­ures so the Amer­i­can pub­lic might be more open to hav­ing the gov­ern­ment direct­ly enter into that busi­ness sec­tor. If gener­ic drugs aren’t com­ing to mar­ket the mar­ket is fail­ing. All the research to get the drug dis­cov­ered and approved was done with the gener­ics. They just need to make the drug. And that’s not hap­pen­ing because ‘the mar­ket’ is col­lud­ing with itself. It’s the per­fect exam­ple of ‘social­ism’ as a back­stop for cap­i­tal­is­m’s fail­ures. And in the Amer­i­can polit­i­cal con­text that’s when ‘social­ism’ becomes par­tic­u­lar­ly potent. When it’s seen as a band-aid for cap­i­tal­is­m’s gross and plen­ti­ful fail­ures. It’s almost the per­fect storm for a teach­able les­son for the Amer­i­can pub­lic about the role gov­ern­ment could play in sec­tors of the econ­o­my where the mar­ket­place is fail­ing con­sumers. If the ‘Amer­i­can Dream’ includes afford­able phar­ma­ceu­ti­cals, Amer­i­ca is going to need a lit­tle ‘social­ism’ to address the mar­ket fail­ures. And drug prices is the show­case issue for this les­son.

    And since the obvi­ous oth­er solu­tion is to break up the con­sol­i­dat­ed gener­ics sec­tor to encour­age com­pe­ti­tion, War­ren’s pro­pos­al does a great job of high­light­ing for the pub­lic the fact that when busi­ness cross­es a thresh­old of con­cen­trat­ed pow­er, the only real solu­tions are going to involve heavy reg­u­la­tions, or break­ing up the sec­tor, or get­ting the gov­ern­ment direct­ly involved in the sec­tor. When the mar­ket­place fails those are the options we have left that real­is­ti­cal­ly might work:

    Politi­co

    War­ren bill would get feds into gener­ic drug man­u­fac­tur­ing

    The Mass­a­chu­setts Demo­c­rat, who’s like­ly run­ning for pres­i­dent in 2020, joins a recent wave of Sen­ate leg­is­la­tion aimed at the phar­ma­ceu­ti­cal indus­try.

    By ALEX THOMPSON and SARAH KARLIN-SMITH

    12/17/2018 11:02 PM EST

    Sen. Eliz­a­beth War­ren (D‑Mass.), a like­ly 2020 pres­i­den­tial can­di­date, will release a bill on Tues­day that would effec­tive­ly cre­ate a gov­ern­ment-run phar­ma­ceu­ti­cal man­u­fac­tur­er to mass-pro­duce gener­ic drugs and bring down prices, sev­er­al sources in her office told POLITICO on Mon­day in an exclu­sive pre­view of the leg­is­la­tion.

    The bill, dubbed the Afford­able Drug Man­u­fac­tur­ing Act, is unlike­ly to pass the Repub­li­can-led Sen­ate, but it sig­nals that a future War­ren White House could try to rad­i­cal­ly revamp the fed­er­al government’s role in the phar­ma­ceu­ti­cal mar­ket in order try to low­er prices.

    “In mar­ket after mar­ket, com­pe­ti­tion is dying as a hand­ful of giant com­pa­nies spend mil­lions to rig the rules, insu­late them­selves from account­abil­i­ty, and line their pock­ets at the expense of Amer­i­can fam­i­lies,” War­ren said in a news release that her staff shared ear­ly.

    War­ren is one of sev­er­al sen­a­tors eye­ing White House runs who have intro­duced bills tar­get­ing the phar­ma­ceu­ti­cal indus­try. Just last week, Sens. Jeff Merkley (D‑Ore.), Kamala Har­ris (D‑Calif.) and Amy Klobuchar (D.-Minn.) intro­duced the CURE High Drug Prices Act, which would allow the fed­er­al gov­ern­ment to block price increas­es on cer­tain drugs. Merkley put for­ward sep­a­rate leg­is­la­tion, the Low Drug Prices Act, weeks ear­li­er. And Sen. Bernie Sanders (I‑Vt.) intro­duced his own bill, the Pre­scrip­tion Drug Price Relief Act, in Novem­ber.

    The flur­ry of bills sug­gests that the pow­er­ful phar­ma­ceu­ti­cal indus­try will be a major pop­ulist tar­get dur­ing the Demo­c­ra­t­ic pres­i­den­tial pri­ma­ry and pos­si­bly the gen­er­al elec­tion, as mil­lions of Amer­i­cans strug­gle with ris­ing health care costs.

    Pres­i­dent Don­ald Trump made drug pric­ing a big issue in his 2016 cam­paign, defy­ing tra­di­tion­al con­ser­v­a­tive ortho­doxy by endors­ing gov­ern­ment-cen­tric solu­tions like fed­er­al nego­ti­a­tion of drug costs in Medicare. He’s con­tin­ued to pur­sue pop­ulist ideas while in office, like a recent move to tie the cost of some expen­sive drugs to the low­er prices paid over­seas.

    “I think the 2020 pol­i­tics will keep weak­en­ing [pharma’s] stran­gle­hold” on Wash­ing­ton, said Alex Law­son, exec­u­tive direc­tor of Social Secu­ri­ty Works, a left-lean­ing group that works to safe­guard Social Secu­ri­ty and is push­ing drug-pric­ing reform. He said he believed that Democ­rats would con­tin­ue com­pet­ing to put out strong drug-pric­ing pol­i­cy and that the issue would “become a lit­mus test for peo­ple who want to take on high­er office.”

    Warren’s bill would estab­lish an Office of Drug Man­u­fac­tur­ing that would be required to man­u­fac­ture at least 15 dif­fer­ent gener­ic drugs in its first year where the agency deter­mines there is a fail­ure in the mar­ket. The sen­a­tor insists that this would be the gov­ern­ment try­ing to repair the sys­tem, not a takeover.

    “The solu­tion here is not to replace mar­kets, but to fix them,” she said in the news release.

    There would be three stan­dards for deter­min­ing a “mar­ket fail­ure”: if no com­pa­ny is pro­duc­ing the gener­ic drug; if just one or two com­pa­nies are mak­ing the drug and there is a short­age or a recent price hike high­er than med­ical infla­tion; or if the drug is on the World Health Organization’s “essen­tial med­i­cine” list and the price is deemed too high while being pro­duced by only one or two com­pa­nies.

    While the vast major­i­ty of pre­scrip­tions are for drugs whose patents have expired, Warren’s bill ulti­mate­ly address­es only a small part of pre­scrip­tion-drug afford­abil­i­ty. There have been some high-pro­file cas­es of huge price spikes in off-patent drugs, but the bulk of the country’s drug-cost prob­lem rests with high-priced brand­ed med­i­cines.

    The Asso­ci­a­tion for Acces­si­ble Med­i­cines, the gener­ic-drug lob­by, came out firm­ly against the leg­is­la­tion.

    “When gener­ics pro­vide Amer­i­cans with nine out of 10 of their pre­scrip­tions at only 23 per­cent of total spend­ing on drugs, it is hard to fath­om why any­one would call this sys­tem bro­ken or insist that the gov­ern­ment com­man­deer the busi­ness of devel­op­ing, man­u­fac­tur­ing and dis­trib­ut­ing these med­i­cines,” the group told POLITICO. At best, it said, “this leg­is­la­tion is an unre­al­is­tic dis­trac­tion from poli­cies that would mean­ing­ful­ly reduce drug prices, such as com­bat­ing patent abuse and cul­ti­vat­ing a robust biosim­i­lars mar­ket.” Like gener­ics, biosim­i­lars are cheap­er ver­sions of drugs known as bio­log­ics — which are often very expen­sive.

    Warren’s team point­ed to a recent­ly dis­closed inves­ti­ga­tion by sev­er­al states into alleged price-fix­ing of at least 300 gener­ic drugs and at 16 dif­fer­ent com­pa­nies as a sure sign that her pol­i­cy is need­ed. Joseph Nielsen, an assis­tant attor­ney gen­er­al and antitrust inves­ti­ga­tor in Con­necti­cut who has been involved in the inves­ti­ga­tion, recent­ly told The Wash­ing­ton Post: “This is most like­ly the largest car­tel in the his­to­ry of the Unit­ed States.”

    State attor­neys gen­er­al in New Mex­i­co and Wash­ing­ton also opened inves­ti­ga­tions in 2017 into whether Eli Lil­ly con­spired with oth­er com­pa­nies to dri­ve up the price of insulin.

    Insulin is a per­fect test case for why an Office of Drug Man­u­fac­tur­ing ought to exist, Warren’s team said. The drug is near­ly a cen­tu­ry old, yet the prices have sky­rock­et­ed in recent years. The cost tripled between 2002 and 2013, which is why War­ren’s bill requires insulin to be one of the drugs man­u­fac­tured by the fed­er­al gov­ern­ment.

    War­ren wants pro­duc­tion on drugs to begin a year after the law is enact­ed. But health pol­i­cy experts cau­tion that gov­ern­ment man­u­fac­tur­ing of gener­ic med­i­cines would be an enor­mous under­tak­ing that could take years to estab­lish. Still, the future bureau­crat­ic hur­dles may not deter War­ren from cam­paign­ing on the issue in 2020.

    ...

    ———–

    “War­ren bill would get feds into gener­ic drug man­u­fac­tur­ing” by ALEX THOMPSON and SARAH KARLIN-SMITH; Politi­co; 12/17/2018

    “The bill, dubbed the Afford­able Drug Man­u­fac­tur­ing Act, is unlike­ly to pass the Repub­li­can-led Sen­ate, but it sig­nals that a future War­ren White House could try to rad­i­cal­ly revamp the fed­er­al government’s role in the phar­ma­ceu­ti­cal mar­ket in order try to low­er prices.”

    Yep, high drug prices is once again poised to be a major 2020 cam­paign issue, as it was in 2016. Because it nev­er gets fixed despite the solu­tions tried. Failed solu­tions like increas­ing the approval of gener­ics that failed due to a lack of com­pe­ti­tion. For War­ren, hav­ing the gov­ern­ment enter the mar­ket is a response to mar­ket fail­ures, not a gov­ern­ment takeover of the sec­tor. It’s an inter­est­ing polit­i­cal fram­ing that has a lot of poten­tial appeal for an Amer­i­can elec­torate: ‘social­ism’ as a means of fix­ing cap­i­tal­ism where it fails:

    ...
    “In mar­ket after mar­ket, com­pe­ti­tion is dying as a hand­ful of giant com­pa­nies spend mil­lions to rig the rules, insu­late them­selves from account­abil­i­ty, and line their pock­ets at the expense of Amer­i­can fam­i­lies,” War­ren said in a news release that her staff shared ear­ly.

    ...

    Warren’s bill would estab­lish an Office of Drug Man­u­fac­tur­ing that would be required to man­u­fac­ture at least 15 dif­fer­ent gener­ic drugs in its first year where the agency deter­mines there is a fail­ure in the mar­ket. The sen­a­tor insists that this would be the gov­ern­ment try­ing to repair the sys­tem, not a takeover.

    “The solu­tion here is not to replace mar­kets, but to fix them,” she said in the news release.

    There would be three stan­dards for deter­min­ing a “mar­ket fail­ure”: if no com­pa­ny is pro­duc­ing the gener­ic drug; if just one or two com­pa­nies are mak­ing the drug and there is a short­age or a recent price hike high­er than med­ical infla­tion; or if the drug is on the World Health Organization’s “essen­tial med­i­cine” list and the price is deemed too high while being pro­duced by only one or two com­pa­nies.
    ...

    “The solu­tion here is not to replace mar­kets, but to fix them.”

    It’s a fas­ci­nat­ing approach because the way War­ren describes this, the gov­ern­ment will only get involved when ‘the mar­ket’ is found to be fail­ing. It’s explic­it­ly not a gov­ern­ment takeover and more like a mar­ket safe­ty-net. It’s a a great coun­ter­point to the absur­dist total­i­tar­i­an depic­tion of ‘social­ism’ Amer­i­cans are used to. Can War­ren pull the Amer­i­can elec­torate out of its intel­lec­tu­al ditch when it comes to rec­og­niz­ing the invalu­able ‘social­ist’ roles the gov­ern­ment can play in mar­ket economies? We’ll see, but it’s an excit­ing pos­si­bil­i­ty.

    And War­ren is going to be far from the only Demo­c­rat who is going to be focus­ing on this issue. So drug prices could eas­i­ly end up being one of the hand­ful of core issues that 2020 elec­tion revolves around. Even Trump endorsed solu­tions the rest of his Repub­li­cans reject like Medicare nego­ti­at­ing drug prices dur­ing the 2016 race. So the pol­i­tics around this issue is in a state of enor­mous flux, adding to the poten­tial War­ren’s approach has as a kind of nation­al teach­able moment:

    ...
    War­ren is one of sev­er­al sen­a­tors eye­ing White House runs who have intro­duced bills tar­get­ing the phar­ma­ceu­ti­cal indus­try. Just last week, Sens. Jeff Merkley (D‑Ore.), Kamala Har­ris (D‑Calif.) and Amy Klobuchar (D.-Minn.) intro­duced the CURE High Drug Prices Act, which would allow the fed­er­al gov­ern­ment to block price increas­es on cer­tain drugs. Merkley put for­ward sep­a­rate leg­is­la­tion, the Low Drug Prices Act, weeks ear­li­er. And Sen. Bernie Sanders (I‑Vt.) intro­duced his own bill, the Pre­scrip­tion Drug Price Relief Act, in Novem­ber.

    The flur­ry of bills sug­gests that the pow­er­ful phar­ma­ceu­ti­cal indus­try will be a major pop­ulist tar­get dur­ing the Demo­c­ra­t­ic pres­i­den­tial pri­ma­ry and pos­si­bly the gen­er­al elec­tion, as mil­lions of Amer­i­cans strug­gle with ris­ing health care costs.

    Pres­i­dent Don­ald Trump made drug pric­ing a big issue in his 2016 cam­paign, defy­ing tra­di­tion­al con­ser­v­a­tive ortho­doxy by endors­ing gov­ern­ment-cen­tric solu­tions like fed­er­al nego­ti­a­tion of drug costs in Medicare. He’s con­tin­ued to pur­sue pop­ulist ideas while in office, like a recent move to tie the cost of some expen­sive drugs to the low­er prices paid over­seas.

    “I think the 2020 pol­i­tics will keep weak­en­ing [pharma’s] stran­gle­hold” on Wash­ing­ton, said Alex Law­son, exec­u­tive direc­tor of Social Secu­ri­ty Works, a left-lean­ing group that works to safe­guard Social Secu­ri­ty and is push­ing drug-pric­ing reform. He said he believed that Democ­rats would con­tin­ue com­pet­ing to put out strong drug-pric­ing pol­i­cy and that the issue would “become a lit­mus test for peo­ple who want to take on high­er office.”
    ...

    Adding to the polit­i­cal poten­tial of this issue is the fact that sev­er­al states appear to have stum­bled onto a giant drug price-fix­ing scheme:

    ...
    Warren’s team point­ed to a recent­ly dis­closed inves­ti­ga­tion by sev­er­al states into alleged price-fix­ing of at least 300 gener­ic drugs and at 16 dif­fer­ent com­pa­nies as a sure sign that her pol­i­cy is need­ed. Joseph Nielsen, an assis­tant attor­ney gen­er­al and antitrust inves­ti­ga­tor in Con­necti­cut who has been involved in the inves­ti­ga­tion, recent­ly told The Wash­ing­ton Post: “This is most like­ly the largest car­tel in the his­to­ry of the Unit­ed States.”

    State attor­neys gen­er­al in New Mex­i­co and Wash­ing­ton also opened inves­ti­ga­tions in 2017 into whether Eli Lil­ly con­spired with oth­er com­pa­nies to dri­ve up the price of insulin.

    Insulin is a per­fect test case for why an Office of Drug Man­u­fac­tur­ing ought to exist, Warren’s team said. The drug is near­ly a cen­tu­ry old, yet the prices have sky­rock­et­ed in recent years. The cost tripled between 2002 and 2013, which is why War­ren’s bill requires insulin to be one of the drugs man­u­fac­tured by the fed­er­al gov­ern­ment.
    ...

    “This is most like­ly the largest car­tel in the his­to­ry of the Unit­ed States.”

    And that’s what ‘the mar­ket’ brought Amer­i­can drug con­sumers: like­ly the largest car­tel in the his­to­ry of the Unit­ed States. Which makes this great time to intro­duce the idea of the gov­ern­ment get­ting into the mar­ket on behalf of the pub­lic when the mar­ket decides to col­lude and con­spire with itself.

    Since War­ren has already sort of staked out the ‘break up the giants’ posi­tion as one of the themes that dis­tin­guish­es her in the Demo­c­ra­t­ic pri­ma­ry this is one of the those issues that could be par­tic­u­lar­ly use­ful for War­ren’s can­di­da­cy. But it seems like a safe bet that pret­ty much all of the Demo­c­ra­t­ic can­di­dates are going to be mak­ing their solu­tion to high drug prices one of their top talk­ing points on the cam­paign trail.

    As an issue, high drug prices in today’s Amer­i­ca after years of ‘mar­ket’ fail­ures is almost a show­case for ‘social­ist’ poli­cies as a last resort for long fail­ing ‘free mar­ket’ fun­da­men­tal­ism. The Rea­gan Rev­o­lu­tion failed for the vast major­i­ty of Amer­i­cans. That’s empir­i­cal at this point and the chron­i­cal­ly high drug prices encap­su­lates that fail­ure in a num­ber of ways. And that all prob­a­bly has some­thing to do with the Trump admin­is­tra­tion’s sud­den eager­ness for Joe Gro­gan, the for­mer Big Phar­ma lob­by­ist, to lead a bipar­ti­san drug price reform pack­age. This issue of the sys­temic mar­ket fail­ures that are a result of the ever increas­ing con­cen­tra­tion of wealth in Amer­i­ca is way too illus­tra­tive of way too much.

    Posted by Pterrafractyl | March 31, 2019, 8:17 pm
  18. A lot of senior Repub­li­cans were seen scratch­ing their heads in bewil­der­ment after the Trump admin­is­tra­tion announced that it was ful­ly back­ing the law­suit to kill off Oba­macare entire­ly being waged by 20 Repub­li­can state attor­neys gen­er­al. Trump even declared that the Repub­li­can Par­ty would soon become the “par­ty of health­care.” It was one of those ‘is he off his meds?’ Trump moments.

    So you have to won­der what Repub­li­can lead­ers are won­der­ing after Trump’s Twit­ter health care tirade yes­ter­day:

    Every­body agrees that Oba­maCare doesn’t work. Pre­mi­ums & deductibles are far too high — Real­ly bad Health­Care! Even the Dems want to replace it, but with Medicare for all, which would cause 180 mil­lion Amer­i­cans to lose their beloved pri­vate health insur­ance. The Repub­li­cans.....— Don­ald J. Trump (@realDonaldTrump) April 2, 2019

    ....are devel­op­ing a real­ly great Health­Care Plan with far low­er pre­mi­ums (cost) & deductibles than Oba­maCare. In oth­er words it will be far less expen­sive & much more usable than Oba­maCare. Vote will be tak­en right after the Elec­tion when Repub­li­cans hold the Sen­ate & win......— Don­ald J. Trump (@realDonaldTrump) April 2, 2019

    ....back the House. It will be tru­ly great Health­Care that will work for Amer­i­ca. Also, Repub­li­cans will always sup­port Pre-Exist­ing Con­di­tions. The Repub­li­can Par­ty will be known as the Par­ty of Great Healt­Care. Mean­time, the USA is doing bet­ter than ever & is respect­ed again!— Don­ald J. Trump (@realDonaldTrump) April 2, 2019

    Yep, Trump just told every­one that the Repub­li­can Par­ty was indeed still plan­ning on unfurl­ing an Oba­macare replace­ment plan, and it’s going to be an awe­some plan that is bet­ter than Oba­macare in every way, but you can’t see it until after the elec­tion and the Repub­li­cans win back con­trol of the House. So Trump is promis­ing that the Repub­li­cans have a plan, but it’s a secret plan. You’ll just have to trust him on that one. And that means Trump did­n’t just ensure that health care is going to be a cen­tral issue in the 2020 cam­paign. He also ensured that Trump’s per­son­al trust­wor­thi­ness will also be a 2020 issue because he’s lit­er­al­ly mak­ing a “trust me!” pledge on one of the top polit­i­cal issues in Amer­i­ca

    The New York Times

    Trump Retreats on Health Care, Say­ing Repub­li­can Plan Will Appear After the 2020 Elec­tion

    By Eileen Sul­li­van and Mag­gie Haber­man
    April 2, 2019

    WASHINGTON — Pres­i­dent Trump announced that Repub­li­cans would not present a health care over­haul pro­pos­al until after the 2020 elec­tion, punt­ing on com­ing up with a replace­ment for the Afford­able Care Act, which the admin­is­tra­tion is cur­rent­ly fight­ing in court to inval­i­date. The issue now will dom­i­nate pres­i­den­tial cam­paigns in the months lead­ing up to the 2020 elec­tion.

    Mr. Trump announced his new timetable in a thread of Twit­ter posts late Mon­day, putting off one of his biggest cam­paign promis­es until, the pres­i­dent hopes, he is re-elect­ed.

    “Every­body agrees that Oba­maCare doesn’t work,” began Mr. Trump, who went on to add that Repub­li­cans were “devel­op­ing a real­ly great Health­Care Plan with far low­er pre­mi­ums (cost) & deductibles than Oba­maCare.”

    He said a vote on it would be tak­en after the elec­tion, “when Repub­li­cans hold the Sen­ate & win back the House.”

    It was not imme­di­ate­ly clear on Tues­day what the Trump admin­is­tra­tion would do if courts ruled in favor of abol­ish­ing the health care sys­tem estab­lished by Pres­i­dent Barack Oba­ma. Last week, the Trump admin­is­tra­tion broad­ened its war on the health care law by argu­ing that the entire Afford­able Care Act should be inval­i­dat­ed. If the law were aban­doned, at least 20 mil­lion peo­ple could lose their health insur­ance. A court bat­tle could stretch past the 2020 elec­tion.

    Mr. Trump described a future Repub­li­can pro­pos­al as “far less expen­sive & much more usable than Oba­maCare.”

    Last week, Mr. Trump declared that Repub­li­cans would become the par­ty of health care, a promise Democ­rats imme­di­ate­ly embraced.On Mon­day, Mr. Trump main­tained that posi­tion, but said Repub­li­cans would pass a new law once they won back both cham­bers of Con­gress in the 2020 elec­tion, vic­to­ries that are not fore­gone con­clu­sions.

    Democ­rats won seats in the 2018 midterm elec­tions, when they took back con­trol of the House, large­ly because of their cam­paign focus on health care — espe­cial­ly pro­tect­ing Amer­i­cans with pre-exist­ing med­ical con­di­tions and low­er­ing health care costs.

    ...

    ———-

    “Trump Retreats on Health Care, Say­ing Repub­li­can Plan Will Appear After the 2020 Elec­tion” by Eileen Sul­li­van and Mag­gie Haber­man; The New York Times; 04/02/2019

    “Last week, Mr. Trump declared that Repub­li­cans would become the par­ty of health care, a promise Democ­rats imme­di­ate­ly embraced.On Mon­day, Mr. Trump main­tained that posi­tion, but said Repub­li­cans would pass a new law once they won back both cham­bers of Con­gress in the 2020 elec­tion, vic­to­ries that are not fore­gone con­clu­sions.

    The price of admis­sion for learn­ing about the secret plan is reelect­ing Trump and giv­ing the Repub­li­cans con­trol of both cham­bers of Con­gress in 2020. That’s quite a polit­i­cal promise. A promise that makes the integri­ty of Trump’s promis­es a much big­ger issue, espe­cial­ly since he made a sim­i­lar promise in 2016 and the Repub­li­cans had com­plete con­trol of con­gress and they still could­n’t do it. In oth­er words, Trump is basi­cal­ly mak­ing the same promise he made in 2016 and broke in 2017. Bold indeed:

    ...
    Mr. Trump announced his new timetable in a thread of Twit­ter posts late Mon­day, putting off one of his biggest cam­paign promis­es until, the pres­i­dent hopes, he is re-elect­ed.

    “Every­body agrees that Oba­maCare doesn’t work,” began Mr. Trump, who went on to add that Repub­li­cans were “devel­op­ing a real­ly great Health­Care Plan with far low­er pre­mi­ums (cost) & deductibles than Oba­maCare.”

    He said a vote on it would be tak­en after the elec­tion, “when Repub­li­cans hold the Sen­ate & win back the House.”

    ...

    Mr. Trump described a future Repub­li­can pro­pos­al as “far less expen­sive & much more usable than Oba­maCare.”

    ...

    Democ­rats won seats in the 2018 midterm elec­tions, when they took back con­trol of the House, large­ly because of their cam­paign focus on health care — espe­cial­ly pro­tect­ing Amer­i­cans with pre-exist­ing med­ical con­di­tions and low­er­ing health care costs.
    ...

    So Trump decid­ed to dou­ble down on his pre­dic­tion that the GOP will become the “par­ty of health­care” with a pledge to come up with a secret plan that will only be revealed if the Repub­li­cans are giv­en con­trol of the House and Sen­ate. It’s the kind of strat­e­gy that rais­es a lot of ques­tions, but per­haps the most obvi­ous ques­tion is whether or not there are any indi­ca­tions that the Trump admin­is­tra­tion is actu­al­ly work­ing on an Oba­macare replace­ment at all. And accord­ing to the fol­low­ing arti­cle, the Trump admin­is­tra­tion has indeed been reach­ing out to right-wing think tanks in recent months about com­ing up with a replace­ment plan. Specif­i­cal­ly, the Her­itage Foun­da­tion, the Mer­ca­tus Cen­ter, and the Hoover Insti­tute. All three heav­i­ly financed by the Koch broth­ers and oth­er right-wing oli­garchs.

    So while the exact nature of the Repub­li­can Par­ty’s plans will remain a secret until after the elec­tion, the peo­ple com­ing up with the plan isn’t a secret: right-wing hacks work­ing for bil­lion­aire-fund­ed think tanks. As usu­al:

    The Wash­ing­ton Exam­in­er

    White House work­ing on secret health­care plan with three con­ser­v­a­tive think tanks

    by Emi­ly Ward
    | March 31, 2019 08:04 PM

    The White House is qui­et­ly work­ing on a health­care pol­i­cy pro­pos­al to replace the Afford­able Care Act, accord­ing to mul­ti­ple sources with knowl­edge of the mat­ter.

    While it is not clear how far along the process is, work on a pro­pos­al has been going on for months. The effort appears to belie crit­i­cism that Trump’s deci­sion to restart the debate on health­care, an issue Democ­rats used to their advan­tage in the 2018 midterms, was an error com­mit­ted with­out fore­thought.

    “The White House, main­ly through the Nation­al Eco­nom­ic Coun­cil, has been engaged on think­ing about health care reform for a while now, and they have been engaged with a group of cen­ter-right health pol­i­cy groups to talk about var­i­ous pro­pos­als and ideas,” a con­ser­v­a­tive health pol­i­cy ana­lyst told the Wash­ing­ton Exam­in­er.

    The ana­lyst said the admin­is­tra­tion has been “hav­ing con­ver­sa­tions” on health­care pol­i­cy and has reached out to numer­ous think tanks, includ­ing the Her­itage Foun­da­tion, the Mer­ca­tus Cen­ter, and the Hoover Insti­tute.

    “They’ve had con­ver­sa­tions for the last sev­er­al months and as recent­ly as a few weeks ago,” the ana­lyst said. “Before the pres­i­dent said what he said, they’d been con­sis­tent­ly focused on work­ing on a health­care plan.”

    Trump said Tues­day that Repub­li­cans would soon become the “par­ty of health­care.” The remark was sur­pris­ing to many, in light of Repub­li­cans’ fail­ure to repeal Oba­macare the drub­bing the GOP took in the midterms. Many Repub­li­can law­mak­ers insist that they won’t act on leg­is­la­tion until Trump comes up with a plan.

    Then on Thurs­day, while speak­ing to reporters on the South Lawn of the White House, Trump said his admin­is­tra­tion was “work­ing on a plan now” — though he said there was “no great rush” to roll out a pro­pos­al and added that he was wait­ing for the courts to repeal the ACA.

    The pres­i­dent brought up health­care again on Fri­day, claim­ing he would have a “much bet­ter” plan than Oba­macare. “The health care’s going very well,” he told reporters in Flori­da.

    The White House did not pro­vide a com­ment, point­ing instead to Trump’s state­ments on Thurs­day.

    Pol­i­cy lead­ers at sev­er­al con­ser­v­a­tive think tanks con­firmed to the Exam­in­er that a health­care plan is indeed the works. They said a pro­pos­al would take con­cepts from the Gra­ham-Cas­sidy bill, by Sen. Lind­sey Gra­ham, R‑S.C. and Sen. Bill Cas­sidy, R‑La., and the Health Care Choic­es pro­pos­al, which was signed by many con­ser­v­a­tive pol­i­cy lead­ers, includ­ing the Her­itage Foun­da­tion and for­mer Sen. Rick San­to­rum, R‑Penn. One ana­lyst said a White House pro­pos­al would most like­ly be brought up in the Sen­ate first.

    Her­itage Foun­da­tion Direc­tor of Domes­tic Pol­i­cy Stud­ies Marie Fish­paw not­ed that the pres­i­dent has already includ­ed con­cepts from the Health Care Choic­es pro­pos­al in his 2020 bud­get.

    The pro­pos­al, accord­ing to Fish­paw, “would low­er pre­mi­ums by up to a third, low­er­ing costs while also pro­tect­ing peo­ple with pre-exist­ing con­di­tions.” It would replace fed­er­al pay­ments to insur­ance com­pa­nies with grants for each state, giv­ing indi­vid­ual states more lee­way to deter­mine how to use the mon­ey.

    One con­ser­v­a­tive pol­i­cy ana­lyst said that although the White House is def­i­nite­ly “explor­ing” the health­care issue, it does not seem ready to unveil a pro­pos­al.

    “I don’t think there’s any­thing that’s ful­ly formed,” the ana­lyst said. “I think a lot of the devil’s in the details.”

    ...

    ———-

    “White House work­ing on secret health­care plan with three con­ser­v­a­tive think tanks” by Emi­ly Ward; The Wash­ing­ton Exam­in­er; 03/31/2019

    “The ana­lyst said the admin­is­tra­tion has been “hav­ing con­ver­sa­tions” on health­care pol­i­cy and has reached out to numer­ous think tanks, includ­ing the Her­itage Foun­da­tion, the Mer­ca­tus Cen­ter, and the Hoover Insti­tute.”

    And that’s who is going to be devel­op­ing Trump’s super secret health care plan: three right-wing think tanks. And we’re even get­ting hints at to the nature of the plan these think tanks are work­ing on: some vari­a­tion of the same failed Gra­ham-Cas­sidy bill that GOP could­n’t pass in 2017 as an Oba­macare replace­ment:

    ...
    Pol­i­cy lead­ers at sev­er­al con­ser­v­a­tive think tanks con­firmed to the Exam­in­er that a health­care plan is indeed the works. They said a pro­pos­al would take con­cepts from the Gra­ham-Cas­sidy bill, by Sen. Lind­sey Gra­ham, R‑S.C. and Sen. Bill Cas­sidy, R‑La., and the Health Care Choic­es pro­pos­al, which was signed by many con­ser­v­a­tive pol­i­cy lead­ers, includ­ing the Her­itage Foun­da­tion and for­mer Sen. Rick San­to­rum, R‑Penn. One ana­lyst said a White House pro­pos­al would most like­ly be brought up in the Sen­ate first.

    Her­itage Foun­da­tion Direc­tor of Domes­tic Pol­i­cy Stud­ies Marie Fish­paw not­ed that the pres­i­dent has already includ­ed con­cepts from the Health Care Choic­es pro­pos­al in his 2020 bud­get.

    The pro­pos­al, accord­ing to Fish­paw, “would low­er pre­mi­ums by up to a third, low­er­ing costs while also pro­tect­ing peo­ple with pre-exist­ing con­di­tions.” It would replace fed­er­al pay­ments to insur­ance com­pa­nies with grants for each state, giv­ing indi­vid­ual states more lee­way to deter­mine how to use the mon­ey.
    ...

    LOL! The mys­tery plan is going to low­er pre­mi­ums up to a third while pro­tect­ing peo­ple with pre-exist­ing con­di­tions. And how will it achieve all that? Who knows because don’t details have yet to be worked out:

    ...
    One con­ser­v­a­tive pol­i­cy ana­lyst said that although the White House is def­i­nite­ly “explor­ing” the health­care issue, it does not seem ready to unveil a pro­pos­al.

    “I don’t think there’s any­thing that’s ful­ly formed,” the ana­lyst said. “I think a lot of the devil’s in the details.”
    ...

    “I don’t think there’s any­thing that’s ful­ly formed...I think a lot of the devil’s in the details.”

    That’s going to be a pret­ty good gener­ic warn­ing head­ing into 2020. A lot of the dev­il is indeed in the details. Espe­cial­ly when it comes to the details of secret plans.

    It’s also worth recall­ing that even the Trump White House was­n’t hap­py with Gra­ham-Cas­sidy back in 2017 and gen­er­al­ly qui­et­ly expressed an atti­tude of ‘it’s bet­ter than noth­ing’ at the time. That’s the plan that this crack team of right-wing think tanks is going to be bas­ing Trump’s super secret health care plan on. But appar­ent­ly this plan that the Trump team did­n’t actu­al­ly like very in 2017 will some­what be tweaked in a way that results in low­er costs for every­one while pre-exist­ing con­di­tions are pro­tect­ed. At least that’s the promise.

    So it appears that the Trump team has decid­ed to ensure that not only will health care be a major issue in the 2020 elec­tion, but trust in Trump and trust in the right-wing think tanks Trump is trust­ing will also be core issues. Which is kind of an amaz­ing polit­i­cal gam­bit con­sid­er­ing most Amer­i­cans view Trump as fun­da­men­tal­ly dis­hon­est. Pre­sum­ably Trump’s real 2020 strat­e­gy will actu­al­ly just be xeno­pho­bia and fear mon­ger­ing about immi­grants.

    Posted by Pterrafractyl | April 2, 2019, 3:14 pm
  19. The issue of Medicare for All is shap­ing up to be poten­tial issue in the upcom­ing 2020 US elec­tions. Polls have shown that, while a major­i­ty of the pub­lic sup­ports the gen­er­al idea of Medicare for All, that sup­port plum­mets if Medicare for All also means elim­i­nat­ing pri­vate insur­ance com­pa­nies. A recent poll put sup­port for Medicare for All at 56 per­cent gener­i­cal­ly, but it fell to 37 per­cent if the plan involved elim­i­nat­ing pri­vate insur­ance. In oth­er words, there’s a large swatch pub­lic likes the option of Medicare for All but would also like the option of keep­ing their exist­ing employ­er-based health plan.

    So it’s going to be inter­est­ing to see if the fol­low­ing sto­ry shifts those poll num­bers at all. Because it’s a sto­ry about the stun­ning suc­cess the GOP is hav­ing in their quest to make pri­vate insur­ance much, much worse for vir­tu­al­ly every­one. Remem­ber when Pres­i­dent Trump announced back in March that the Trump admin­is­tra­tion was join­ing the 20 Repub­li­can state attor­ney gen­er­als in their law­suit to over­turn Oba­macare and press for the entire law to be over­turned and not just the pro­tec­tions for pre­ex­ist­ing con­di­tions? That was the law­suit that assert­ed that the entire Oba­macare law became uncon­sti­tu­tion­al after the GOP-con­trolled con­gress elim­i­nat­ed the indi­vid­ual man­date penal­ty as part of the GOP’s 2017 tax cut law. And remem­ber when Trump announced that the GOP was secret­ly work­ing on an Oba­macare replace­ment plan that would only be revealed after the 2020 elec­tions. Well, the GOP had bet­ter be work­ing on that super secret replace­ment plan, because based on the behav­ior of the Repub­li­can-appoint­ed fed­er­al appeals judges hear­ing the case it’s look­ing like that law­suit just might suc­ceed. If it does suc­ceed all of the pro­vi­sions of Oba­macare that made pri­vate insur­ance bet­ter for the pub­lic will go away. And this could hap­pen right in the mid­dle of the 2020 elec­tion

    Politi­co

    Appeals court skep­ti­cal Oba­macare can sur­vive

    Health insur­ance for 20 mil­lion peo­ple and pro­tec­tions for pre-exist­ing con­di­tions are on the line.

    By PAUL DEMKO

    07/09/2019 05:02 PM EDT
    Updat­ed 07/09/2019 06:34 PM EDT

    NEW ORLEANS — A pan­el of fed­er­al appeals judges aggres­sive­ly ques­tioned whether Oba­macare can sur­vive dur­ing Tues­day after­noon oral argu­ments in a case that could upend the 2010 health care law.

    Two Repub­li­can appointees on the three-judge pan­el fre­quent­ly inter­rupt­ed attor­neys to ques­tion whether the Afford­able Care Act’s indi­vid­ual man­date is uncon­sti­tu­tion­al and if not whether the entire law could stand with­out it. The ACA’s future appeared murky after two hours of oral argu­ments at the 5th U.S. Cir­cuit Court of Appeals, but it’s not clear if the judges were ready to uphold a fed­er­al judge’s ear­li­er deci­sion inval­i­dat­ing the law.

    The law­suit, which is sup­port­ed by the Trump admin­is­tra­tion, puts at risk cov­er­age for 20 mil­lion peo­ple cov­ered by the ACA, as well as the law’s pop­u­lar pro­tec­tions for insur­ance pro­tec­tions. The close­ly watched case is expect­ed to even­tu­al­ly move to the Supreme Court, which has saved the law twice already, and could ulti­mate­ly decide Obamacare’s fate next year in the height of the 2020 cam­paign.

    This lat­est legal threat to Oba­macare was filed by a group of red states in Feb­ru­ary 2018, months after Repub­li­can-led efforts to repeal the law col­lapsed in Con­gress. They argue that Con­gress’ deci­sion to scrap the indi­vid­ual man­date penal­ty in its 2017 tax cut ren­dered the law uncon­sti­tu­tion­al because the Supreme Court pre­vi­ous­ly upheld the man­date as a valid exer­cise of tax­ing pow­er. Con­gress low­ered the penal­ty for not pur­chas­ing health cov­er­age to $0, but the man­date remains on the books.

    In Decem­ber, U.S. Dis­trict Court Judge Reed O’Connor sided with the Repub­li­can-led states, shock­ing legal experts. The law­suit was once seen as a long-shot, but it’s received seri­ous con­sid­er­a­tion by Repub­li­can-appoint­ed judges.

    Appel­late Judge Jen­nifer Elrod, a George W. Bush appointee, on Tues­day posit­ed that law­mak­ers — who failed to agree on an Oba­macare replace­ment plan two years ago — delib­er­ate­ly elim­i­nat­ed the man­date penal­ty because they knew the rest of the law would have to fall. She said per­haps law­mak­ers thought, “Aha, this is the sil­ver bul­let that’s going to undo Oba­macare.”

    Attor­neys for the 20 Demo­c­ra­t­ic-led states that are defend­ing the law, as well as the Demo­c­ra­t­ic-con­trolled House, coun­tered that Con­gress clear­ly intend­ed for the rest of the law to sur­vive when it elim­i­nat­ed the man­date penal­ty.

    “All the court has to do is look at the text,” said Samuel Siegel, the attor­ney rep­re­sent­ing the Demo­c­ra­t­ic-led states.

    The three-judge appel­late pan­el is expect­ed to rule in the com­ing months. They could back the low­er court rul­ing inval­i­dat­ing all of Oba­macare or over­turn it entire­ly. The judges may also deter­mine that the elim­i­na­tion of the indi­vid­ual man­date penal­ty only ren­ders cer­tain parts of the ACA uncon­sti­tu­tion­al, such as its pro­tec­tions for indi­vid­u­als with pre­ex­ist­ing med­ical con­di­tions. That was the Trump administration’s orig­i­nal stance on the law­suit before recent­ly embrac­ing the low­er court rul­ing against the entire ACA.

    Judge Kurt Engel­hardt, a Trump appointee, point­ed out that Con­gress could set­tle the dis­pute over the health law’s future by imme­di­ate­ly strip­ping out the indi­vid­ual man­date entire­ly, elim­i­nat­ing the basis for the law­suit. He also ques­tioned why the Repub­li­can-con­trolled Sen­ate hasn’t weighed in on the law­suit.

    “They’re sort of the 800-pound goril­la who’s not in the room,” Engel­hardt said.

    But in Wash­ing­ton, Sen­ate Repub­li­cans were not eager to talk about the case, and sev­er­al are bet­ting pri­vate­ly that the ACA will sur­vive. Some expressed con­cern a court deci­sion throw­ing out the entire law could cre­ate chaos in the health care sys­tem if it took effect imme­di­ate­ly.

    “If the appel­late court upholds the low­er court’s deci­sion, then I hope they’re able to pro­vide a tran­si­tion,” said Sen. Kevin Cramer (R‑N.D.). “If the court decides it’s not [con­sti­tu­tion­al], then we have our work cut out for us.”

    Sen­ate Major­i­ty Leader Mitch McConnell on Tues­day said Con­gress would act “quick­ly, on a bipar­ti­san basis” to restore pre­ex­ist­ing con­di­tion pro­tec­tions if the courts struck them, but there’s no guar­an­tee that they would. Repub­li­cans have sup­port­ed less robust pro­tec­tions than those pro­vid­ed by the ACA, and Democ­rats aren’t like­ly to accept any­thing less.

    Democ­rats, who saw their promis­es to defend cov­er­age and pre-exist­ing con­di­tions as win­ning cam­paign mes­sages in 2018, are eager to again press that case in 2020.

    “The stakes can­not be high­er,” said Sen­ate Minor­i­ty Leader Chuck Schumer. “Mil­lions of Amer­i­cans will suf­fer if Repub­li­cans suc­ceed. Shame on them.”

    Still, what hap­pens next in the courts isn’t clear. Dur­ing the Tues­day hear­ing, the Repub­li­can-appoint­ed judges raised numer­ous ques­tions about whether any par­ty had any legal stand­ing to chal­lenge the ACA’s con­sti­tu­tion­al­i­ty in the first place or to appeal the fed­er­al judge’s ear­li­er rul­ing against the ACA.

    The stand­ing issue emerged as a recent wild card in the legal pro­ceed­ings — the appeals pan­el two weeks ago first raised ques­tions about whether any­one could chal­lenge the deci­sion after the Trump admin­is­tra­tion in March shift­ed its legal strat­e­gy to ful­ly side with the Repub­li­can-led states.

    The judges could toss the entire law­suit if they deter­mined the red states who brought the case haven’t suf­fered any harm from the removal of the indi­vid­ual man­date penal­ty. Attor­neys for those states argued that even with­out a tax penal­ty, the man­date caus­es harm by forc­ing them to spend mon­ey on gov­ern­ment health care cov­er­age for more peo­ple.

    “The ACA caus­es clas­sic pock­et­book injury to the states,” said Kyle Hawkins, the attor­ney rep­re­sent­ing the Repub­li­can-led states.

    Mean­while, the judges seemed con­fused by the Trump admin­is­tra­tion’s legal posi­tion. The Depart­ment of Jus­tice sup­ports the low­er court rul­ing against the entire ACA, but at the same time it has argued that some pro­vi­sions of the law — which the DOJ hasn’t spec­i­fied — should remain.

    DOJ attor­ney August Flen­t­je argued that it’s too soon to deter­mine exact­ly which pro­vi­sions can remain even if it’s struck down.

    “A lot of this stuff will need to be sort­ed out,” Flen­t­je said. “It’s com­pli­cat­ed.”

    The lone Demo­c­ra­t­ic appointee on the three-judge pan­el was silent through­out the hear­ing. The judges gave no indi­ca­tion on when they might rule on the case.

    ...

    ———-

    “Appeals court skep­ti­cal Oba­macare can sur­vive” by PAUL DEMKO; Politi­co; 07/09/2019

    “The law­suit, which is sup­port­ed by the Trump admin­is­tra­tion, puts at risk cov­er­age for 20 mil­lion peo­ple cov­ered by the ACA, as well as the law’s pop­u­lar pro­tec­tions for insur­ance pro­tec­tions. The close­ly watched case is expect­ed to even­tu­al­ly move to the Supreme Court, which has saved the law twice already, and could ulti­mate­ly decide Obamacare’s fate next year in the height of the 2020 cam­paign.”

    It’s not just a law­suit against “Oba­macare”. It’s a law­suit against all the pri­vate insur­ance pro­tec­tions that were part of the Afford­able Care Act. Very pop­u­lar pro­tec­tions like pro­tec­tions for pre­ex­ist­ing con­di­tions or life­time caps. So how pop­u­lar is pri­vate insur­ance going to be with the Amer­i­can pub­lic if they learn that they sud­den­ly lost all of those pro­tec­tions? We just might find out because the two Repub­li­can-appoint­ed judges on this three-judge pan­el appear to be recep­tive to the argu­ment that the elim­i­na­tion of the penal­ty for the indi­vid­ual man­date real­ly does inval­i­date the entire law.

    Recall how the law­suit cen­ters on the ques­tion of what Con­gress intend­ed when it removed the man­date penal­ty in the 2017 tax cut. When the Oba­macare first passed, Con­gress argued that the indi­vid­ual man­date penal­ty was “non-sev­er­able” from the rest of the bill. In oth­er words, the penal­ty was required for the law to work. But when Con­gress got rid of the penal­ty, but kept the man­date, as part of the 2017 tax bill it did­n’t clar­i­fy whether or not Con­gress still felt the penal­ty was “non-sev­er­able” from the rest of the law. That’s the idi­ot­ic basis for this law­suit. One of the Repub­li­can-appoint­ed judges even sug­gest­ed that it’s pos­si­ble Con­gress intend­ed for law to be inval­i­dat­ed by remov­ing the penal­ty man­date, opin­ing that per­haps law­mak­ers thought, “Aha, this is the sil­ver bul­let that’s going to undo Oba­macare.” And if the judges deter­mine that, yes, Con­gress want­ed Oba­macare over­turned as a result of the removal of the man­date penal­ty that could be the legal basis for rul­ing that Oba­macare can’t work as intend­ed and is there­fore invalid:

    ...
    Two Repub­li­can appointees on the three-judge pan­el fre­quent­ly inter­rupt­ed attor­neys to ques­tion whether the Afford­able Care Act’s indi­vid­ual man­date is uncon­sti­tu­tion­al and if not whether the entire law could stand with­out it. The ACA’s future appeared murky after two hours of oral argu­ments at the 5th U.S. Cir­cuit Court of Appeals, but it’s not clear if the judges were ready to uphold a fed­er­al judge’s ear­li­er deci­sion inval­i­dat­ing the law.

    ...

    This lat­est legal threat to Oba­macare was filed by a group of red states in Feb­ru­ary 2018, months after Repub­li­can-led efforts to repeal the law col­lapsed in Con­gress. They argue that Con­gress’ deci­sion to scrap the indi­vid­ual man­date penal­ty in its 2017 tax cut ren­dered the law uncon­sti­tu­tion­al because the Supreme Court pre­vi­ous­ly upheld the man­date as a valid exer­cise of tax­ing pow­er. Con­gress low­ered the penal­ty for not pur­chas­ing health cov­er­age to $0, but the man­date remains on the books.

    In Decem­ber, U.S. Dis­trict Court Judge Reed O’Connor sided with the Repub­li­can-led states, shock­ing legal experts. The law­suit was once seen as a long-shot, but it’s received seri­ous con­sid­er­a­tion by Repub­li­can-appoint­ed judges.

    Appel­late Judge Jen­nifer Elrod, a George W. Bush appointee, on Tues­day posit­ed that law­mak­ers — who failed to agree on an Oba­macare replace­ment plan two years ago — delib­er­ate­ly elim­i­nat­ed the man­date penal­ty because they knew the rest of the law would have to fall. She said per­haps law­mak­ers thought, “Aha, this is the sil­ver bul­let that’s going to undo Oba­macare.”
    ...

    And even the Trump-appoint­ed judge on the pan­el not­ed that this entire ques­tion of the “sev­er­abil­i­ty” of the penal­ty from the rest of the law could eas­i­ly be set­tled by Con­gress. But Con­gress, specif­i­cal­ly the Sen­ate Repub­li­cans, refus­es to answer:

    ...
    Judge Kurt Engel­hardt, a Trump appointee, point­ed out that Con­gress could set­tle the dis­pute over the health law’s future by imme­di­ate­ly strip­ping out the indi­vid­ual man­date entire­ly, elim­i­nat­ing the basis for the law­suit. He also ques­tioned why the Repub­li­can-con­trolled Sen­ate hasn’t weighed in on the law­suit.

    “They’re sort of the 800-pound goril­la who’s not in the room,” Engel­hardt said.

    But in Wash­ing­ton, Sen­ate Repub­li­cans were not eager to talk about the case, and sev­er­al are bet­ting pri­vate­ly that the ACA will sur­vive. Some expressed con­cern a court deci­sion throw­ing out the entire law could cre­ate chaos in the health care sys­tem if it took effect imme­di­ate­ly.

    “If the appel­late court upholds the low­er court’s deci­sion, then I hope they’re able to pro­vide a tran­si­tion,” said Sen. Kevin Cramer (R‑N.D.). “If the court decides it’s not [con­sti­tu­tion­al], then we have our work cut out for us.”
    ...

    And note how Sen­ate Major­i­ty Leader Mitch McConnell is mak­ing the absurd pledge that if the law is over­turn by the courts, Con­gress will rapid­ly work in a bipar­ti­san man­ner to restore the lost pro­tec­tions. These are, of course, the same pro­tec­tions the GOP was try­ing to gut dur­ing their pre­vi­ous failed attempt to over­turn Oba­macare:

    ...
    Sen­ate Major­i­ty Leader Mitch McConnell on Tues­day said Con­gress would act “quick­ly, on a bipar­ti­san basis” to restore pre­ex­ist­ing con­di­tion pro­tec­tions if the courts struck them, but there’s no guar­an­tee that they would. Repub­li­cans have sup­port­ed less robust pro­tec­tions than those pro­vid­ed by the ACA, and Democ­rats aren’t like­ly to accept any­thing less.
    ...

    And note that oth­er argu­ment being made the the Repub­li­can state attor­ney gen­er­als: the man­date caus­es harm on the states by forc­ing them to spend mon­ey on gov­ern­ment health care cov­er­age for more peo­ple. That’s the harm to states...paying for more health care cov­er­age. Recall that it was the Repub­li­can-led states that gen­er­al­ly refused the Med­ic­aid expan­sion that could arguably increase costs for states:

    ...
    Still, what hap­pens next in the courts isn’t clear. Dur­ing the Tues­day hear­ing, the Repub­li­can-appoint­ed judges raised numer­ous ques­tions about whether any par­ty had any legal stand­ing to chal­lenge the ACA’s con­sti­tu­tion­al­i­ty in the first place or to appeal the fed­er­al judge’s ear­li­er rul­ing against the ACA.

    The stand­ing issue emerged as a recent wild card in the legal pro­ceed­ings — the appeals pan­el two weeks ago first raised ques­tions about whether any­one could chal­lenge the deci­sion after the Trump admin­is­tra­tion in March shift­ed its legal strat­e­gy to ful­ly side with the Repub­li­can-led states.

    The judges could toss the entire law­suit if they deter­mined the red states who brought the case haven’t suf­fered any harm from the removal of the indi­vid­ual man­date penal­ty. Attor­neys for those states argued that even with­out a tax penal­ty, the man­date caus­es harm by forc­ing them to spend mon­ey on gov­ern­ment health care cov­er­age for more peo­ple.

    “The ACA caus­es clas­sic pock­et­book injury to the states,” said Kyle Hawkins, the attor­ney rep­re­sent­ing the Repub­li­can-led states.
    ...

    But keep in mind that the fed­er­al gov­ern­ment was cov­er­ing 100 per­cent of the cost of the Med­ic­aid expan­sion for the first few years and will cov­er 90 per­cent of the cost going for­ward so the notion. Plus, stud­ies have found that Med­ic­aid expan­sion actu­al­ly saved mon­ey for many states because expand­ed Med­ic­aid cov­er­age reduces costs in oth­er areas like reduced pay­ments to hos­pi­tals. So the idea that the option­al Med­ic­aid expan­sion (which was made option­al for states in 2012 with the Supreme Court’s rul­ing) is cost­ing states a bur­den­some amount of mon­ey is about as hon­est as the rest of this law­suit.

    Final­ly, keep in mind that the judges won’t nec­es­sar­i­ly inval­i­date the entire law. They much just strip out cer­tain parts of the law, like pro­tec­tions for pre­ex­ist­ing con­di­tions:

    ...
    Attor­neys for the 20 Demo­c­ra­t­ic-led states that are defend­ing the law, as well as the Demo­c­ra­t­ic-con­trolled House, coun­tered that Con­gress clear­ly intend­ed for the rest of the law to sur­vive when it elim­i­nat­ed the man­date penal­ty.

    “All the court has to do is look at the text,” said Samuel Siegel, the attor­ney rep­re­sent­ing the Demo­c­ra­t­ic-led states.

    The three-judge appel­late pan­el is expect­ed to rule in the com­ing months. They could back the low­er court rul­ing inval­i­dat­ing all of Oba­macare or over­turn it entire­ly. The judges may also deter­mine that the elim­i­na­tion of the indi­vid­ual man­date penal­ty only ren­ders cer­tain parts of the ACA uncon­sti­tu­tion­al, such as its pro­tec­tions for indi­vid­u­als with pre­ex­ist­ing med­ical con­di­tions. That was the Trump administration’s orig­i­nal stance on the law­suit before recent­ly embrac­ing the low­er court rul­ing against the entire ACA.
    ...

    And that whole legal night­mare that could sud­den­ly make pri­vate insur­ance much worse is poised to play out right in the mid­dle of the 2020 cam­paign sea­son. A cam­paign sea­son when Medicare for All remains a polar­iz­ing issue because lots of Medicare for All sup­port­ers still like their pri­vate insur­ance.

    Posted by Pterrafractyl | July 12, 2019, 4:26 pm

Post a comment