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.
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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, 2017As 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.
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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.
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“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, 2017Tucked 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.
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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.
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“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:
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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, 2017ORANGE, 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.
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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.”
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““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:
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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.
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“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:
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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.”
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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, 2011WASHINGTON — 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.
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“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, 2017The 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.”
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“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:
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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.
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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 doubtfulLeaders 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.
...
———-
““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.
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:
““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:
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.
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?
“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:
““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:
““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:
““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:
“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:
And the Koch network wants a much more conservative Obamacare repeal:
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.
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:
“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:
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:
“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:
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:
“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...
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:
“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:
“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.
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:
“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:
And the worst part is, the Kochs love. And their Freedom Caucus pets:
And it even sounds like most GOP Senators would rather amend it all away (and probably amend Ted Cruz away if they could):
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:
““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:
“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:
“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:
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:
“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:
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.
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:
“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:
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:
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:
“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:
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 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:
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]”
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:
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.
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:
““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:
““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:
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:
““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:
“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:
“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:
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.
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:
““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 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:
“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:
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:
“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:
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:
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.
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 June — gave 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:
“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:
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:
“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.
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:
““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:
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:
“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):
“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:
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:
“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.
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:
“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:
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:
“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:
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
So this happened. Or rather, didn’t happen:
“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.
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:
“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?
$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:
“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:
“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”:
“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:
““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):
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:
““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.
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:
“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:
“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:
““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:
“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:
But then Trump changed his tune. To a tune that sounds a lot like what Paul Ryan has been whistling:
““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.
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:
“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:
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:
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:
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”
“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:
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:
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:
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:
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:
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.
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:
“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:
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:
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:
“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:
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:
And as the article notes, both Mulvaney and Trump share the same political instinct: cater to the hard core base at all costs:
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:
“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:
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:
“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.
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:
“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:
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:
“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:
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:
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:
“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:
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:
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:
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:
And as the article notes, without the competition of generics, the branded manufacturers can continue raising prices around 10 percent a year:
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:
“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:
“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:
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:
“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.
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:
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
“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:
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 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:
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:
“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.
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
“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:
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:
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:
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:
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 might just strip out certain parts of the law, like protections for preexisting conditions:
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.
As the consensus grows that President Trump is all but guaranteed to be impeached by House over his #UkraineGate election meddling extortion scheme, here’s a quick reminder that the list of Trump’s impeachable offenses isn’t limited to illicit abuses of power involving foreign governments. For example, the Trump administration’s long-standing and ongoing sabotage of the Affordable Care Act (Obamacare) is arguably an impeachable offense too:
“Subpoenas to government officials might reveal even clearer evidence of the direct links between Trump’s stated intent to destroy the law and the administration’s specific actions that undermined it. A robust investigation might also elicit even more damning evidence by reassuring would-be whistleblowers within the government who believe coming forward is worth the risks. The current impeachment inquiry has already made abundantly clear that a serious investigation with real potential consequences attracts public servants willing to tell the truth. Finally, hearings with witnesses affected by Trump’s attacks on the ACA could build public awareness about the severity of Trump’s actions. Congress needs to make clear that these abuses are not just reprehensible but likely unconstitutional.”
As the article makes clear, at a minimum there’s grounds for a congressional investigation. An investigation into whether or not all of the various moves by the administration that have undermined the viability of Obamacare — like ending insurance company subsidies for covering poorer Americans — wasn’t done out of an ideologically driven attempt to faithfully implement the law but was actually a bad-faith attempt to undermine the law, as Steve Bannon bragged at the time. Administrations have a wide discretionary latitude in how to implement laws passed by Congress, but they don’t have the latitude to undermine them. That’s not how the US government works:
Is it constitutionally acceptable for an administration to engage in bad faithed efforts to undermine the laws passed by congress? That’s clearly not how the US government is supposed to work according to the constitution and even Andrew Johnson’s impeachment included the accusation of him failing to “take care” to execute the Tenure of Office Act. But, for now, this kind of behavior is being treated as less than an impeachable offense.
Also keep in mind that the intentionally bad faithed sabotage of Obamacare is just one example the Trump administration refusing to faithfully execute laws passed by Congress. Like when Trump appointed Mick Mulvaney to be acting director of the Consumer Financial Protection Board (CFPB) — despite Mulvaney previously calling for the abolition of the CFPB — and then Mulvaney proceeded to undermine the agency. Or when the administration engages in the bad faithed undermining of the scientific methods used by the EPA to assess the environmental regulations required to comply with the law. There’s all sorts of examples of the Trump administration refusing to even try to administer the law in good faith.
Is the bad faithed undermining of law by the executive branch constitutional? That’s one of the impeachment related questions now facing the US congress whether or not the question ultimately gets asked in the context of the ongoing impeachment investigations. And it’s unfortunately unclear whether or not expanding the ongoing impeachment proceedings beyond the scope of #UkraineGate to include the issue of the bad faithed undermining of law would help or hurt the impeachment proceedings. Would adding all of these new constitutional offenses to the inquiry just distract from Trump’s impeachable Ukraine scheming? Or would it underscore the unconstitutional nature of this administration’s fundamental approach to governing? It points to one of the underlying challenges facing the Trump impeachment inquiry: the full scope of Trump’s crimes are so voluminous that they become their own distraction. Trying to absorb the full scope of Trump’s criminality is like the blind men and the elephant. You can’t take it in all at once. It’s too multifaceted. Which seems like an impeachable offense. An ironically simple impeachable offense.
Is the coronavirus economic crisis going to be used as an excuse to gut Medicare and Social Security? While that’s unlikely to happen in 2020 due to the enormous political costs of such a move during an election year, if the following article about the internal debate going on within the Trump administration is any indications of what to expect it’s looking like the American public is being set up for a big switcheroo should Trump win reelection: making future cuts to entitlements the costs of federal coronavirus assistance. That’s literally the proposal put being explored by senior White House officials: one idea is that Americans could get $5,000 in exchange for a future delay of their Social Security benefits. Another proposal, backed by Art Laffer, is to give American’s $10,000 in exchange for curbing future federal retirement benefits like Social Security...presumably it would include more than just Social Security cuts and include other benefits like Medicare.
And while the White House is officially decrying these proposals and reiterating Trump’s past pledges to not cut Social Security or Medicare, as the article notes Trump is now pushing for cuts to the suspension of the federal payroll tax that pays for Social Security and Medicare as one of the next stimulus measures.
Now, we have to point out a payroll tax is far more stimulative to the economy than the kind of supply-side tax cuts the GOP normally passes. While higher earning people will still get the largest cuts (because they pay a higher payroll tax), it’s still not nearly as wildly skewed towards the super-rich as Trump’s 2017 tax cut. At the same time, it’s the kind of stimulus that’s implicitly a cut to Social Security and Medicare unless there’s a plan to make up for the shortfall to the programs later and one thing we can be very confident of is that Trump and the GOP are never going to allow for a reform to Social Security and Medicare that somehow involves putting more money into the programs. Also keep in mind that a payroll tax cut wouldn’t actually help the tens of millions of unemployed people because it’s a tax taken out of paychecks. So we have reports that senior White House officials are considering a plan to make further federal coronavirus assistance contingent on future entitlement cuts at the same time we have denials that Trump is even considering the idea and is instead proposing a payroll tax cut proposal a suspension that will exacerbate long-term funding challenges of the programs and do basically nothing to to help the millions of unemployed:
“Senior White House economic officials also are exploring a proposal floated by two conservative scholars that would allow Americans to choose to receive checks of up to $5,000 in exchange for a delay of their Social Security benefits, according to three people familiar with the internal matter. That plan was written by Andrew Biggs of the right-leaning American Enterprise Institute and Joshua Rauh of the right-leaning Hoover Institution at Stanford University.”
$5,000 in cash today for a delay in Social Security benefits in the future. Cash for cuts. And for $10,000 in cash today you can get even more futures cuts to entitlements. Medicare cuts perhaps? That’s “Eagle Plan” that senior White House officials are reportedly considering:
And while White House is officially denying that the plan is even under consideration, it’s kind of hard to ignore the fact that Trump’s alternative stimulus proposal is a payroll tax cut that won’t actually help the unemployed but will exacerbate these programs’ funding challenges:
And Trump isn’t just advocating for a payroll tax cut. He’s been demanding it and threatening to veto any congressional stimulus packages don’t include it. And that tax cut is still a better alternative than the “Eagle Plan” his senior advisors are cooking up. That’s how bad the Trump White House’s coronavirus response policy has been. And it’s hard to ignore how conveniently Trump’s pay roll tax cut would dovetail into an “Eagle Plan” style policy in 2021 should Trump win reelection: first you eliminate the payroll tax to acceleration the elimination of the Social Security trust fund and then, after Trump wins reelection on a platform of not cutting Social Security, do a policy where you ‘offer’ the economically desperate Americans immediate cash in exchange for future entitlement cuts.
Given that dire policy future, here’s a piece from Alex Lawson — a long-time advocate of the immense widespread socioeconomic benefits of simply expanding a program like Social Security — that’s a reminder that one of the most effective policy responses to the coronavirus pandemic and the resulting economic chaos is expanding Social Security and making it a lot more robust:
“Economic security for seniors and people with disabilities has never been more important. It is clear we will not see any leadership from the White House. Only congressional action can alleviate the pain that individuals and families are experiencing due to the coronavirus pandemic.”
Economic security for seniors and people with disabilities has never been more important. If ever there was a time for that to become a US political rallying cry this would be it. A global pandemic that poses a disproportionate threat to
the sick and elderly. A global pandemic that forced an emergency economic lockdown that we are now trying to extricate ourselves from. It would be a lot easier to get the economy restarted while still allowing for the sick and elderly to protect themselves if we systematically ensured they had the resources they need to survive. Old age poverty was already a massive and growing problem in America. It’s going to be mega-crisis as a result of this pandemic and that means there’s going to be a whole lot of Americans in exactly that target demographic we want to self-isolate who are going to have to choose between going to work and facing the coronavirus to pay for food and medicine or not going to work and living in complete poverty, reliant on the increasingly bare Medicaid program that the Trump administration has been assaulting. Reopening the economy without forcing the elderly poor to risk exposure to the virus requires meaningful economic assistance and by far the easiest and most efficacious way to address that is simply expanding Social Security, Medicare and other safety-net programs:
It’s the reality staring the US in the face more than ever right now that the GOP’s mega-donors want to obscure as much as possible: Reforming entitlements and the safety-net in ways that actually make these programs bigger and stronger than ever has never been so profitable. It really could be a cornerstone to safely reopening the economy. How do you put a price tag on that?
If ‘reopening, safe or not’ is going to be the new US social contract as Trump and the GOP is demanding then the people found to be exceptionally vulnerable to the virus should be given the resources they need to not have to go to work just to survive as part of that new social contract too. And that group happens to be the social security population. All indications are there’s no real hope for a rapid “V”-shape recovery. A vaccine is likely years away if ever. Climbing out of this crisis is a long-term project that will involve long-term reforms to the American economy and society. Why not start that long-term climb on a foundation of a new social contract that finally recognizes the reality that America is hurtling into a major retirement crisis that’s about to get a lot worse as a result of this economic calamity and the only realistic long-term solution is creating a safety-net you can retire on. As should have happened decades ago.
Oh, and it would be a great excuse to finally address decades of yawning wealthy inequality that somehow exploded even more under Trump and is only getting more grotesque as the covid crisis plays out. We could address that too since it would be a great way to pay for these expanded programs. Which is why there’s so much interest in not thinking about this obvious covid-response option staring America in the face. For the GOP mega-donors who have spent decades trying to shred these programs this is a precarious situation in the sense that they really are at risk of seeing those efforts get undone before expanding entitlements really is such an obviously sane and sober long-term policy response to the covid nightmare.
When you think about it, it’s kind of amazing just how great a fit expanding entitlements as a policy response to the covid nightmare, short-term and long-term. Expanding entitlements would put in the immediately economic support required to allow the elderly and vulnerable to avoid forced work just to live while providing a long-term support base during a period of extreme uncertainty where we have no idea how many economic re-closing and opening cycles we’ll be experiencing going forward. For all we know COVID-21 in a couple of year will make COVID-19 look like a kitten. Trump’s magical-thinking happy talk isn’t a great way for businesses and households to deal with that kind of hyper-insecurity that could go on for years or decades. This could be over in six months or sixty years. No one knows, but we do know America is facing a retirement crisis that’s about to explode which is why this is the absolute perfect time to finally build create a long-term safety-net we can all retire on if and when that becomes necessary. And all it requires is making America’s most popular programs better and more popular.
Or we could eliminate the payroll tax — which only helps the employed and starves these programs of funds — and then wait for people to become economically desperate and then them $5,000 in exchange for future entitlement cuts. That’s clearly another policy option.
Here’s a set of articles about a pair of Obamacare-related lawsuits that are working their way through US courts and the GOP’s ongoing push to have Obamacare repealed entirely. In the middle of a pandemic:
First, the Trump administration’s Justice Department just answered the question of whether or not the administration was planning on continuing its politically precarious backing of the GOP’s lawsuit arguing that the 2017 tax cut’s ending of the individual mandate invalidated the entire law. The answer, of course, is yes, the Justice Department is plowing ahead with lawsuit that could suddenly end health care coverage for millions of Americans in the middle of a pandemic. The Justice Department just issued a new legal brief reiterating its support for the lawsuit. The brief was sent to the Supreme Court, requesting that it hear the case, so it’s an attempt to push the GOP’s legal quest to kill Obamacare into the final phase where a Supreme Court ruling could actually end it.
The second Obamacare-related lawsuit is much more recent and isn’t another GOP attempt to end it. No, it’s a lawsuit by the city of Chicago over the Trump administration’s refusal to follow the Obamacare rules. Specifically, the rule that said the Obamacare enrollment window for Obamacare can be reopened during special public health emergencies where large numbers of people might need to coverage. Like, for example, a viral pandemic that just put tens of millions of people out of work. The rules are that Obamacare exchanges can reopen and people can get a new opportunity to enroll during such a public health emergency but the Trump administration has refused to do so. Instead, it came up with a scheme to pay hospitals directly for COVID-related services for the uninsured. A scheme that, as we’ll see, fails to actually cover the costs of people with major COVID-related health complications.
So we we have the Trump administration’s Justice Department reiterating its support for a joke lawsuit to end Obamacare — a deathly serious joke lawsuit — at the same time Chicago is suing over the refusal to allow enrollment in Obamacare in the middle of a pandemic and mass unemployment.
Ok, first here’s a Politico article from a few days ago about the Justice Department’s letter to the Supreme Court requesting that it take up the case and end Obamacare once and for all. As the article notes, when Trump announced in the Oval Office last month that his administration would continue with its support of this lawsuit despite the reality that it would strip away healthcare from tens of millions in the middle of a pandemic and economic turmoil, Trump declared “What we want to do is terminate it and give health care...We’ll have great health care, including preexisting conditions.” But as the article also notes, the proposed GOP replacements for Obamacare haven’t actually those protections for preexisting conditions and Trump administration health officials have said they won’t put forward an alternative plan unless the Supreme Court strikes down Obamacare. Recall how when the Trump administration first threw its support behind the state-led GOP lawsuit to end Obamacare in early 2018 it pledge that the administration was working on a secret Obamacare replacement that wouldn’t be revealed until after the 2020 when the Republicans win back control of the House. So that’s one pledge the administration is clearly still standing by: the pledge not to tell the public what it’s Obamacare replacement plans are until after the GOP has killed Obamacare and a request that we just trust that Trump and the GOP will ultimately do the right thing in the mean time.
And as the article also notes, if the Supreme Court does end up hearing the case this fall it’s unlikely to happen before the November election. So the legal peril facing Obamacare probably won’t really be fully apparent to the public until after the election too.
And that’s all part of what makes the story of this still-looming legal battle that threatens to eliminate Obamacare — the protections for preexisting conditions that came with it — so trouble: it’s the latest reminder that this public health timebomb is still ticking but the public may not really find out about it until after the elections:
“The Trump-backed lawsuit, brought by a group of Republican-led states, puts at risk health insurance for more than 20 million people covered by Obamacare, as well as insurance protections for people with preexisting medical conditions. Biden during a Thursday campaign event attacked Trump for seeking to upend those protections when a growing number of coronavirus survivors are developing potentially long-term health complications.”
Over 20 million people covered by Obamacare and all of the preexisting conditions protections. That’s just part of what’s going to be suddenly stripped away if the Supreme Court rules in favor of the GOP plaintiffs. This lawsuit is still happening more than two years after Trump promised that he’s working with conservative think-tanks to come up with a secret replacement that would only be revealed if Trump won reelection in 2020 and the GOP retook control of the House. And still happening months after Trump refused to open a special enrollment period for Obamacare in the wake of the COVID public health and economic catastrophe. If we had to list the top priorities of the Trump administration thus far killing Obamacare would have to be near the top of the list. Replacing Obamacare is clearly much further down on the list. But the these warped priorities won’t necessarily become apparent until after the election too because that’s when the Supreme Court is likely to rule on it. It’s all part of the ticking-timebomb nature of the Trump administration: it’s been exploding the whole time but is set to explode to at a whole new level if we keep it ticking with a second Trump term:
Ok, next we have a Politico article from back in early April about that decision by the Trump administration to refuse to open the Obamacare exchanges for an emergency enrollment period in response to the COVID pandemic and mass economic shock. Based on numerous sources, it sounds like nearly everyone, including people in the Trump administration, was expecting the special enrollment window to be opened because Obamacare has a special provision for exactly these kinds of situations. But it Trump personally ruled against it in the end and forced the rushed creation of a program where the uninsured can go to hospitals for COVID care without getting charged and hospitals would be reimbursed:
“The White House instead rejected the prospect of allowing new sign-ups across the 38 Affordable Care Act marketplaces it controls — a decision that shocked the health care industry, triggered widespread criticism and prompted a scramble within the administration to find a new way to care for the growing population left exposed to the pandemic.”
A sudden decision from the White House that surprised everyone and caused a sudden scramble to come up with a replacement program in the face of the COVID public health care crises. That’s what just happened in early April after the White House suddenly decided to kill the special Obamacare enrollment program to deal with the flood of COVID-related health care needs and job losses. As one unnamed Republican close to the administration described the decision, “It’s purely ideological,” and it sounds like the decision was made exclusively by Trump and his senior advisors:
Instead, there was the rushed plan of a program to reimburse hospitals for COVID-related care for the uninsured. So rushed that some officials inside the administration were reportedly surprised by its unveiling because they thought it was still under consideration:
But note the interesting dynamic this whole debacle creates for states when deciding whether or not they want to set up their own Obamacare exchanges or use the federal government’s default national exchange: the states that operated their own exchanges were already opening the special enrollment windows in response to the COVID crisis on their own:
Will we see a push by states to set up their own Obamacare exchanges after this experience? We’ll see. But as the following Chicago Tribune article from a couple of weeks ago makes clear, setting up state exchanges isn’t the only possible response to the Trump administration’s refusal to implement an emergency reopening of the exchanges. Another option is to take the Trump administration to court, which is exactly what Chicago did under the legal argument that the Trump administration’s refusal was ideologically driven. And as we just saw, it clearly was ideologically driven, even GOP operatives close to the administration admitted this. And that’s part of what makes this lawsuit so interesting: it’s a lawsuit over whether or not the Trump administration is engaged in purely ideological attempts to thwart Obamacare at the same time the Trump administration is clearly engaged in purely ideological attempts to thwart Obamacare:
“The 60-page lawsuit, filed in U.S. District Court in Washington, D.C., alleged Trump’s decision in April not to reopen enrollment was yet another attempt in the president’s three-year campaign to sabotage the signature legislation of his predecessor.”
It’s not exactly a leap in logic to conclude that the decision to refuse to reopen Obamacare exchanges in the middle of a major public health pandemic is yet another attempt in the president’s three-year campaign to sabotage the signature legislation of his predecessor. It would be shocking if that wasn’t the case. The decision was so obviously ideologically driven that Republicans close to the White House told Politico this in that April article we just looked at. No one can honestly think otherwise but the Trump administration is going to have to argue otherwise so a very sad legal battle is now going to be waged by the city of Chicago against the GOP’s legal Army of Darkness and it’s not clear which side will come out on top:
How will the Trump’s long-standing palpable desire to sabotage Obamacare — a desire made abundantly clear by the administration’s support of the GOP state lawsuit to end Obamacare — factor into the courts’ decision on whether or not the Trump administration’s refusal to open Obamacare enrollment in the middle of a pandemic was purely ideological? It’s a big case to watch. If the city of Chicago wins it’s going to be scoring much more than a legal argument. It will have received a court ruling that agrees the Trump administration was making purely ideological decisions when it comes to Obamacare, something that is completely obvious and yet can’t be officially acknowledged.
But as the final Politico article from a few days ago makes clear, the impact of the administration’s refusal to reopen the Obamacare exchanges is going to become very clear to the uninsured people who go to the hospital for COVID-related treatments and end up requiring major treatment. Because it turns out the Trump administration’s program for compensating hospitals for COVID-related treatment is dragging its feet when it comes to paying for the myriad of expensive long-term treatments that are going to be required for a number of COVID patients. It’s a problem that’s impacting the insured too. Hospitals were assured COVID-related expenses would be covered but as the Trump administration refuses to cover the costs of various treatments those costs are being passed along to the insured and uninsured and some of these costs are devastatingly huge.
Additionally, the Trump administration’s “public health emergency” declaration that has forced health insurers to cover pandemic-related expenses is set to expire in July and the Trump administration just indicated to insurers that they can back out of their enhanced coronavirus pledges to fully cover coronavirus treatment once the emergencies are lifted and instead change policies with “reasonable” notice, or when the emergency declaration expires, instead of the 60-day warning usually required to make policy changes. So the Trump administration is currently underfunding its emergency hospital fund at the same time its hinting that it’s planning on formally ending the coronavirus emergency, a move that could trigger a financial emergency for the most heavily hit COVID-19 patients, whether they’re insured and uninsured:
“Patients with and without insurance have already been hit with staggering bills, despite a White House promise to cover their costs, according to patient advocates. That’s because health care providers and insurers are classifying some complications as distinct from the virus during the billing process. The extent of the problem is still not fully known due to the lag time in settling medical claims.”
Whether you have health insurance or not, the Trump administration promised to cover health care costs. But the devil was in the details and those details mean patients, insured or not, are getting billed by hospitals for a whole range of very expensive treatments that aren’t being deemed to be COVID-related. And the insured patients are being rejected by insurers who want access to the hospital bailout fund. It’s precisely the kind of clusterf*ck that universal health care would solve which is why Obamacare would have been a step in the right direction. But that wasn’t an option for ideological reasons so here we are with the clusterf*ck:
And note how the Trump administration’s pledges (questionable pledges) to cover COVID-related hospitals costs are set to expire in July. And the Trump administration has been giving health insurance plans wide berth to back out of pledges to cover coronavirus treatment costs once the emergency is lifted. So on top of the clear signal that the Trump administration sent when it refused to temporarily reopen the federally-run Obamacare exchanges — a signal that it doesn’t really care about helping people deal with the short or long-term health care costs of this pandemic — it’s also been sending the signal to insurers that they won’t have to cover long-term COVID-related costs soon:
It’s in that broader clusterf*ck context that we have have to think about these twin lawsuits. A two-year old GOP lawsuit to eliminate Obamacare based on policy schemes from the 2017 tax scam and bad-faithed legal arguments and a two-week old lawsuit from the city of Chicago that’s designed to call out these bad-faithed actions and force the Trump administration to end its sabotage. It’s very clear which lawsuit COVID patients should favor although it remains entirely unclear which lawsuit will prevail, if either. In the mean time, it’s clear the sabotage will continue so hopefully all these COVID patients have strong immune systems because their legal and political systems went haywire a while ago.
There’s a rare bit of positive US health care news: The people of Missouri just voted to expand Medicaid, 53 to 47 percent. While it’s always a good time to expand Medicaid this was obviously a particularly opportune time for the expansion. Pandemics are no time for shoddy health care safety-nets.
But it was also a very opportune story in terms of the broader 2020 election because it’s not like the issue of health care reform is settled in the US. Trump and the GOP aren’t through trying to dismantle Obamacare, as the ongoing GOP lawsuit makes unambiguously clear. So the voters of Missouri just made a big new example of what will be taken away if Trump is reelected and allowed to finally succeed in his years long pledge to repeal and replace Obamacare. That expanded Medicaid is going to be rescinded real fast under whatever the GOP comes up with, of that we can be sure. Although we still can’t be sure what that Trump/GOP replacement health care reform package would look like because they never tell us. Our closest bet was the failed 2017 package which was so bad even the Republicans couldn’t pass it when they had the power to do it themselves. All we have thus far is empty promises and very real threats. So good for the voters of Missouri. They reminded Americans the ballot box and government can actually be used to help people:
““242,000 rural people in that Wall of Red voted for this bill, that will pass by 87,000 votes,” said Dunne. Without those 242,000 votes it would never have passed.””
242k rural voters in favor of the expansion. The “Yes” votes may not have won outside of the big cities but with 590k voters who voted against the expansion, most of whom were rural, that means there’s still around a third of rural voters who were in favor the expansion in rural Missouri which is Trump country:
What’s going to be very interesting to see is how rural attitudes toward the expansion change after they get the expansion next year and see the improved lives. Of course, that assumes Trump isn’t reelected and doesn’t dismantle Obamacare like he has promised over and over to do. Remember when we were told back in April of 2019 that Trump and Republican think tanks were working on a secret health care plan that would only be revealed after he wins reelection in 2020, well, that’s apparently still the plan. The secret plan is the plan. Because there’s still no plan. Although as the following article notes, Trump did suddenly promise that he would be signing some sort of health care reform package while he was being interviewed by Chris Wallace during a July 19 Fox New interview. He appears to have the health care reform bee in his bonnet again and he keep dropping hints that he’s got a big reform package. And Republican enablers like Senator Lindsey Graham are eagerly talking up Trump’s interest in health care reform and praising him for bringing the idea up before the election. And we’re also told that there’s still no indication at all that there’s even a hint of a real plan being created. So either Trump is about to unveil some sort of surprise Obamacare replacement plan or his plan for not having a replacement plan is to run around talking about his awesome plan and just never give any details:
““We’re going to be doing a health-care plan. We’re going to be doing a very inclusive health-care plan. I’ll be signing it sometime very soon,” Trump said during an exchange with reporters at an event in Belleair, Fla., on Friday. When a reporter noted that he told Fox’s Wallace that he would sign it in two weeks, Trump added: “Might be Sunday. But it’s going to be very soon.””
It’s coming soon. It’s just around the corner, maybe in a couple weeks. That’s what Trump was just telling Chris Wallace a couple weeks ago.
Senator Lindsey Graham suggests it’s going to come in the form of an executive order, and since that’s something Trump can do unilaterally it’s possible the Trump administration does have some sort of gimmick in mind. But if it’s limited to being an executive order it’s going to be at best some sort of symbolic band aid presumably related to the pandemic. And yet senior Republican aides on Capital Hill were apparently unaware of any major Trump White House planning on health care. So if Trump does have a gimmick executive order in mind it sounds like it’s going to be a typical Trump half-baked gimmick:
And yet if you listen to Trump’s language to that Chris Wallace interview he isn’t sounding like he’s just going to issue some executive order to help people during the pandemic. “We’re getting rid of it because we’re going to replace it with something much better.” That’s standard Obamacare ‘repeal and replace’ talk. Which obviously isn’t happening:
Will we see an underwhelming executive order gimmick or nothing at all? Those are the two realistic outcomes between now and the election because he clearly can’t repeal and replace Obamacare. Yes, Trump can in theory issue an executive order that might help people but he’s just not good at doing that. The GOP as a party has a real problem with that. The party’s idea of helping the public is making things harder as a form or encouragement. Or tax cuts. If tax cuts happen to help than the GOP can do that just fine. The party is clearly allergic to other forms of help and that’s not going to suddenly change just because an election is coming up.
But at least by bringing up this whole fantasy Obamacare replacement that’s never going to happen Trump did at least remind the electorate that there’s a mad man seeking fantasy solutions to health care seeking reelection. That was helpful.
We got a set of updates on Trump’s big health care reform package that he’s going to unveil before election. It’s a one-two punch of deceptive awfulness:
first, Trump made a surprise announcement on Saturday that he’s pledging to permanently cut the payroll tax that funds Social Security and Medicare. Payroll tax cuts are the the kind of cuts that are dicey under normal circumstances because it directly removes the funds that finance Social Security and Medicare. If those revenues aren’t paid back that’s only going to financially undermine these programs. And since financially undermining Social Security and Medicare and replacing privatizing these programs is a long-standing GOP goal we have to assume Trump is very serious when he pledges to permanently cut the payroll tax. Cutting the payroll tax permanently has been on the GOP agenda since the start of the safety-net.
The second major plank of Trump’s health care reform scheme was also unexpectedly hinted at during a Friday stump speech in Bedminster, New Jersey when Trump told the audience that, “Over the next two weeks, I’ll be pursuing a major executive order requiring health insurance companies to cover all preexisting conditions for all customers. That’s a big thing. I’ve always been very strongly in favor. ... This has never been done before.” Of course, as many health care policy experts and non-experts immediately pointed out, such an executive order would merely be extending pre-existing condition protections that already exist thanks to Obamacare.
So that appears to be Trumps big health care pitch for 2020: a payroll tax cut tha will undermine Social Security and Medicare and an executive order that confers pre-existing conditions protections that already exist under Obamacare. It’s the kind of reelection health care platform that’s a timely reminder that while Trump’s agenda may be based on a bed of lies they aren’t hidden lies. They’re in-your-face lies:
“In doing so, though, Trump would be embarking on a fraught process that could have catastrophic fiscal effects on programs including Social Security, which watchdogs recently have warned is in dire financial straits, expected next year to have costs that exceed its total incomes.”
Trump finally finds a tax cut that primary targets the poor. So of course it’s a tax cut that also undermines the safety-net. And if you lost your job this does nothing for you because it’s a payroll tax cut. It’s like the worst stimulus for poor Americans Trump could come up with: It doesn’t really help poor Americans and immediately harms the programs that do help:
And then there’s Trumps second health care related pledge. This one is from a campaign trail speech Trump gave in Bedminster, New Jersey, on Friday where Trump proclaimed that he’s going to issue an executive order to force insurers to cover pre-existing conditions. The problem, of course, with this executive order is that these pre-existing condition protections are already covered by Obamacare are by far the most popular part of Obamacare:
“Trump, who did not specify a date he would sign the order, said such a mandate “has never been done before.” But insurance companies are already required to cover patients with pre-existing conditions under the Affordable Care Act, commonly known as Obamacare, which Trump has consistently attempted to dismantle during his time in office.”
Pre-existing condition protections have never been done before. That’s what Trump proudly declare when he announced his planned executive order that would create the pre-existing conditions protections that already exist uder Obamacare. Obamacare that the Trump administration is actively trying to dismantle:
And that’s Trump’s health care plan for 2020: a pledge to enact a tax cut for the poor that creates a fiscal emergency for the safety-net and an executive order for pre-existing protections that already exists. So darkly ironic sabotage is his health care plan for 2020. It’s much like the 2019 plan but more dark and ironic.
Here’s a story that’s tangentially related to the ongoing story of the Trump administration’s sabotage of the US Postal System in anticipation of the wave of pandemic mail-in voting for the 2020 US election. It’s also a story very directly related to the reality that the Republican Party has long held the goal of privatizing Medicaid and Medicare: It turns out Postmaster General Louis DeJoy’s wife, Aldona Wos, has her own history of shady privatization schemes. Fairly recent history. Wos — a physician, socialite, and Republican fundraiser who was appointed ambassador to Estonia by George W. Bush’s from 2004–2006 — was made the secretary of the North Carolina Department of Health and Human Services back in 2013 by Republican Governor Pat McCrory. And, of course, Wos’s big project during her two and a half years in the post was helping the North Carolina Republicans try to privatize the state’s Medicaid program and hand it over to for-profit companies. They didn’t succeed, in part because North Carolina’s Medicaid program was already operated by a public-private non-profit corporate entity, Community Care of North Carolina, run by the state’s healthcare providers and with a track record of delivering care at below the national average costs. So the North Carolina Republicans were intent on a replacing an existing non-profit partially-privatized Medicaid provider that was already saving them money with a for-profit model. Because priorities:
“Worst, Wos didn’t know that Medicaid, which serves the very poor and accounts for $13 billion of the $18 billion budget, including about $3.7 billion in state funds, was not “broken,” as she’d thought or was told by the equally clueless McCrory. She was a long time learning that lesson and never got the hang of explaining it.”
North Carolina’s Medicaid system was broken and needed a privatization overhaul to fix it. That was the fantasy governor Pat McCrory and his fellow North Carolina Republicans were telling the public when he took office in 2013 and Aldona Wos was more than happy to play along...until it became painfully clear that they were trying to turn an existing non-profit public-private system into a for-profit public-private system and the whole scheme was built on a foundation of lies:
So as we can see, when Postmaster General Louis DeJoy went before Congress on Friday and made up-is-down pronouncements — like asserting that the Postal System that he was actively sabotaging would be perfectly capable of handling election-related mail despite all the sabotage that he refuses to reverse — he already had quite a role model right at home. Which is not to say he was otherwise lacking in available role models.
With the Supreme Court now set to be the central issue heading into the 2020 election following the death of Ruth Bader Ginsburg, one of the sadly interesting questions that we’re going to see answered over the next six weeks is whether or not the Trump administration will finally release its Obamacare replacement plan now that the Supreme Court is poised to have the kind of unstoppable 6–3 conservative majority that should make overturning Obamacare a triviality. A looming triviality that could be executed in the near future thanks to the ongoing Trump administration/state GOP lawsuit to completely cancel the law. A lawsuit that’s currently before the the Supreme Court and therefore ready to go any upcoming 6–3 conservative majorities.
But as the following article notes, while finding a conservative majority to cancel Obamacare might be a triviality with a 6–3 conservative majority, the politics of blowing up a health care law that is now quite popular is far less trivial. It’s part of John Roberts’s burden as a corporatist right-wing Chief Justice during one of the partisan and polarized periods of US history: He needs to ensure his far right corporatist agenda that the GOP’s mega-donors succeeds while at the same time avoiding the kinds of rulings that are extreme popular with the GOP voter base but would be political poison for the party if they ever came to fruition. Roe v Wade has long been the most prominent example of a legal battle the conservative movement can’t afford to actually win but as Obamacare has become more and more popular — with a solid majority supporting the law earlier this year, an all time high — these Supreme Court cases are increasingly in the category of cases that the GOP base demands and yet the party can’t afford to win despite the endless promises of doing so. It would just be too politically toxic at this point.
And as the chief crytpo-fascist corporatist on the Supreme Court it’s John Roberts’s job to navigate these tricky areas. A job that is going to get a lot harder with a 6–3 right-wing majority. For almost 50 years the GOP has promised the Religious Right that it would eventually overturn Roe v Wade but there’s also been an excuse for not doing so. Overturning Obamacare has only been on the GOP for the last decade the intensity of the GOP base’s loathing of Obamacare has arguably eclipsed the base’s loathing of Roe v Wade. And now the Supreme Court is set to have no real excuse to not reverse both. If the party can’t deliver on these longstanding core goals with a 6–3 majority there’s going to be a real risk of disillusioning that base. And for a party built on lies like the GOP disillusionment of the base is a serious risk. A risk that explodes if the Supreme Court ends up reversing Roe v Wade and Obamacare in coming years and won’t go away for decades to come. It’s the line Roberts has to walk: the right-wing majority is secure for decades to come which means there’s decades of ensuring the general public doesn’t come to recognize that the Supreme Court is run by an reactionary far right corporatist clique that was installed by the Federalist Society to carry out an elitist far right agenda.
Carrying out that far right elitist agenda without waking up the rabble isn’t going to be easy but that’s the job John Roberts accepted. A job about to get much more difficult now that the US’s decades-old frail 5–4 conservative majority becomes a virtually unstoppable 6–3 majority. Carrying out a far right agenda is easy when you have the power to do so. Carrying it out without the public noticing is a lot harder and the key rulings the GOP base is most interested in seeing are rulings that the general public can’t help but notice. Nonetheless, Obamacare is slated for a Supreme Court death panel with this GOP lawsuit, whether or not Ginsburg’s seat is filled by then. That’s the consequence of the fact that the ruling that got appealed to the Supreme Court is a ruling made by a Texas federal judge in favor of the GOP that would invalid Obamacare. Recall how the GOP lawsuit is based on the idea that individual mandate in the original law was “inseverable” from the rest of the law and so when the GOP removed the individual mandate in the 2017 GOP tax cut that meant the entire law had to be repealed. It’s a wildly stupid legal argument that was laughable from the beginning but thanks to the GOP’s wild success at stacking the federal courts with right-wing cronies the GOP was able to find a federal judge in Texas who ruled in their favor. That’s the ruling that was appealed to the Supreme Court, which means that a 4–4 tie ruling in the case of an unfilled seat would uphold a lower court ruling that undid Obamacare. Although, as the following article notes, it’s likely that there was would a new round of appeals that send the case back to the Supreme Court months or years later at which point there would likely be a full 9 judge court that avoids the possibility of a tie. And that means John Roberts alone can’t prevent the implosion of Obamacare. He can potentially postpone its implosion with a 4–4 tie but he can’t end this. Only the GOP can end it by ending the lawsuit and that’s something its incapable of allowing itself to do.
So if Roberts is going to avoid having the Supreme Court be the institution that blows up Obamacare he’s going to need another one of his fellow right-wing judges to find a way to keep the law at least somewhat intact. As the following article describes, there are suspicions that both Brett Kanvanaugh or Clarence Thomas might be might be amendable to the idea that individual mandate is “severable” from the rest of the law and keep it intact. And maybe that’s what will happen. But if it does it could end up being the first big disappointment ruling of the upcoming 6–3 right-wing majority. A big disappointment to a GOP base that’s been using the Supreme Court as the primary justification for why it should stick with the GOP despite decades disappointment.
Another possibility that keeps the law intact is a ruling that undermines something much more significant and popular like the protections for pre-existing conditions. It’s an outcome Roberts would probably like to avoid due to the political toxicity of such a ruling but it could end up being the best compromise Roberts can get from his fellow conservatives that still keeps the law intact:
“If only Roberts sides with the court’s three liberal justices to uphold Obamacare, that would leave a 4–4 tie. This would ultimately kick the case back to a conservative federal judge in Texas, Reed O’Connor, who in 2018 ruled that the entire law was invalid. O’Connor would likely reach a similar conclusion, triggering another round of appeals that could bring the case back to the Supreme Court months or even years later.”
It was already looking ominous for Obamacare before Ginsburg died but at this point a 4–4 tie that kicks it back down to the federal court that invalidated the law in the first place is one of the better feasible scenarios. It’s possible Brett Kavanaugh to side with Roberts in keeping the law intact by agreeing that the independent mandate is “severable” from the rest of the law. But it’s also entirely feasible Kavanaugh or maybe Thomas will decide some features, like pre-existing conditions protections, aren’t severable and have to go too, a ruling that would thrill the GOP base and mega-donors but would otherwise be politically toxic:
And regardless of how the conservative majority rules on this lawsuit, the fact that its before the court forces the obvious and never-answered question of what the GOP is going to replace Obamacare with if that lawsuit succeeds. The replacement plan that the Trump administration repeatedly insists either secretly exists or is in the works but never reveals. So it’s worth noting that two days before Ginsburg’s death White House press secretary Kayleigh McEnany mocked a reporter who asked about whether or not that Trump administration’s secret health care plan actually exists. McEnany was asked the question in response to Trump telling an ABC News town hall that the long-promised secret health care replacement plan that he promised last year the White House was working on (but the public wasn’t allowed see until after the election) is “all ready”. McEnany mocked the reporter by telling her if she wants to see the plan she should join the administration. So we are back to the Trump White House telling the public that an Obamacare replacement a plan exists but its a secret the public isn’t allowed to see until after the election:
“Administration officials faced questions a day after Trump said during an ABC News town hall that the vague health care plan he’s been promising will be rolled out dating back to last year is “all ready.” But three administration health officials have testified that they were not involved in crafting the plan, and McEnany would not specify who has worked on the proposal.”
The long-awaited secret Obamacare replacement plan is “all ready”. That’s the bombshell Trump dropped during a town hall. A bombshell that had the distinct feel of being another Trump lie, especially after McEnany and White House chief of staff Mark Meadows both refused to offer any details at all the next day:
And that leaves open the question: will Trump manage to get away with unveiling this mythical health care replacement plan before the election? We’ll see, but in keeping with the general theme here the real challenge facing the Trump administration isn’t the challenge of coming up with a real viable replacement. It’s the challenge of managing perceptions to minimize the fallout from blowing up Obamacare with actually having a replacement plan.
Just as with the Roberts court the primary challenge isn’t make high quality legal rulings for the benefit of the general public. The primary challenge facing Roberts is executing a far right corporatist agenda that pleases the far right base enough to keep them voting for Republicans without tipping off the rest of the general public to the fact that the court has been stacked with far right extremists who possess a truly chilling vision of how America. That need for maintaining Supreme Court appearances is the only thing protecting Obamacare at this point and it’s a primary challenge that’s about to get a lot more challenging for decades to come with the death of RBG...thanks to the wild success the GOP has had in stacking the court.
The immediate primary challenge for the American public is of course seeing through the BS and voting the GOP out of power. And if that doesn’t work, the primary challenge of living in a far right America without decent affordable health care.
Here’s an article that points towards a trend in the final two week stretch of US 2020 election cycle that just might end up impacting the rural area vote, either by causing voters to reassess which candidates they support or, in the worst case scenario, by preventing someone from voting at all by effectively incapacitating them:
The COVID-19 pandemic appears to have finally started surging in the rural Midwest, with states like Wisconsin, North Dakota, South Dakota, and Montana. Rural hospitals with limited resources and capacity are buckling under the strain as would expect. But as the following article notes, there’s another reason this pandemic could end up impacting the lives of rural residents in a way that doesn’t really affect areas with higher populations: in a lot of small towns there’s just one grocery store, one gas station, one school, and a handful of churches. So even though rural areas have the benefit of a low population density that can helps contain the spread, these places also have individual locations where almost everyone in the area frequents. And many of these locations, like gas stations or grocery stores, only have a handful of local employees available. So when the pandemic hits a rural town it can effectively shut the town down if enough of people staffing those key locations end up getting sick. In addition, when someone dies in a small rural community there’s a good chance a large portion of the local population knows them.
And as we’ve already seen with this virus, once it gets a foothold in an area it’s not going away without a fight. And since the vast majority of America’s rural communities are almost entirely in the thrall of President Trump — who has made opposition to preventing the spread of the virus a signature talking point after he himself caught the virus — there’s no realistic expectation that rural America is going to do much of anything to prevent a further outbreak. So one of the growing questions as we get closer and closer to Election Day is the question of how bad will this rural surge will get and what impact will it have on voter attitudes in these communities that, while geographically spread apart, are remarkably tight-knit and dependent on individual members of the community and therefore remarkably vulnerable to this pandemic:
““All of a sudden it hit, and as it does, it just exploded,” said Dr. Tom Dean, one of just three doctors who work in the county.”
A sudden explosion of cases. That’s how one rural doctor is describing the situation his community. A situation that rural communities across the Midwest are either currently experiencing. And if a rural community hasn’t experience this explosion yet it’s coming. The explosion may hit before the election or after but it’s coming. And when it does hit, those local resources that everyone depends on can suddenly become unavailable. Resources like gas stations and grocery stores. And hospitals:
As this pandemic has repeatedly demonstrated, a lot can happen in two weeks, which is plenty of time for a troubling rise in cases to turn into an explosion. So how many rural communities are going to experience a wave of deaths of elderly and vulnerable loved ones everyone in town knew along with the temporary closure of basic services like gas, groceries, and healthcare before Election Day and how might that impact the rural vote? We’ll find out, but at this point it’s pretty clear that whether or not a rural community experiences this surge before or after Election Day, the surge is coming.
Alarm bells went off for democracy activists of all sorts this week after the state of Georgia passed a law that imposes so many new voter rights restrictions it’s being compared to the Jim Crow era. It was a move widely seen as the opening shot in a what is expected to be nationwide concerted push by the Republican Party to take its decades-long voter-suppression agenda to a new level of intensity. When bringing water to people waiting in line is outlawed at the same time steps are taken to ensure long-lines in urban areas, that’s when you know what just transpired was an opening shot. There’s going to be A LOT more laws of this nature coming to Georgia and every other Republican-controlled state.
And that brings us to the following article about another story from last week that could be seen as a prelude of Republican power-grabs to come: The Republican-controlled Missouri legislature just blocked the state from implementing the Medicaid expansion. But that’s now why this is significant news. Republicans blocking a Medicaid expansion isn’t news. Republicans accepting a Medicaid expansion would be news. No, what makes this national news is that the Republican legislators blocked the Medicaid expansion after the votes in the state voted with a 53% to 46% majority to approve the Medicaid expansion back in August and the Republican governor even included the expansion in his proposed budget. And Missouri was just the latest in a string of Republican-led states that belated agreed to the expansion last year, leaving only 12 states that have yet to accept the expansion and the billions of dollars in federal aide that comes with it.
So how did the Republican legislature manage to block a voter-approved initiative after the Republican governor already added it to the budget? It appears to be based on some sort of legislative gimmickry, where Budget Chair Cody Smith removed from the $34 billion state budget bill the $130 million that state would have to spend on the expansion — as well as the $1.6 billion in federal funds the state would have then received by accepting the expansion — and declared that he would introduce a different bill to spend the money elsewhere. That move appears to have allowed the Republicans to effectively block the expansion.
It’s a pretty egregious power-grab, even if it’s entirely to be expected at this point. This is more or less what the Republican Party is nowadays. But the public justifications for the more are telling: on the one hand, we’re hearing complaints that the expansion would bankrupt the state. Keep in mind we’re talking about a $130 million increase in spending that comes with a $1.6 billion federal bonus. It’s almost free. But Missouri’s Republicans would rather cut over $1.7 billion in health care spending on the poor in order to save $130 million. Because they care.
On the other hand, we’re being told that the expansion wasn’t actually passed by a majority of the state’s eligible voters. Again, it was passed by a 53–46 majority, albeit with support overwhelmingly coming from Missouri’s urban centers and rural voters overwhelmingly rejecting the expansion. Republican Representative Ed Lewis said despite that 53% of those who cast ballots in favor of expansion, the number did not amount to a majority of Missouri’s eligible voters or population. Now, it’s a little tricky to parse exactly what he’s getting at here, because it’s possible he was pointing to what was presumably a relatively low voter-turnout rate in the August 4, 2020, state election where the expansion was approved. But that would be a rather odd way of interpreting democratic results. Virtually every race in the modern era would lack a majority of eligible voters. But Representative Sara Walsh was far more explicit: “Rural Missouri said no...I don’t believe it is the will of the people to bankrupt our state.” And that appears to capture the general message of the Missouri GOP. The overwhelmingly conservative rural voters oppose the expansion and their voice is the real voice of Missouri’s electorate. It’s a message consistent with the larger rural vs urban strategic divisions the GOP has been stoking for decades and cranked up to 11 during the COVID-plagued campaign of 2020. When we hear Republicans deny that a majority of eligible voters approved of the expansion, it’s basically a dog-whistle to the pandemic of Republican voter fraud claims. Implications that a number of voters who voted in favor or the expansion were either outright fraudulent (e.g. illegal immigrant voters) or somehow undeserving of being counted as a real voter (e.g. non-white urban votes). So during the same week Georgia gave us a big preview of the party’s nationwide voter suppression ambitions, Missouri’s Republicans gave us different kind of preview. With a very similar theme:
“The House Budget Committee voted along party lines not to pass a bill allowing Missouri to spend $130 million in state funds and $1.6 billion in federal money to pay for the program’s expansion. Under the Affordable Care Act, the federal government picks up 90% of the tab on expanding Medicaid.”
It’s like someone offering you $100 in value for $10 and you turn it down in order to save that $10. That’s what Missouri’s GOP just did, over the objection of a majority of the state’s voters. What was the excuse? Well, that 53% of the voters somehow did not amount to a majority of Missouri’s eligible voters or population. The rural voters are apparently the only one’s that count (except for the 1/3 of rural voters who actually voted for the expansion):
And then there’s the cost argument. The cost argument that it’s worth turning down $1.6 billion from the federal government in order to save $130 million, which is a cost argument that clearly isn’t factoring in the actual human cost of going without health care. Although, in fairness, the human cost of going without health care is probably being factored into the Missouri GOP’s analysis when they arrive at these conclusions, but just with an extremely low priority. Like the lowest priority:
And, again, this move to ignore the majority will of the Missouri voters by the Missouri GOP was happening basically in parallel with the Georgia GOP’s move to cement permanent minority rule in the state. So while the Georgia GOP’s actions were clearly creating a template that we should expect to show up in Republican-controlled states, the question should also be asked if Missouri’s GOP showed us the other part of the GOP’s new voter suppression agenda: an agenda of preposterous, be apparently legally tenable, legislative excuses to just ignore voter-backed initiatives. After all, if the GOP is truly going to become a permanent-minority-rule party, it has to be thinking about complications like voter-backed initiatives. What’s to stop a wave of voter-backed initiatives from eventually undermining the rigged system the GOP is putting in place to secure that permanent-minority-rule? Well, as we saw in Missouri, poor reasoning and bad faith arguments are what’s to stop a wave of voter-backed initiatives from eventually undermining the rigged system the GOP is putting in place to secure that permanent-minority-rule. At least it worked in Missouri.
And as the following piece from back in August of 2020 reminds us, much of the Trump phenomena itself represents a real split between the GOP’s voters and the party’s billionaire benefactors. In other words, much of MAGA-land genuinely hates Koch-land. And the power of big business in general. Sure, there are plenty of corporatist sycophants in the Republican electorate. But the real power brokers in the party, the mega-donor dark money class, aren’t actually that popular with anyone. It’s lonely at the oppressive exploitative top. And that means the rise of the Trump phenomena doesn’t just represent a historic opportunity for a rebranding of the GOP as some sort of populist party, laughably as it sounds. It presents the risk that the rabble, Trumpian and non-Trumpian alike, might get enough combined political influence to channel their shared dislike of the billionaire class running their lives into the ground. So when we ask what kind of template Missouri’s GOP may have created for the rest of the states, it’s worth keeping in mind that the GOP mega-donors are probably planning on using this template against MAGA-land too:
“In the context of relatively free and fair elections, the only question is what will give first. The commitment of elite Republicans to priorities their rank-and-file reject? Or the commitment of rank-and-file Republicans to politicians who continue to ignore their needs?”
What will give first? The commitment of elite Republicans to priorities their rank-and-file reject? Or the commitment of rank-and-file Republicans to politicians who continue to ignore their needs? That was the question raised when Missouri’s voters approved the Medicaid expansion back in August. Sure, a majority of Republican voters may not have voted for it, but a sizable enough minority did to put the initiative over the top in a state generally dominated by Republicans. A significant ideological conflict erupted inside the Missouri GOP between wishes of the GOP electorate and mega-donor elites when that initiative passed. And the Republican legislator just gave us our answer on who wins that conflict. The mega-donors win. They win so convincingly that the GOP is just outright ignoring a publicly-backed initiative, with all of the political repercussions that might entail. Even Missouri’s Republican governor was planning on going ahead with the expansion. But this was not going to be allowed to happen, voter-will or not. What are the implications of this? Because there are a lot of issues beyond Medicaid where you could easily find a majority coalition of Democrats and at least some Republicans supporting a common populist cause. Like the kind of anti-Big Business sentiments that animates a lot of Trump’s base. You can’t have permanent-minority rule while a large chunk of that minority-voting based wants to join with the majority on voter initiatives. Something has to give:
What’s going to give? Whatever remains of the GOP’s mask of civility and respect for democratic norms. As usual. Whether or not just ignoring voter-backed initiatives is going to become ‘the usual’ for the GOP remains to be seen. It’s going to require a lot more instances of sizable numbers of Republican voters joining with other voters in support of a common cause for the greater good. So in a weird we way should probably hope this becomes ‘thus usual’ for the GOP. At least there would be some source of hope. There are far worse ways the Republican Party’s internal lack of integrity could manifest.
We finally got the final word on the GOP’s absurdist Obamacare lawsuit. That would be the lawsuit started by Texas Republican attorney general Ken Paxton, and later joined by the Republican attorneys general for 20 other states, arguing that Obamacare became an unconstitutional law after the GOP eliminated the personal mandate fine that would be imposed on adults who don’t get healthcare coverage. The reasoning being that when the law was first passed the Democrats argued that the personal mandate was a fundamental requirement for the law to function. The issue of “severability” suddenly became central to the fate of the law. Could Obamacare be severed from the personal mandate and still remain constitutional?
It was exactly the kind of bad-faith legal ‘gotcha’ argument we’ve come to expect from the contemporary GOP. The big question was what we should expect from the Supreme Court. A court that, under the leadership of Chief Justice John Roberts, has demonstrated a consistent willingness to strategically side with corporate interest without succumbing to the most blatantly outlandish far right whims that would risk overly discrediting the court the eye of the public. In other words, we’ve seen a Supreme Court conservative majority that’s willing to shill for the right-wing billionaire oligarchs who installed these justices, but to shill responsibly while avoiding the kind of hyper-aggravating rulings that would enrage an overwhelming majority of the public. A conservative majority engaged in a good-faith attempt to responsibly implement a bad-faith agenda of shilling for far right interests.
It’s the kind of situation where we should expect some, but not all, of the ill-intended GOP lawsuits to succeed. The far right may have a Supreme Court majority, but it still needs to be judicious in which cases its going to go into shill-mode when ruling. And that was the situation before Amy Coney Barrett was placed on the court, giving the far right a 6–3 super-majority. It’s why Barrett’s ascension raised so many questions about the fate of Obamacare, with that bad-faith absurdist GOP lawsuit still scheduled for a Supreme Court ruling during Barrett’s nomination process. Barrett did hail from a religious cult that was arguably the inspiration for a A Handmaiden’s Tale, after all. There were reasonable reasons for concern about what a 6–3 far right super-majority might be willing do to.
At the same time, we can’t ignore the reality that the lawsuit was so legally preposterous that it still didn’t look like the lawsuit had a real chance even when it was clear Barrett was going to be joining the court. Beyond that, there’s also the reality that while Obamacare remains deeply unpopular with the Republican base, the actual provisions that make up Obamacare are wildly popular even with Republicans. It’s something the court’s conservative majority simply can’t ignore. Navigating the often contradictory fears and desires of the profoundly confused Republican electorate is part of the Supreme Court conservative majority’s bad-faithed responsibility. And that’s why it was hardly a surprise when the Supreme Court just issued its 7–2 ruling rejecting the lawsuit and upholding Obamacare. The lawsuit was simply too bad-faithed for the conservative majority’s bad-faithed agenda, leaving the conservative majority no real choice than to do what it has done before and protect the GOP from the consequences of its growing insanity:
“I never believed the most recent lawsuit stood much of a chance. The court’s conservatives, after some wavering, decided the first lawsuit intended to destroy Obamacare was too silly to risk their reputational capital on. The second, even sillier lawsuit lost by a wider margin. It stood to reason that the third lawsuit, the silliest one yet, would probably lose, even though conservatives had gained an additional seat.”
Yes, if the Supreme Court upheld Obamacare in the face of two earlier, somewhat less-absurd lawsuits, we shouldn’t have been surprised when they did it again, even after Amy Coney Barrett created a 6–3 far right majority. To assume otherwise is to misunderstand the nature of this kind of corruption. The conservative majority isn’t there to rubber-stamp every idiotic right-wing lawsuit that comes its way. It’s there to implement a far right corporatist agenda, something that necessitates choosing which far right battles are to be won at a given moment. You can’t overturn a democracy overnight:
And that’s all why the real lesson learned from this latest ruling isn’t that Obamacare is safe. The real lesson is that the vast majority of GOP attorneys general were willing to back a lawsuit so legally specious that it couldn’t even win with a 6–3 far right majority. But we already basically knew that.