House­keep­ing note: Com­ments 1–50 avail­able here

Here’s some good new for Okla­homa res­i­dents: Okla­homa is final­ly accept­ing the fed­er­al Med­ic­aid expan­sion funds in order to cov­er a gap­ing bud­get deficit that threat­ens to shut down the state’s health­care sys­tem. It’s also good news for ardent oppo­nents of Oba­macare who are will­ing to jump through what­ev­er men­tal hoops are nec­es­sary to tell them­selves that they aren’t actu­al­ly engaged in a Med­ic­aid expan­sion because that would some­how be giv­ing in to the Big Bad Oba­ma. Every­one’s a win­ner:

Bloomberg Pol­i­tics

Okla­homa Eyes Oba­macare Funds, But With­out Med­ic­aid Expan­sion
Crash­ing oil rev­enue has the state rethink­ing fed­er­al health-care aid.

John Tozzi

April 7, 2016 — 4:00 AM CDT
Updat­ed on April 7, 2016 — 6:02 AM CDT

Dwight Sub­lett has seen a lot of busts in his 33 years as a pedi­a­tri­cian in Still­wa­ter, Okla­homa, but this year ranks among the worst. With oil hov­er­ing at $35 a bar­rel, the state is fac­ing a $1.3 bil­lion bud­get short­fall for the fis­cal year start­ing on July 1. On March 29 the Okla­homa Health Care Author­i­ty warned it would have to cut 25 per­cent from reim­burse­ments to physi­cians, hos­pi­tals, and oth­er med­ical providers under the state’s Med­ic­aid pro­gram, Soon­er­Care. The pro­gram cov­ers a mil­lion poor Okla­homans each year, more than a quar­ter of the state’s pop­u­la­tion. “For the rur­al physi­cians, this is going to be a dev­as­tat­ing blow,” Sub­lett says.

Across the coun­try, Med­ic­aid cov­ers 71 mil­lion low-income Amer­i­cans. Med­ic­aid is joint­ly fund­ed by the fed­er­al gov­ern­ment and states, and it typ­i­cal­ly accounts for 20 per­cent to 35 per­cent of a state’s annu­al bud­get. The crash in oil prices has made it hard­er for ener­gy-depen­dent states to come up with their share. “These states that have had fair­ly sta­ble budgets—Oklahoma would be the clas­sic example—suddenly they’re run­ning real­ly big deficits,” says Gre­go­ry Hagood, senior man­ag­ing direc­tor of Solic Cap­i­tal, an invest­ment and advi­so­ry firm that works with hos­pi­tals in finan­cial dis­tress.

Okla­homa has declined to expand Med­ic­aid, leav­ing unin­sured an esti­mat­ed 91,000 peo­ple who might have qual­i­fied for fed­er­al­ly sub­si­dized cov­er­age under the 2010 Afford­able Care Act. “You men­tion ‘Med­ic­aid expan­sion,’ that’s dirty words in this state” because of the link to Oba­macare, Sub­lett says. About 16 per­cent of Okla­homans had no health insur­ance in 2014, com­pared with 10 per­cent of the nation­al pop­u­la­tion, accord­ing to the Kaiser Fam­i­ly Foun­da­tion.

Years of tax cuts in Okla­homa have con­tributed to the bud­get hole. The top state income tax rate declined from 6.65 per­cent in 2004 to 5 per­cent this year, elim­i­nat­ing $1 bil­lion in annu­al rev­enue, accord­ing to the non­prof­it Okla­homa Pol­i­cy Insti­tute. Tax rev­enue will come in about 7 per­cent below the lev­el expect­ed for the bud­get year end­ing on June 30, says Nico Gomez, chief exec­u­tive offi­cer of the Okla­homa Health Care Author­i­ty, which over­sees Med­ic­aid. He’s prepar­ing for a 15 per­cent cut in state fund­ing next year, though the pre­cise amount is uncer­tain. For every 40¢ the state cuts from Med­ic­aid, Okla­homa los­es 60¢ in fed­er­al match­ing funds.

...

Gomez has pro­posed what he calls a long-term solu­tion. Under his plan, about 350,000 Okla­homans who are on Med­ic­aid or unin­sured would get sub­si­dized insur­ance through a state pro­gram, Insure Okla­homa, that pre­dates the Afford­able Care Act and is most­ly fund­ed by tobac­co tax­es. The change would require approval from admin­is­tra­tors in Wash­ing­ton to free up an infu­sion of fed­er­al Med­ic­aid funds.

The pro­pos­al is broad­ly sim­i­lar to back­door arrange­ments sev­er­al Repub­li­can-led states, includ­ing Arkansas and Indi­ana, have used to get fed­er­al funds for expand­ing health cov­er­age with pri­vate insur­ance rather than Med­ic­aid. Gomez is quick to note that his pro­pos­al would shrink the Med­ic­aid rolls in his state. “We’re not actu­al­ly grow­ing the enti­tle­ment,” he says.

Health-care providers in Okla­homa would wel­come the move, what­ev­er it’s called. “We don’t seem to have a prob­lem in this state in accept­ing fed­er­al dol­lars for roads or oth­er pur­pos­es,” says Craig Jones, pres­i­dent of the Okla­homa Hos­pi­tal Asso­ci­a­tion, which has pushed the state to take advan­tage of fed­er­al mon­ey avail­able under the Afford­able Care Act. “It’s only because it’s tied to Oba­macare that peo­ple have had a real con­cern about it.”

“The pro­pos­al is broad­ly sim­i­lar to back­door arrange­ments sev­er­al Repub­li­can-led states, includ­ing Arkansas and Indi­ana, have used to get fed­er­al funds for expand­ing health cov­er­age with pri­vate insur­ance rather than Med­ic­aid. Gomez is quick to note that his pro­pos­al would shrink the Med­ic­aid rolls in his state. “We’re not actu­al­ly grow­ing the enti­tle­ment,” he says.”
Sure, sure, no expand­ed enti­tle­ment pro­gram at all. Just say what­ev­er is nec­es­sary in order to pro­vide the polit­i­cal cov­er required to imple­ment a big new expan­sion of health insur­ance cov­er­age so Okla­homa can get its hands on those bil­lions in fed­er­al Med­ic­aid expan­sion funds and pre­vent an implo­sion of its med­ical sys­tem:

Asso­ci­at­ed Press

In sur­pris­ing turn­about, Okla­homa eyes Med­ic­aid expan­sion

By SEAN MURPHY
May. 16, 2016 8:43 AM EDT

OKLAHOMA CITY (AP) — Despite bit­ter resis­tance in Okla­homa for years to Pres­i­dent Barack Oba­ma’s health care over­haul, Repub­li­can lead­ers in this con­ser­v­a­tive state are now con­fronting some­thing that alarms them even more: a huge $1.3 bil­lion hole in the bud­get that threat­ens to do wide­spread dam­age to the state’s health care sys­tem.

So, in what would be the grand­est about-face among right­ward lean­ing states, Okla­homa is now mov­ing toward a plan to expand its Med­ic­aid pro­gram to bring in bil­lions of fed­er­al dol­lars from Oba­ma’s new health care sys­tem.

What’s more, GOP lead­ers are con­sid­er­ing a tax hike to cov­er the state’s share of the costs.

“We’re to the point where the provider rates are going to be cut so much that providers won’t be able to sur­vive, par­tic­u­lar­ly the nurs­ing homes,” said Repub­li­can state Rep. Doug Cox, refer­ring to pos­si­ble cuts in state funds for indi­gent care that could cause some hos­pi­tals and nurs­ing homes to close.

Despite furi­ous oppo­si­tion by con­ser­v­a­tive groups, Repub­li­can Gov. Mary Fallin and some GOP leg­isla­tive lead­ers are push­ing the plan, and sup­port appears to be grow­ing in the over­whelm­ing­ly Repub­li­can Leg­is­la­ture. Details have not been ironed out but the pro­pos­al is based on an Indi­ana pro­gram that received fed­er­al approval.

...

A bust in the oil patch has dec­i­mat­ed state rev­enues, com­pound­ed by years of income tax cuts and grow­ing cor­po­rate sub­si­dies intend­ed to make the state more busi­ness-friend­ly.

Okla­homa’s Med­ic­aid agency has warned doc­tors and oth­er health care providers of cuts of up to 25 per­cent in what the state pays under Med­ic­aid.

“We are near­ing a colos­sal col­lapse of our health care sys­tem in Okla­homa,” warned Craig Jones, the pres­i­dent of the Okla­homa Hos­pi­tal Asso­ci­a­tion, which rep­re­sents more than 135 hos­pi­tals and health care sys­tems in the state. “We have doc­tors turn­ing away patients. We have peo­ple with men­tal ill­ness­es who are going with­out treat­ment. Hos­pi­tals are clos­ing, and this is only going to get worse this sum­mer if the Leg­is­la­ture does not act imme­di­ate­ly to turn this around.”

In the pover­ty-wracked south­east­ern cor­ner of the state, where 96 per­cent of babies in the McCur­tain Memo­r­i­al Hos­pi­tal are born to Med­ic­aid patients, most health care would end, said hos­pi­tal CEO Jah­ni Tap­ley.

“A 25 per­cent cut to Med­ic­aid would not put my hos­pi­tal in jeop­ardy, because we are already in jeop­ardy,” Tap­ley said. “A 25 per­cent cut would shut­ter our doors for good, leav­ing 33,000 peo­ple with­out access to health care.”

Nurs­ing homes have been warn­ing res­i­dents that they may be clos­ing. Asked where she would go if the Bea­dles Nurs­ing Home in the small town of Alva clos­es, Jeanie Yohn, 89, said: “I just can’t imag­ine. I have three daugh­ters, but they don’t live here.”

Under the pro­pos­al, which would be fund­ed in part with a $1.50-per-pack tax on cig­a­rettes, Okla­homa would shift 175,000 peo­ple from its Med­ic­aid rolls onto the fed­er­al health exchange cre­at­ed by the Afford­able Care Act. That would make room for adding to Med­ic­aid rough­ly the same num­ber of work­ing poor who are cur­rent­ly unin­sured. Par­tic­i­pants would pay nom­i­nal pre­mi­ums and co-pays.

The move, by increas­ing the num­ber of unin­sured peo­ple cov­ered, would allow the state to tap into the extra mon­ey offered under the fed­er­al law. Begin­ning in 2017, the fed­er­al gov­ern­ment would cov­er 95 per­cent of the state’s Med­ic­aid costs, decreas­ing to 90 per­cent of the share in 2020.

No mat­ter what state lead­ers call it, con­ser­v­a­tive groups aren’t hap­py about the idea of more gov­ern­ment health spend­ing.

“They can call it Med­ic­aid rebal­anc­ing, but there’s only one fed­er­al pro­gram that offers a 9‑to‑1 fed­er­al match, and that’s Oba­macare,” said Johnathan Small, pres­i­dent of Okla­homa Coun­cil on Pub­lic Affairs, a free-mar­ket think-tank that oppos­es high­er tax­es. The oppo­nents have called for cov­er­ing health costs by cut­ting spend­ing for less essen­tial pro­grams.

Amer­i­cans for Pros­per­i­ty, anoth­er con­ser­v­a­tive think-tank backed by the bil­lion­aire phil­an­thropist Koch broth­ers, David and Charles, also has launched a cam­paign against the pro­pos­al and is host­ing a “Noba­maCare” event at the state Capi­tol to voice their oppo­si­tion.

“Fallin, a for­mer con­gress­woman who vot­ed against Oba­ma’s health plan when it came before the House, argues that the plan does­n’t amount to expand­ing Med­ic­aid because the pro­gram’s rolls don’t grow. Rather, she said, it “tran­si­tions 175,000 Med­ic­aid enrollees to the pri­vate insur­ance mar­ket.””
Uh huh. This isn’t like Oba­macare at all. It’s “Med­ic­aid rebal­anc­ing”:

...
“They can call it Med­ic­aid rebal­anc­ing, but there’s only one fed­er­al pro­gram that offers a 9‑to‑1 fed­er­al match, and that’s Oba­macare,” said Johnathan Small, pres­i­dent of Okla­homa Coun­cil on Pub­lic Affairs, a free-mar­ket think-tank that oppos­es high­er tax­es. The oppo­nents have called for cov­er­ing health costs by cut­ting spend­ing for less essen­tial pro­grams.
...

Just remem­ber: It’s a “Med­ic­aid rebal­anc­ing” scheme that just hap­pens to involve accept­ing the fed­er­al gov­ern­men­t’s 9‑to‑1 match­ing funds that states like Okla­homa have been reject­ing all along. Make sure no one uses the term “Med­ic­aid expan­sion,” because Okla­homa’s law­mak­ers might become ashamed enough of their Oba­macare accep­tance that they go back to shame­less­ly let­ting their con­stituents die. And that would be a shame. And sort of manslaugh­ter.

When you think about the arch of the Oba­macare roll out, from the 110 per­cent oppo­si­tion from the GOP to the Supreme Court’s 2012 rul­ing that made Med­ic­aid expan­sion option­al and a polit­i­cal foot­ball, it’s easy to for­get what the fol­low­ing arti­cle from the sum­mer of 2012 reminds us, which is that not only did most Amer­i­cans sup­port the bulk of Oba­macare back then.

A major­i­ty of Repub­li­cans sup­port­ed it. They just did­n’t like it when it was called “Oba­macare”. Which parts weren’t like by a major­i­ty of GOP vot­ers accord­ing to the poll below? The long hat­ed “indi­vid­ual man­date” (although Trump only start­ed hat­ing it in Feb­ru­ary). Anoth­er aspect of Oba­macare that was­n’t backed by a major­i­ty of GOP vot­ers in 2012 was, per­haps not sur­pris­ing­ly but still some­what sur­pris­ing­ly, the Med­ic­aid expan­sion:

The Wash­ing­ton Post

Repub­li­cans sup­port Obama’s health reforms — as long as his name isn’t on them

By Greg Sar­gent June 25, 2012

The new Reuters-Ipsos poll finds that Oba­macare remains deeply unpop­u­lar; 56 per­cent of Amer­i­cans oppose the law, ver­sus only 44 per­cent who favor it. The poll also finds that strong majori­ties of Amer­i­cans favor the indi­vid­ual pro­vi­sions in the law – the hat­ed indi­vid­ual man­date except­ed, of course.

What’s par­tic­u­lar­ly inter­est­ing about this poll is that sol­id majori­ties of Repub­li­cans favor most of the law’s main pro­vi­sions, too..

...

* Eighty per­cent of Repub­li­cans favor “cre­at­ing an insur­ance pool where small busi­ness­es and unin­sured have access to insur­ance exchanges to take advan­tage of large group pric­ing ben­e­fits.” That’s backed by 75 per­cent of inde­pen­dents.

* Fifty-sev­en per­cent of Repub­li­cans sup­port “pro­vid­ing sub­si­dies on a slid­ing scale to aid indi­vid­u­als and fam­i­lies who can­not afford health insur­ance.” That’s backed by 67 per­cent of inde­pen­dents.

* Fifty-four per­cent of Repub­li­cans favor “requir­ing com­pa­nies with more than 50 employ­ees to pro­vide insur­ance for their employ­ers.” That’s backed by 75 per­cent of inde­pen­dents.

* Fifty two per­cent of Repub­li­cans favor “allow­ing chil­dren to stay on par­ents insur­ance until age 26.” That’s backed by 69 per­cent of inde­pen­dents.

* Sev­en­ty eight per­cent of Repub­li­cans sup­port “ban­ning insur­ance com­pa­nies from deny­ing cov­er­age for pre-exist­ing con­di­tions; 86 per­cent of Repub­li­cans favor “ban­ning insur­ance com­pa­nies from can­celling poli­cies because a per­son becomes ill.” Those are backed by 82 per­cent of inde­pen­dents and 87 per­cent of inde­pen­dents.

* One pro­vi­sion that isn’t backed by a major­i­ty of Repub­li­cans: The one “expand­ing Med­ic­aid to fam­i­lies with incomes less than $30,000 per year.”

“Most Repub­li­cans want to have good health cov­er­age,” Ipsos research direc­tor Chris Jack­son tells me. “They just don’t nec­es­sar­i­ly like what it is Oba­ma is doing.”

I’d add that Repub­li­cans and inde­pen­dents favor reg­u­la­tion of the health insur­ance sys­tem in big num­bers. But the law has become so defined by the indi­vid­ual man­date — not to men­tion Oba­ma him­self — that pub­lic sen­ti­ment on the reforms them­selves has been entire­ly drowned out. It’s anoth­er sign of the con­ser­v­a­tive mes­sag­ing tri­umph in this fight and the fail­ure of Dems to make the case for the law. And it sug­gests that if the law is struck down, Dems might be able to sal­vage at least some­thing from the wreck­age by refo­cus­ing the debate on the idi­vid­ual reforms they’ve been cham­pi­oning — and what Repub­li­cans would replace them with, if any­thing.

“I’d add that Repub­li­cans and inde­pen­dents favor reg­u­la­tion of the health insur­ance sys­tem in big num­bers. But the law has become so defined by the indi­vid­ual man­date — not to men­tion Oba­ma him­self — that pub­lic sen­ti­ment on the reforms them­selves has been entire­ly drowned out. It’s anoth­er sign of the con­ser­v­a­tive mes­sag­ing tri­umph in this fight and the fail­ure of Dems to make the case for the law. And it sug­gests that if the law is struck down, Dems might be able to sal­vage at least some­thing from the wreck­age by refo­cus­ing the debate on the indi­vid­ual reforms they’ve been cham­pi­oning — and what Repub­li­cans would replace them with, if any­thing.”
Yes, when a major­i­ty of Amer­i­cans oppose a big new reform pack­age that can dra­mat­i­cal­ly dra­mat­i­cal­ly help mil­lions, and that oppo­si­tion is large­ly due to for lies, hype, and an appar­ent mass lack of aware­ness of how the reforms actu­al­ly worked, it’s a safe bet that there’s been anoth­er con­ser­v­a­tive mes­sag­ing tri­umph.
But when it’s a life and death issue like health­care access, it might not be a per­ma­nent mes­sag­ing tri­umph. At least when it comes to the Med­ic­aid expan­sion. At least in Texas:

The Hous­ton Chron­i­cle

Study: Tex­ans favor Med­ic­aid expan­sion
Major­i­ty in sur­vey favor expan­sion of Med­ic­aid

By Jen­ny Deam
May 18, 2016 Updat­ed: May 18, 2016 9:01pm

More than 60 per­cent of Tex­ans sup­port an expan­sion of Med­ic­aid here and plan to take those views into the vot­ing booth in Novem­ber, a new sur­vey com­mis­sioned by the Texas Med­ical Cen­ter Health Pol­i­cy Insti­tute finds.

The sur­vey results, unveiled Wednes­day at the annu­al Med­ical World Amer­i­c­as con­ven­tion in Hous­ton, show the pub­lic at odds with the state’s Repub­li­can lead­er­ship, which has stead­fast­ly refused to con­sid­er such an expan­sion, call­ing it waste­ful and a bad solu­tion.

“I under­stand peo­ple in Austin have been reluc­tant, but I believe what this sur­vey demon­strates is that peo­ple want some­thing done to improve access,” said Dr. Arthur “Tim” Gar­son, direc­tor of the Health Pol­i­cy Insti­tute. “Peo­ple are look­ing for help and their choice seems to be Med­ic­aid expan­sion. A unique­ly Texas solu­tion would be best, but we have to do some­thing.”

The find­ings fur­ther res­onate in a state that con­tin­ues to lead the nation in the num­ber of unin­sured. Texas remains one of 19 states that has cho­sen not to expand Med­ic­aid under the Afford­able Care Act.

The sec­ond annu­al Med­ical Cen­ter study gaug­ing pub­lic opin­ion on health care issues cov­ered top­ics rang­ing from access to health care to the wis­dom of rais­ing the price of foods that con­tribute to obe­si­ty.

Of the 1,000 peo­ple polled by Nielsen in five states, close to 100 per­cent said they feel it is deeply impor­tant to have insur­ance for them­selves and their fam­i­ly. In Texas, 96 per­cent val­ue health insur­ance.

The study’s mar­gin of error is 3 per­cent­age points over­all and close to 5 per­cent­age points in Texas.

Beyond self-inter­est, 91 per­cent of respon­dents in Texas, Cal­i­for­nia, New York, Ohio and Flori­da said it was impor­tant to them that every­one in the nation have health insur­ance.

The stick­ing point has always been how to get there.

In Texas, 63 per­cent of those polled said they sup­port an expand­ed Med­ic­aid pro­gram. Sim­i­lar­ly, 68 per­cent in Flori­da also favored a Med­ic­aid expan­sion. These num­bers are sig­nif­i­cant because of the states sur­veyed, only Flori­da and Texas did not expand the safe­ty-net pro­gram, which is joint­ly paid for with fed­er­al and state dol­lars.

...

Seek­ing more flex­i­bil­i­ty

On Wednes­day night, the head of the con­ser­v­a­tive Texas Pub­lic Pol­i­cy Foun­da­tion said she remains unmoved.

“Though we haven’t yet seen the study, no study will change the fact that Med­ic­aid is a pro­gram that pro­vides a very low qual­i­ty of care at a very high cost to tax­pay­ers,” exec­u­tive direc­tor Arlene Wohlge­muth said in a state­ment.

“The fed­er­al require­ments that come with Med­ic­aid expan­sion make it the wrong way to address the unique health care needs of Tex­ans. Instead, states must be giv­en the flex­i­bil­i­ty to cre­ate a pro­gram that bet­ter serves Tex­ans in need, and one that works with com­mu­ni­ties to design pro­grams that work for them and for tax­pay­ers.”

Health care costs and access also are part of the nation­al polit­i­cal debate. On the Repub­li­can side, pre­sump­tive nom­i­nee Don­ald Trump is echo­ing calls to dis­man­tle the Afford­able Care Act alto­geth­er, although he pre­vi­ous­ly said he favored the man­date that required every­one to car­ry health cov­er­age.

Among Democ­rats, front-run­ner Hillary Clin­ton has said she would con­tin­ue the fed­er­al health care law and expand it. Her rival Sen. Bernie Sanders has pro­posed uni­ver­sal health care, say­ing cov­er­age is a right not a priv­i­lege.

In the five states sur­veyed for the Health Pol­i­cy Insti­tute, respon­dents were emphat­ic that a polit­i­cal can­di­date’s stance on health issues will influ­ence how they vote, a sen­ti­ment shared by 82 per­cent of Tex­ans.

...

Despite wide­ly dif­fer­ing demo­graph­ics, both red and blue polit­i­cal­ly, and with and with­out Med­ic­aid expan­sion, opin­ions in the sur­veyed states remained most­ly con­sis­tent.

“What I found inter­est­ing was not how dif­fer­ent peo­ple were but how much they were the same,” Gar­son said.

“In Texas, 63 per­cent of those polled said they sup­port an expand­ed Med­ic­aid pro­gram. Sim­i­lar­ly, 68 per­cent in Flori­da also favored a Med­ic­aid expan­sion. These num­bers are sig­nif­i­cant because of the states sur­veyed, only Flori­da and Texas did not expand the safe­ty-net pro­gram, which is joint­ly paid for with fed­er­al and state dol­lars.”
Well, it would appear that a major­i­ty of the elec­torate, includ­ing the red state elec­torates that vote in state gov­ern­ments that oppose the Oba­macare Med­ic­aid expan­sion, wants the full Oba­macare pro­gram in place includ­ing the Med­ic­aid expan­sion. Except maybe no the indi­vid­ual man­date. But if there is still strong oppo­si­tion to the indi­vid­ual man­date, poll results like:

...
Beyond self-inter­est, 91 per­cent of respon­dents in Texas, Cal­i­for­nia, New York, Ohio and Flori­da said it was impor­tant to them that every­one in the nation have health insur­ance.
...

make it hard to see where exact­ly the oppo­si­tion is com­ing from.

So it appears that vot­ers in Texas and else­where with­out Oba­macare are increas­ing­ly less swayed by the argu­ment that they should be turn­ing away bil­lions of dol­lars in free fed­er­al health­care mon­ey that most oth­er states are tak­ing in order to keep the fed­er­al debt down a lit­tle bit. Sure, turn­ing down those bil­lions of dol­lars in fed­er­al health­care dol­lars is a great way to for politi­cians to show they’re will­ing to walk the talk. But it also involves gen­er­al­ly finan­cial­ly under­min­ing the state. And let­ting peo­ple die. Which is why it’s not par­tic­u­lar­ly sur­pris­ing a strong major­i­ty of Tex­ans want their Med­ic­aid expand­ed.

That’s also why it’s not par­tic­u­lar­ly sur­pris­ing that Geor­gia’s GOP is look­ing into no longer allow­ing so many Geor­gians to need­less­ly die for a polit­i­cal pos­ture. Look­ing into it grudg­ing­ly:

Mod­ern Health­care

Geor­gia eyes Med­ic­aid expan­sion

By Vir­gil Dick­son | May 18, 2016

In an effort to bet­ter pro­vide health­care to Geor­gia’s explod­ing pop­u­la­tion and as a way to bal­ance the state’s bud­get, con­ser­v­a­tive law­mak­ers are renew­ing tem­po­rary Med­ic­aid pay­ment increas­es and look­ing at expand­ing the pro­gram, accord­ing to a Repub­li­can state Sen­ate leader.

Sen. Renee Unter­man, chair­woman of the Sen­ate’s Health and Human Ser­vices Com­mit­tee, said that while she’s been crit­i­cal of Med­ic­aid expan­sion, she’s see­ing hos­pi­tals close and peo­ple wait­ing to see providers.

Unter­man said there is enough sup­port in the Sen­ate for a con­ser­v­a­tive expan­sion mod­el, sim­i­lar to the one in place in Arkansas. Under that state’s mod­el, res­i­dents with incomes between 100% and 138% pay up to 2% of their income in month­ly pre­mi­ums.

The Geor­gia Cham­ber of Com­merce is expect­ed to present some expan­sion ideas to the Gen­er­al Assem­bly when it recon­venes in Jan­u­ary 2017, she said.

State Rep. Sharon Coop­er, the Repub­li­can chair­woman of the House­’s Health and Human Ser­vices Com­mit­tee, said she and her col­leagues will enter­tain the pro­pos­als, but added that she does­n’t believe it will solve the access prob­lem.

“The prob­lem with expan­sion is, who is going to treat these peo­ple,” Coop­er said. “We don’t have the physi­cians, nurse prac­ti­tion­ers or physi­cian assis­tants to care for them in rur­al areas of the state.”

Access to care is scarce in rur­al parts of Geor­gia, where five hos­pi­tals have closed since 2012, accord­ing to state data.

Unter­man and oth­er law­mak­ers say that access to care issues are only increas­ing as the state’s pop­u­la­tion explodes. A healthy job mar­ket has drawn more than a 20% pop­u­la­tion spike between 2000 and 2015. There are cur­rent­ly 10.2 mil­lion res­i­dents in the state, accord­ing to cen­sus data.

And as many as 400,000 peo­ple would be eli­gi­ble for Med­ic­aid expan­sion. An expan­sion could have drawn $33 bil­lion in fed­er­al fund­ing between 2013 to 2022, with near­ly $13 bil­lion of that going to hos­pi­tals, accord­ing to a 2014 Urban Insti­tute report. The fund­ing could have aid­ed the 66% of rur­al hos­pi­tals that in 2014 end­ed the year with neg­a­tive mar­gins. In all, 41% of Geor­gia’s hos­pi­tals end­ed 2014 with neg­a­tive mar­gins, accord­ing to the Geor­gia Hos­pi­tal Asso­ci­a­tion.

Okla­homa, like­wise, is now look­ing at an expan­sion to help cov­er a $1.3 bil­lion bud­get hole that’s dev­as­tat­ed the state’s providers.

...

“And as many as 400,000 peo­ple would be eli­gi­ble for Med­ic­aid expan­sion. An expan­sion could have drawn $33 bil­lion in fed­er­al fund­ing between 2013 to 2022, with near­ly $13 bil­lion of that going to hos­pi­tals, accord­ing to a 2014 Urban Insti­tute report. The fund­ing could have aid­ed the 66% of rur­al hos­pi­tals that in 2014 end­ed the year with neg­a­tive mar­gins. In all, 41% of Geor­gia’s hos­pi­tals end­ed 2014 with neg­a­tive mar­gins, accord­ing to the Geor­gia Hos­pi­tal Asso­ci­a­tion.”
Ouch. Well, that Med­ic­aid oppo­si­tion was some utter­ly point­less polit­i­cal pos­tur­ing that inflict­ing $33 bil­lion in dam­age to the state’s health­care sys­tem and peo­ple. Drop­ping oppo­si­tion to that expan­sion sure sounds like the kind of reform the US health­care sys­tem could use right now. We got Zika and stuff to wor­ry about. It’s not the best time to keep col­laps­ing health­care sys­tems on the med­ical wor­ry list.

So with more and more states look­ing like­ly to expand Med­ic­aid soon­er or lat­er, the grudg­ing nature of Geor­gia’s GOP’s open mind­ed­ness to the expan­sion is a reminder that every state’s Med­ic­aid expan­sions is going to be heav­i­ly con­tin­gent on whether or not there’s a Pres­i­dent Trump in 2017. If Pres­i­dent Trump hap­pens, so long Med­ic­aid expan­sion and hel­lo untreat­ed Zika! It’s one of the rea­sons it won’t be super sur­pris­ing if get­ting sol­id details on how Pres­i­dent Trump and a GOP Con­gress plan on replac­ing Oba­macare and the Med­ic­aid expan­sion becomes one of the biggest issues of the 2016 cam­paign. It’s just very time­ly because health­care is always time­ly. And the rab­ble is sort of wak­ing up.

But it also won’t be super sur­pris­ing if oth­er issues take the pub­lic focus away from ques­tions of the GOP’s post-Oba­macare vision. The com­pe­ti­tion for the the issues that will cap­ture the atten­tion of the 2016 elec­tion nation­al dis­course is fierce.

Now that Pres­i­dent-elect Don­ald Trump and the GOP-con­trolled Con­gress are set to repeal the New Deal and replace with a new fas­cist social con­tract, one of the biggest ques­tions remains how they will pull this off while avoid­ing blame for doing this that Trump pledge not the do and GOP vot­ers have resist­ed for years. Things like pri­va­tiz­ing Social Secu­ri­ty and Medicare. It’s one of the grand per­ver­sions of the GOP: One of the GOPs pri­ma­ry goals as a par­ty is to avoid all the inevitable blame it real­ly deserves recieve for achiev­ing the par­ty’s poli­cies goals. It’s one of the rea­sons the GOP loves it when the Democ­rats agree to sup­port Repub­li­can poli­cies out of some mis­guid­ed spir­it of bi-par­ti­san­ship.

At the same time, giv­en the fact that Pres­i­dent Trump cam­paigned as an out­sider who’s not real­ly a Repub­li­can instead but some sort of pop­ulist, we’ve cre­at­ed this fas­ci­nat­ing sit­u­a­tion where the GOP can now achieve vir­tu­al­ly all of its long-time pol­i­cy goals and let Trump take all the blame. And while Don­ald Trump will cer­tain­ly deserve and immense amount of blame for night­mare he’s about to unleash, he still should­n’t get all of it. It’s one of the many bizarre ten­sions that will now come to dom­i­nate Wash­ing­ton DC: Now that the elec­torate effec­tive­ly removed the Democ­rats from pow­er, the par­ty isn’t real­ly able to play the tra­di­tion­al game of “avoid­ing blame for cor­po­ratist pol­i­cy real-world con­se­quences” hot-pota­to. But with an alleged “out­sider” as the new pres­i­dent, that game can still tran­spire. It’s just an intra-GOP now and the more Trump “takes over” the GOP while essen­tial­ly car­ry­ing out a the clas­sic GOP cor­po­ratist agen­da, the more he’ll end up essen­tial­ly absorb­ing all the blame that should right­ly be incurred by the rest of the GOP. And since this is a dynam­ic Don­ald Trump must real­ize , you have to won­der if that’s part of the rea­son Trump is now sug­gest­ing he might keep key ele­ments of Oba­macare:

Talk­ing Points Memo Livewire

Trump: There Won’t Be A Gap Between Oba­macare Repeal And Replace­ment

By Caitlin Mac­Neal
Pub­lished Novem­ber 12, 2016, 10:58 AM EDT

In an inter­view on CBS News’ “60 Min­utes” set to air in full on Sun­day, Don­ald Trump said that there would not be a gap between repeal­ing Oba­macare and putting in place a replace­ment.

“We’re going to do it simul­ta­ne­ous­ly. It’ll be just fine. That’s what I do. I do a good job. You know, I mean, I know how to do this stuff. We’re going to repeal it and replace it. And we’re not going to have, like, a two-day peri­od and we’re not going to have a two-year peri­od where there’s noth­ing,” he said. “It will be repealed and replaced. I mean, we’ll know. And it’ll be great health care for much less mon­ey.”

Trump also con­firmed what he said in a Fri­day Wall Street Jour­nal inter­view about two aspects of Oba­macare he’s look­ing to keep in place. He does not want to elim­i­nate the pro­vi­sion that keeps insur­ers from deny­ing cov­er­age to those with pre-exist­ing con­di­tions, and he wants to allow chil­dren to stay on their par­ents’ health insur­ance until age 26.

“Trump also con­firmed what he said in a Fri­day Wall Street Jour­nal inter­view about two aspects of Oba­macare he’s look­ing to keep in place. He does not want to elim­i­nate the pro­vi­sion that keeps insur­ers from deny­ing cov­er­age to those with pre-exist­ing con­di­tions, and he wants to allow chil­dren to stay on their par­ents’ health insur­ance until age 26.”

Oh look at that, Don­ald Trump, who made repeal­ing and replac­ing Oba­macare one of his cam­paign ral­ly­ing cry, now wants to keep parts of Oba­macare: no denial of cov­er­age for pre-exist­ing con­di­tions and allow­ing chil­dren to stay on their par­ents’ insur­ance until the age of 26. And it’s no mys­tery as to why he would want to keep them. Those are real­ly pop­u­lar pro­vi­sion and who­ev­er takes them away is going to have so unhap­py vot­ers to deal with.

Still, you have to admit it’s a bit odd con­sid­er­ing repeal­ing and replac­ing Oba­macare with some sort of GOP cor­po­ratist scheme was­n’t just Trump’s ral­ly­ing cry dur­ing the cam­paign but the GOP’s ral­ly­ing cry for the past six years. Espe­cial­ly since keep­ing the pro­vi­sion about no denial of cov­er­age for pre-exist­ing con­di­tions is the part about Oba­macare that neces­si­tates all the oth­er parts about Oba­macare that the GOP pledges not to include in its replace­ment scheme if the scheme:

The Wash­ing­ton Post

Don­ald Trump is about to face a rude awak­en­ing over Oba­macare

By Steven Pearl­stein
Novem­ber 12, 2016 at 9:53 AM

After reit­er­at­ing his promise to repeal and replace the Afford­able Care Act, Pres­i­dent-elect Don­ald Trump has indi­cat­ed that he may keep two of the law’s most pop­u­lar pro­vi­sions. One is straight­for­ward enough — chil­dren up to the age of 26 being allowed to stay on their par­ents’ plan. The oth­er — pre­vent­ing insur­ance com­pa­nies from deny­ing cov­er­age because of pre­ex­ist­ing con­di­tions — offers a per­fect illus­tra­tion of why Trump and most of the oth­er Repub­li­cans crit­ics of Oba­macare don’t under­stand the health insur­ance mar­ket.

Let’s say that in the beau­ti­ful new world of “repeal and replace,” insur­ers are required to sell you insur­ance despite the fact that your kid has a brain tumor. Insur­ance com­pa­nies know what to do with that. Their actu­ar­ies can cal­cu­late that kids with brain tumors typ­i­cal­ly require (I’m mak­ing this num­ber up) about $200,000 a year in med­ical care. So they’ll offer to sell you a pol­i­cy at an annu­al pre­mi­um of $240,000.

So how do you pre­vent that kind of gam­ing of the sys­tem by con­sumers? Well, that’s easy. You require that every­one buy at least some min­i­mal lev­el of insur­ance at the begin­ning of every year, so they can’t buy insur­ance only after they get sick. Let’s call that an” indi­vid­ual man­date.” But because you can’t expect poor peo­ple to pay $1,000 a month, they will require sub­si­dies to keep their out-of-pock­et costs to some­thing like 10 per­cent of income. To pay for the sub­si­dies, a new tax will be required.

So let’s review what just hap­pened. To guar­an­tee that peo­ple with pre-exist­ing con­di­tions can get afford­able health insur­ance, you need to have rules requir­ing guar­an­teed issue and com­mu­ni­ty rat­ing. To keep insur­ance com­pa­nies in busi­ness because of guar­an­teed issue and com­mu­ni­ty rat­ing, you need to have an indi­vid­ual man­date. And because poor peo­ple can’t afford health insur­ance, you need sub­si­dies. Com­bine all three, and what you have, in a nut­shell, is ... Oba­macare.

Yes, it’s a bit more com­pli­cat­ed than that, but not much. It’s pos­si­ble to allow insur­ance com­pa­nies charge twice or three times as much, to peo­ple who are old­er or sick­er. You can let healthy peo­ple buy some­what more bare­bones “cat­a­stroph­ic” poli­cies to sat­is­fy­ing their oblig­a­tion under the indi­vid­ual man­date. You could even avoid com­mu­ni­ty rat­ing by send­ing sick peo­ple into “high risk pools” where their pre­mi­ums would be sub­si­dized by a tax on every­one else’s health care pre­mi­ums.

But at the end of the day, once you decide that every­one, regard­less of age or med­ical con­di­tion, should be able to buy health insur­ance at an afford­able price, you have essen­tial­ly bought into the idea that young and healthy peo­ple have an oblig­a­tion to sub­si­dize the old­er and sick­er peo­ple in some fash­ion. And once you do that, it’s sort of inevitable you end up where every health reform plan has end­ed up since the days of Richard Nixon. You end up with some vari­a­tion on Oba­macare.

Of course, if you want to scrap guar­an­teed issue, scrap com­mu­ni­ty rat­ing, scrap the indi­vid­ual man­date and scrap the sub­si­dies, as Repub­li­cans, pro­pose, then you end up where the coun­try was in 2008—with a mar­ket sys­tem that inevitable gives way to an insur­ance spi­ral in which steadi­ly ris­ing pre­mi­ums cause a steadi­ly ris­ing per­cent­age of Amer­i­cans with­out health insur­ance.

There are no easy solu­tions here, no free lunch­es. You can’t have all the good parts of an unreg­u­lat­ed insur­ance mar­ket (free­dom to buy what you want, when you want, with mar­ket pric­ing) with­out the bad parts (steadi­ly ris­ing pre­mi­ums and insur­ance that is unaf­ford­able for peo­ple who are old and sick).

At the same time, you can’t have all the good parts of a social­ized sys­tem (uni­ver­sal cov­er­age at afford­able prices) with­out free­dom-reduc­ing man­dates and reg­u­la­tions and large dos­es of sub­si­dies from some peo­ple to oth­er peo­ple. Any­one who says oth­er­wise – any­one promis­ing bet­ter qual­i­ty health care at low­er cost with few­er reg­u­la­tions and low­er taxes—is ped­dling hokum.

“But at the end of the day, once you decide that every­one, regard­less of age or med­ical con­di­tion, should be able to buy health insur­ance at an afford­able price, you have essen­tial­ly bought into the idea that young and healthy peo­ple have an oblig­a­tion to sub­si­dize the old­er and sick­er peo­ple in some fash­ion. And once you do that, it’s sort of inevitable you end up where every health reform plan has end­ed up since the days of Richard Nixon. You end up with some vari­a­tion on Oba­macare.”

So now we get to find out if Trump’s Oba­macare par­tial-repeal that keeps the pre-exist­ing con­di­tions pro­tec­tions will also include a com­mit­ment to ensure access to afford­able insur­ance or instead guar­an­tees access to unaf­ford­able insur­ance for those with pre-exist­ing con­di­tions...

...
Let’s say that in the beau­ti­ful new world of “repeal and replace,” insur­ers are required to sell you insur­ance despite the fact that your kid has a brain tumor. Insur­ance com­pa­nies know what to do with that. Their actu­ar­ies can cal­cu­late that kids with brain tumors typ­i­cal­ly require (I’m mak­ing this num­ber up) about $200,000 a year in med­ical care. So they’ll offer to sell you a pol­i­cy at an annu­al pre­mi­um of $240,000.
...

Or maybe do what the rest of the GOP pro­pos­es, which is repeal Oba­macare and replace it with the night­mare that exist­ed before Oba­macare...

...
Of course, if you want to scrap guar­an­teed issue, scrap com­mu­ni­ty rat­ing, scrap the indi­vid­ual man­date and scrap the sub­si­dies, as Repub­li­cans, pro­pose, then you end up where the coun­try was in 2008—with a mar­ket sys­tem that inevitable gives way to an insur­ance spi­ral in which steadi­ly ris­ing pre­mi­ums cause a steadi­ly ris­ing per­cent­age of Amer­i­cans with­out health insur­ance.
...

That’s all what Trump and the GOP get to decide on health­care reform: Do they replace Oba­macare with...Obamacare, and at least avoid all the fall­out that would come with replac­ing Oba­macare with some bro­ken joke sys­tem. Or do they replace Oba­macare with a bro­ken joke sys­tem and blame then play “avoid­ing blame for cor­po­ratist pol­i­cy real-world con­se­quences” hot-pota­to. We’ll find out what they decide to do about Oba­macare, but it’s worth not­ing that what­ev­er path they end up tak­ing will be but one of the many upcom­ing Trump/GOP assaults on Amer­i­cans’ retire­ment secu­ri­ty and safe­ty-net:

Reuters

After U.S. elec­tion, retire­ment secu­ri­ty heads for a crash

By Mark Miller | CHICAGO
Fri Nov 11, 2016 | 7:09am EST

Retire­ment secu­ri­ty already looked like a loom­ing train wreck for most U.S. house­holds before Elec­tion Day. Now, the con­sol­i­da­tion of Repub­li­can con­trol of gov­ern­ment threat­ens to accel­er­ate the crash.r

It is too ear­ly to pre­dict the agen­da Don­ald Trump will bring to the White House on retire­ment pol­i­cy, or where it might fit on his pri­or­i­ty list. We live in a rapid­ly aging nation, but retire­ment pol­i­cy nev­er received a seri­ous air­ing dur­ing the hot mess of a cam­paign that just end­ed.

It is also impos­si­ble to pre­dict how Trump’s pri­or­i­ties will match up with those of Repub­li­can lead­ers in Con­gress, con­sid­er­ing their deep divides on many issues dur­ing the cam­paign.

But pre­vi­ous Repub­li­can pro­pos­als and Trump’s cam­paign pledges point toward a range of pos­si­ble GOP retire­ment ini­tia­tives between now and the 2018 midterm elec­tions.

The eco­nom­ic frus­tra­tions of old­er, mid­dle-class vot­ers played an impor­tant role in Trump’s upset win over Hillary Clin­ton. Exit polling reveals that vot­ers above age 45 favored him, espe­cial­ly among mid­dle-class house­holds.

These are house­holds bear­ing the brunt of job loss, income inequal­i­ty, the decline of tra­di­tion­al defined ben­e­fit pen­sions, ris­ing health­care costs and shrink­ing Social Secu­ri­ty ben­e­fits. And they have man­aged to save pre­cious lit­tle for retire­ment: 62 per­cent of work­ing house­holds head­ed by peo­ple aged 55–64 have less than one year of annu­al income, accord­ing to the Nation­al Insti­tute on Retire­ment Secu­ri­ty (NIRS) — far less than they will need to main­tain their stan­dard of liv­ing in retire­ment.

But here is the irony: Repub­li­can con­trol of the White House and Con­gress over the next two years could leave these strug­gling near-retire­ment house­holds even worse off. Below is just a par­tial run­down of the retire­ment-relat­ed issues that will bear care­ful watch­ing.

OBAMACARE REPEAL

This might not seem like a retire­ment issue at first glance. But if Trump and Repub­li­can law­mak­ers make good on their promis­es to repeal the Afford­able Care Act, mil­lions of old­er Amer­i­cans who fall short of Medicare’s eli­gi­bil­i­ty age (65) like­ly will lose their health insur­ance.

Hate Oba­macare if you like, but it has huge­ly ben­e­fit­ed mil­lions of old­er low- and mid­dle-income house­holds. The Com­mon­wealth Fund esti­mates that the per­cent­age of unin­sured Amer­i­cans aged 50–64 fell to 9.1 per­cent this year, com­pared with 14 per­cent in 2013. That trans­lates to 3.1 mil­lion pre­vi­ous­ly unin­sured peo­ple who now have health insur­ance.

Repub­li­cans will like­ly try to repeal the law, or at min­i­mum gut many of its most impor­tant pro­vi­sions, such as Med­ic­aid cov­er­age for low-income peo­ple, and pre­mi­um sub­si­dies for mid­dle-income house­holds.

The unin­sured-and-over-fifty group will be more like­ly to forego health­care, and they will arrive at Medicare’s doorstep with more untreat­ed ill­ness­es.

“If they repeal it and don’t replace it with some­thing mean­ing­ful, it’s going to real­ly hurt this old­er pop­u­la­tion,” said Chris­t­ian Weller, pro­fes­sor of pub­lic pol­i­cy at the Uni­ver­si­ty of Mass­a­chu­setts Boston.

SPIKE THE FIDUCIARY RULE

The U.S. Depart­ment of Labor final­ized rules this year requir­ing all finan­cial advis­ers work­ing with retire­ment accounts to avoid con­flicts and act in the best inter­est of clients in the prod­ucts they rec­om­mend. This is a huge, pos­i­tive step in reform­ing the way retire­ment sav­ings are man­aged.

Trump took no posi­tion on the so-called fidu­cia­ry rule, but he has pledged to cut gov­ern­ment reg­u­la­tion aggres­sive­ly. And one of his advis­ers promised dur­ing the cam­paign to repeal the rule, even liken­ing it to slav­ery.

...

CUT SOCIAL SECURITY AND MEDICARE

Trump said dur­ing the cam­paign he does not favor cut­ting Social Secu­ri­ty or Medicare ben­e­fits. But Repub­li­can con­gres­sion­al lead­er­ship has long favored rais­ing the Social Secu­ri­ty retire­ment age, reduc­ing cost-of-liv­ing adjust­ments and at least par­tial pri­va­ti­za­tion of the pro­gram by allow­ing work­ers to divert part of their pay­roll tax con­tri­bu­tion to a per­son­al sav­ings account.

This year’s Repub­li­can con­ven­tion plat­form stat­ed that Social Security’s sol­ven­cy prob­lems should be addressed with­out tax increas­es. That is a de fac­to call for ben­e­fit cuts, because there are only two ways to solve Social Security’s finan­cial prob­lems: cut ben­e­fits or increase rev­enue. The plat­form also con­tained a vague call for pri­va­ti­za­tion.

On Medicare, House Speak­er Paul Ryan has advanced plans repeat­ed­ly to shift Medicare toward so-called pre­mi­um sup­port. Seniors could choose between pri­vate insur­ance plans and tra­di­tion­al Medicare, and receive a vouch­er from the fed­er­al gov­ern­ment to pur­chase cov­er­age. Stud­ies have shown this approach would shift costs to seniors.

RETIREMENT SAVING, LONG-TERM CARE

Among the oth­er ques­tions to pon­der: How will we reform our retire­ment sav­ing sys­tem to increase cov­er­age and low-cost sav­ing? How will we fix our bro­ken approach to financ­ing long-term care?

All told, the inequal­i­ties in our retire­ment secu­ri­ty sys­tem could grow worse over the next four years — much worse. That would be not just an iron­ic out­come of this elec­tion — it would be trag­ic.

(The opin­ions expressed here are those of the author, a colum­nist for Reuters)

“All told, the inequal­i­ties in our retire­ment secu­ri­ty sys­tem could grow worse over the next four years — much worse. That would be not just an iron­ic out­come of this elec­tion — it would be trag­ic.”

Yes indeed, if Trump car­ries out the GOP agen­da our retire­ment secu­ri­ty sys­tem will shat­ter and the pub­lic will either blame Trump or the GOP. Prefer­ably both, but that’s part of what’s going to be so fas­ci­nat­ing to see now that the game of “blame for cor­po­ratist pol­i­cy real-world con­se­quences” hot-pota­to is in ful­ly swing and the only groups play­ing are Don­ald ‘the out­sider’ Trump and the rest of the GOP. If the Con­gress pri­va­tizes Social Secu­ri­ty and Medicare as it appears they’re now going to do after Don­ald Trump cam­paign on not touch­es those pro­grams, what are Trump and his GOP allies in Con­gress going to do to deflect the inevitable blame? Well, there is one option, and it looks like it’s going to be the option they’re prob­a­bly going to try to do: Blame Oba­ma. And if that sounds absurd, check out Paul Ryan’s lat­est rea­son for why we need to pri­va­tize Medicare:

Esquire

The Repub­li­can Health­care Plan: Gut Medicare and Blame Oba­ma

Ladies and gen­tle­men, intro­duc­ing Paul Ryan.

By Charles P. Pierce
Nov 11, 2016

My Walk To Work, Novem­ber 11, 2016: Part Two.

Every few days, when I walk to the Blog­Cave, I stop at a local McDon­ald’s for one of their Triglyc­eride Fes­ti­val break­fasts. Every time I’ve done this, there has been a table full of elder­ly gents sit­ting at the same table by the side door. (Yeah, elder­ly. They’re old­er than me.) All of them wear base­ball caps. One of them always wears a cap that marks him as a “Viet­nam Vet­er­an.” Some­time last sum­mer, I noticed that a cou­ple of them had tak­en to wear­ing those famil­iar red base­ball caps that told the world that the elder­ly gents were ready to Make Amer­i­can Great Again. Pre­sum­ably, most of these guys, if not all of them, ben­e­fit from Medicare.

Gen­tle­men? May I intro­duce you to Paul Ryan, the zom­bie-eyed granny starv­er from the state of Wis­con­sin? Jonathan Chait in New York would like to explain to you all how you are about to get bam­boo­zled into a worse life than you have right now.

“Your solu­tion has always been to put things togeth­er, includ­ing enti­tle­ment reform,” says Baier, using Repub­li­can code for pri­va­tiz­ing Medicare. Ryan replies, “If you’re going to repeal and replace Oba­macare, you have to address those issues as well. … Medicare has got some seri­ous issues because of Oba­macare. So those things are part of our plan to replace Oba­macare.”

Yep. That’s what’s going to hap­pen to your health­care, gen­tle­men. And he’s going to blame the black guy for it, and my mon­ey’s all on you guys buy­ing that whole­sale. It is, of course, a bla­tant lie, because Paul Ryan is the…say it with us now…Biggest. Fake. Ever.

The Medicare trust fund has been extend­ed 11 years as a result of the pas­sage of Oba­macare, whose cost reforms have helped bring health care infla­tion to his­toric lows. It is also untrue that repeal­ing Oba­macare requires chang­ing tra­di­tion­al Medicare. But Ryan clear­ly believes he needs to make this claim in order to sell his plan, or prob­a­bly even to con­vince fel­low Repub­li­cans to sup­port it.

One of the few posi­tions on which the Pres­i­dent-elect was mar­gin­al­ly con­sis­tent dur­ing the cam­paign was that he would not touch enti­tle­ments. How­ev­er, his eco­nom­ic plan was so stuffed with vague non­sense that I am fair­ly sure this is what’s going to hap­pen: Ryan will come up with some bull­shit “stim­u­lus” pro­gram that is lard­ed with tax-cuts and oth­er good­ies, and he will offer it to the White House in exchange for his life’s dream of shred­ding what’s left of the social safe­ty net. He will put togeth­er a big pot of offal, slap a label read­ing “Medicare” on it, and then ped­dle it to the suck­ers.

The guys at McDon­ald’s will find them­selves choos­ing between cat food and insulin and it will be Barack Oba­ma’s fault. Love­ly.

“Yep. That’s what’s going to hap­pen to your health­care, gen­tle­men. And he’s going to blame the black guy for it, and my mon­ey’s all on you guys buy­ing that whole­sale. It is, of course, a bla­tant lie, because Paul Ryan is the…say it with us now…Biggest. Fake. Ever.”

Yes, we need to pri­va­tize Medicare because of Oba­macare. Sure, that’s not remote­ly true and Paul Ryan and all the oth­er GOP­ers who will be repeat­ing this lie know it. But they also know that Don­ald Trump was just elect­ed pres­i­dent based on an entire plat­form of eas­i­ly fal­si­fi­able lies, so why not tell the coun­try that they have to pri­va­tize Medicare because of Oba­macare? It’s hard to see what the GOP has to lose? So get ready for Oba­ma and Oba­macare to be blamed for pret­ty much every­thing the GOP is about to do because there’s no way Trump or the rest of the GOP wants the kind of blame it’s going to deserve.

It all rais­es anoth­er inter­est­ing ques­tion about the Trump/GOP Oba­macare replace­ment schemes: Since the final scheme will almost cer­tain­ly reduce the amount of actu­al heath care in the coun­try, regard­less of whether that’s due to peo­ple los­ing their insur­ance or peo­ple get­ting moved to cheap “catastrophic”-only insur­ance that does­n’t cov­er their needs, will Oba­macare some­how be blamed for the inevitable death pan­els? Pri­vate insur­ers will pre­sum­ably play a death pan­el role under Paul Ryan’s Medicare pri­va­ti­za­tion plans, but with the block-grant­i­ng of social safe­ty net health­care pro­grams like Medicare also part of the Ryan-agen­da, it seems like state gov­ern­ments are also going to be make a large num­ber of death pan­el-ish deci­sions. Either way, it’s going to be impor­tant to keep in mind that one of the con­se­quences of the GOP’s total con­trol of the fed­er­al gov­ern­ment and the real­iza­tion of a GOP cor­po­ratist enti­tle­ment reform dream is that one of the absolute­ly crit­i­cal goals of the Trump and admin­is­tra­tion and GOP is some­how con­vinc­ing as many Amer­i­cans as pos­si­ble of the neces­si­ty of let­ting peo­ple die from a lack of being able to pay for things like med­ical care. Espe­cial­ly after Medicare gets pri­va­tized, since the whole point of pri­va­tiz­ing Medicare is to move the respon­si­bil­i­ty of cov­er­ing poten­tial­ly expen­sive health­care in old age from the gov­ern­ment (soci­ety) onto the indi­vid­ual. It’s a reminder that Mak­ing Amer­i­ca Great Again isn’t just going to be about Mak­ing Amer­i­ca Hate Again. It’s also going to require Mak­ing Amer­i­cans Not Care About Each Oth­er Again, which is sort of like hat­ing, but not exact­ly.

Check out who’s lead­ing the Trump’s “land­ing team” at the Social Secu­ri­ty Admin­is­tra­tion: A guy who real­ly, real­ly wants to pri­va­tize Social Secu­ri­ty and Medicare:

Talk­ing Points Memo Livewire

Trump’s Social Secu­ri­ty Advis­er Called For Pri­va­ti­za­tion Of Medicare

By Lau­ren Fox
Pub­lished Novem­ber 21, 2016, 4:27 PM EDT

On the cam­paign trail, Pres­i­dent-elect Don­ald Trump promised not to touch Medicare or Social Secu­ri­ty, but Trump’s selec­tion of Tom Lep­pert to lead the “land­ing team” at the Social Secu­ri­ty Admin­is­tra­tion may sug­gest Trump’s admin­is­tra­tion could move in a dif­fer­ent direc­tion.

CNN flagged Mon­day that Lep­pert, a for­mer Dal­las may­or, has been on record sup­port­ing the pri­va­ti­za­tion of Medicare and Social Secu­ri­ty.

Lep­pert revealed his pri­va­ti­za­tion plan in 2012 when he was run­ning in the Repub­li­cans Sen­ate pri­ma­ry in Texas, accord­ing to CNN. The plans, which were archived and first dis­cov­ered by CNN, reveal Lep­pert was a major sup­port­er of pri­va­ti­za­tion.

“I will nev­er shy away from any issue, even the so-called “third rail” of enti­tle­ment reform. Talk to any young per­son today, and they will tell you Social Secu­ri­ty and Medicare won’t be there for their gen­er­a­tion,” Lep­pert wrote. “To pre­serve these vital pro­grams, we first and fore­most must not change any­thing for those ages 55 and old­er. These folks rely on their ben­e­fits and we’ve made a promise to them. But for younger work­ers, we need to pro­vide Medicare sub­si­dies for the pur­chase of cer­ti­fied pri­vate plans, raise the retire­ment age, encour­age greater retire­ment sav­ings, and launch an ini­tia­tive of Per­son­al Retire­ment Accounts to allow every Amer­i­can, not just the wealthy, to save and invest toward their retire­ment.”

Lep­pert went on to explain in more detail that he sup­ports now House Speak­er Paul Ryan’s plan

“I believe we must move to a sys­tem like that pro­vid­ed to Mem­bers of Con­gress. This pre­mi­um sup­port mod­el would give seniors greater choice and inde­pen­dence. They can choose the plan that is right for them, with sub­si­dies pro­vid­ed by Medicare. This would be grad­u­al­ly phased-in over time and would not affect any­one cur­rent­ly over the age of 55,” the plan said. “For younger indi­vid­u­als, when they reach retire­ment, they will receive a sub­sidy from the fed­er­al gov­ern­ment that will allow them to pur­chase cer­ti­fied cov­er­age plans. Those with the low­est incomes would receive more funds from vouch­ers and would be eli­gi­ble for addi­tion­al Med­ic­aid cov­er­age.”

Lep­pert did­n’t win the pri­ma­ry bid for the Sen­ate in 2012. He has most recent­ly served as the CEO of Kaplan, the edu­ca­tion and test prep com­pa­ny. He endorsed Trump ear­ly in the pri­ma­ry.

“I will nev­er shy away from any issue, even the so-called “third rail” of enti­tle­ment reform. Talk to any young per­son today, and they will tell you Social Secu­ri­ty and Medicare won’t be there for their gen­er­a­tion,” Lep­pert wrote. “To pre­serve these vital pro­grams, we first and fore­most must not change any­thing for those ages 55 and old­er. These folks rely on their ben­e­fits and we’ve made a promise to them. But for younger work­ers, we need to pro­vide Medicare sub­si­dies for the pur­chase of cer­ti­fied pri­vate plans, raise the retire­ment age, encour­age greater retire­ment sav­ings, and launch an ini­tia­tive of Per­son­al Retire­ment Accounts to allow every Amer­i­can, not just the wealthy, to save and invest toward their retire­ment.”

Well, if Don­ald Trump has any inten­tion of stick­ing to his cam­paign pledges to not touch Medicare or Social Secu­ri­ty, he sure has a strange way of sig­nalling it. Per­haps this is some sort of bold Trumpian style of lead­er­ship to bring peo­ple togeth­er by choos­ing a team with views dif­fer­ent from his own? Or, you know, maybe it’s a sig­nal that Pres­i­dent-elect Trump is a mali­cious liar who was always plan­ning on gut­ting these pro­grams? We’ll find out!

But also keep in mind that gut­ting enti­tle­ments is a rather dicey propo­si­tion for a brand new Trump admin­is­tra­tion if it has any hope of get­ting reelect­ed. That kind of deep betray­al of vot­ers seems like more of a sec­ond-term move. And yet we still have reports that Repub­li­cans in Con­gress want to move ahead with some sort of major enti­tle­ment over­haul this year. So what’s the plan here? Has Trump already told the GOP that he’s will­ing to be their aus­ter­i­ty fall-guy and polit­i­cal­ly self-immo­late in a blaze of aus­ter­i­ty glo­ry? While Trump does seem to rel­ish implod­ing soci­ety, he also rel­ish­es being adored by the rab­ble. So what’s the plan? Might the plan involve flip­ping a Demo­c­rat or two?

Talk­ing Points Memo Edi­tor’s Blog

Hatch Wants Phase­out if Dems Will Help

By Josh Mar­shall
Pub­lished Novem­ber 17, 2016, 5:28 PM EDT

Inter­est­ing report here from Lau­ren Fox about a Q&A with Sen. Orrin Hatch about Medicare. Hatch makes pret­ty clear that he sup­ports the Ryan Medicare Phase­out plan (phas­ing out Medicare and replac­ing it with pri­vate insur­ance and vouch­ers.) But he also makes clear that he’s reluc­tant to do it unless Democ­rats give Repub­li­cans cov­er. As we pred­i­cat­ed, a lot of this will come down to whether Democ­rats give Repub­li­cans cov­er to phase­out Medicare on a notion­al­ly bipar­ti­san basis. He also makes clear that he thinks some form of phase­out will be nec­es­sary to afford the rest of Trump’s agen­da. Read.

“As we pred­i­cat­ed, a lot of this will come down to whether Democ­rats give Repub­li­cans cov­er to phase­out Medicare on a notion­al­ly bipar­ti­san basis. He also makes clear that he thinks some form of phase­out will be nec­es­sary to afford the rest of Trump’s agen­da”

Well, that might help explain things: The GOP, at least in the Sen­ate, is indeed hop­ing to achieve its long held goal of gut­ting and phas­ing out Medicare this year. But it prob­a­bly also needs Democ­rats to pro­vide the bipar­ti­san polit­i­cal cov­er if the par­ty wants to avoid the “granny killer” label for decades to comes and main­tain the “both sides do it” false equiv­a­lence meme that the GOP relies on. That’s pret­ty much how it always is. But here’s the new twist: Due to Trump’s mas­sive tax cuts for the rich that will be strain­ing fed­er­al bud­gets for decades to come, the GOP has to gut enti­tle­ments if it wants those juicy tax cuts. Or, as Hatch put it when asked if enti­tle­ment reforms were going to be nec­es­sary to accom­plish the Trump agen­da, “I think that is prob­a­bly the under­state­ment.”:

Talk­ing Points Memo DC

Sen­ate Finance Chair Eyes Medicare Changes But Is Vague On Specifics

By Lau­ren Fox
Pub­lished Novem­ber 17, 2016, 4:55 PM EDT

Sen. Orrin Hatch (R‑UT) said that Repub­li­cans will need to make changes to Medicare and oth­er enti­tle­ments in order to ensure Don­ald Trump’s admin­is­tra­tion is fis­cal­ly respon­si­ble.

In an inter­view with reporters Thurs­day, Hatch said that mak­ing changes to Medicare was essen­tial.

“I think we’re going to have to do that. We’re going to have to make it bet­ter,” Hatch said. “So it will take care of peo­ple because the cur­rent sys­tem is not work­ing.”

When asked if enti­tle­ment reforms were going to be nec­es­sary to accom­plish the Trump agen­da, Hatch said, “I think that is prob­a­bly the under­state­ment.”

Hatch, the chair­man of the Sen­ate Finance Com­mit­tee, made his com­ments after House Bud­get Chair­man Tom Price told reporters ear­li­er Thurs­day that the new GOP Con­gress like­ly would­n’t take up Medicare until the mid­dle of 2017, in a sec­ond bud­get rec­on­cil­i­a­tion as part of the 2018 bud­get process. Hatch was far more vague about tim­ing he want­ed to see on Medicare.

“I don’t think it’s a fast type of a thing, but I would like it to be,” Hatch said.

Hatch said he want­ed to see a more bipar­ti­san approach and he remained vague about what blue­prints he’s seen that he’d want to exe­cute.

“I’ve gone through a wide vari­ety of things and there are some ideas that I think are very good,” he said.

...

“When asked if enti­tle­ment reforms were going to be nec­es­sary to accom­plish the Trump agen­da, Hatch said, “I think that is prob­a­bly the under­state­ment.””

So let’s sum­ma­rize: Pres­i­dent-elect Trump cam­paigned on not touch­ing Social Secu­ri­ty or Medicare but also cam­paigned on a bud­get-destroy­ing mas­sive tax cut for the wealthy. And now that he won, the GOP has the oppor­tu­ni­ty to pri­va­tize these same pro­grams like its want­ed to do for decades. Not only that, but the GOP basi­cal­ly has to pri­va­tize these pro­grams, in par­tic­u­lar Medicare which isn’t as self-fund­ing as Social Secu­ri­ty, if its going to make those mas­sive tax cuts law and just oblit­er­ate the fed­er­al gov­ern­men­t’s spend­ing pow­er going for­ward. Plus, don’t for­get that if the GOP kills Oba­macare as Trump has pledged to do, that puts Medicare on shaki­er foot­ing too since Oba­macare was keep­ing down the growth in health care costs. And in order to make the enti­tle­ment cuts, along with all the oth­er spend­ing cuts, that are going to be required to finance Trump’s tax cuts, the GOP must have Demo­c­ra­t­ic sup­port. Sup­port that the Democ­rats are extreme­ly unlike­ly to want to pro­vide (let’s hope)

It all rais­es a seri­ous ques­tion that will prob­a­bly be loom­ing over Con­gress dur­ing the Trump years: So how exact­ly is the GOP plan­ning on threat­en­ing or black­mail­ing the Democ­rats into giv­ing them the cov­er they need to leg­isla­tive­ly loot the coun­try with­out incur­ring all the vot­er wrath? Because we’re talk­ing about tril­lions of dol­lars in poten­tial loot­ing that’s going to be at the GOP’s leg­isla­tive fin­ger­tips, but they need Democ­rats to sign on board in order to avoid­ing turn­ing what could be a once in a life­time orgy of loot­ing into a Phyrric vic­to­ry that destroys the par­ty’s rep­u­ta­tion. So how is the GOP plan­ning on get­ting that bipar­ti­san cov­er? What sort of hor­ri­ble leg­is­la­tion is the GOP threat­en­ing if it does­n’t get that bipar­ti­san sup­port? Bring­ing back child labor? Pro-lead-poi­son­ing poli­cies? Ted Cruz of the Supreme Court?

Con­sid­er­ing the stan­dard GOP agen­da typ­i­cal­ly dou­ble as threats against soci­ety and life on earth in gen­er­al, it’s hard to say what exact­ly the GOP might threat­en that’s so unique­ly bad that it forces the Democ­rats into pro­vid­ing that much need­ed cov­er. But don’t for­get that we’re talk­ing about tril­lions of dol­lars for the GOP’s oli­garch back­ers at stake over the next cou­ple of years so you can bet the GOP is already brain­storm­ing. It’s pos­si­ble they’ll just go ahead with the gut­ting with­out Demo­c­ra­t­ic sup­port and just try to blame it all on Oba­ma. We’ll see what they come up with.

It’s that time again for Amer­i­cans. The time to reflect on that which you’re thank­ful for while you stuff your­self sil­ly.

And for this year’s Thanks­giv­ing, that process of giv­ing thanks has unfor­tu­nate­ly become a lit­tle eas­i­er: if you’re on Medicare, give thanks for Medicare. Because as the Josh Mar­shall notes below, we just got a major hint from the Trump team is indeed intent on keep­ing his pledge that Medicare will be there. But only for cur­rent Medicare recip­i­ents. If you’re too young to qual­i­fy for Medicare yet, on the oth­er hand, you should prob­a­bly be giv­ing pre­emp­tive thanks for any good health in old age that you will hope­ful­ly expe­ri­ence because you’re not going to be get­ting any Medicare:

Talk­ing Points Memo Livewire

Con­way: Trump Will Look At Paul Ryan’s Plan, Oth­er Medicare ‘Alter­na­tives’ (VIDEO)

By Matt Shuham
Pub­lished Novem­ber 23, 2016, 10:24 AM EDT

Don­ald Trump’s senior advis­er Kellyanne Con­way said Tues­day night that the Pres­i­dent-elect was “open to hear­ing” alter­na­tives to the Medicare pro­gram, includ­ing one put forth by House Speak­er Paul Ryan.

Con­way was respond­ing to a ques­tion from “PBS New­sHour” host Judy Woodruff, who asked about Trump’s view of Ryan’s pro­pos­al that Medicare be phased out in favor of a “pre­mi­um sup­port sys­tem”—his term for pri­va­ti­za­tion.

“Pres­i­dent-elect Trump has made very clear that he wants to make good on the promis­es that we as a nation have made to the seniors who rely upon Medicare, and cer­tain­ly the low­er income Amer­i­cans who rely upon Med­ic­aid and oth­er enti­tle­ments like Social Secu­ri­ty, frankly, for those who receive that,” Con­way began.

Still, she said, Trump was open to hear­ing “dif­fer­ent solu­tions and bet­ter ways of doing things.”

“He will, I’m sure, take a look at Speak­er Ryan’s pro­pos­al and oth­er pro­pos­als,” she con­tin­ued. “In this case, he will go ahead and look at alter­na­tives, Judy, as long as it does not inter­fere with what he has said, his com­mit­ment to keep the promis­es to those cur­rent­ly rely­ing on them.”

Dur­ing the cam­paign Trump had vowed that he was “not going to cut Medicare or Med­ic­aid.” Now, his tran­si­tion web­site states that he will “mod­ern­ize” Medicare, “so that it will be ready for the chal­lenges with the com­ing retire­ment of the Baby Boom gen­er­a­tion – and beyond” and “[m]aximize flex­i­bil­i­ty for States [sic] in admin­is­ter­ing Med­ic­aid.”

...

“He will, I’m sure, take a look at Speak­er Ryan’s pro­pos­al and oth­er proposals...In this case, he will go ahead and look at alter­na­tives, Judy, as long as it does not inter­fere with what he has said, his com­mit­ment to keep the promis­es to those cur­rent­ly rely­ing on them.”

Get ready for “pre­mi­um sup­port” and pri­vate insur­ance death pan­els when you’re old and frail, kids! Won’t that be fun.

So just how much ‘sup­port’ should you expect from the Trump/Ryan “pre­mi­um sup­port” plan? Well, one way to look at it is that it will be very equal sup­port. Equal in that the sense that every­one will get the same amount of sup­port. The same amount of com­plete­ly inad­e­quate sup­port to actu­al­ly cov­er the real cost of health care:

The Fis­cal Times

GOP Cuts in Medicare May Be Next After Dis­man­tling Oba­macare

By Eric Pianin
Novem­ber 18, 2016

The pledge by Pres­i­dent-elect Don­ald Trump and con­gres­sion­al Repub­li­cans to “repeal and replace” the Afford­able Care Act begin­ning ear­ly next year has dom­i­nat­ed the nation­al pol­i­cy debate since Trump, and the GOP swept to vic­to­ry in last week’s elec­tion.

With poten­tial­ly 20 mil­lion or more Amer­i­cans threat­ened with the dis­rup­tion or loss of their Oba­macare insur­ance cov­er­age in the com­ing years, Trump and GOP lead­ers are com­ing under mount­ing pres­sure to explain pre­cise­ly how they would replace Oba­macare once they pass leg­is­la­tion ear­ly next year to dis­man­tle key ele­ments of the pro­gram.

How­ev­er, prac­ti­cal­ly overnight the Repub­li­cans have sub­stan­tial­ly raised the stakes in their dri­ve to reform the gov­ern­ment health care sys­tem and cut costs. House Bud­get Com­mit­tee Chair Tom Price (R‑GA) told reporters on Thurs­day that the House GOP will like­ly push next year for major changes and cuts in Medicare, the pre­mier health care pro­gram for 57 mil­lion seniors that has been the bedrock of retirees’ health cov­er­age since the mid-1960s.

Price, who report­ed­ly is being con­sid­ered by Trump to head the Depart­ment of Health and Human Ser­vices, said that Repub­li­cans would like­ly move “with­in the first six to eight months” of Trump’s admin­is­tra­tion to begin imple­ment­ing their plan. Key ele­ments include rais­ing the age of eli­gi­bil­i­ty from 65 to 67 and grad­u­al­ly pri­va­tiz­ing the sys­tem with gov­ern­ment-issued vouch­ers or “pre­mi­um sup­ports” to defray the cost of insur­ance poli­cies pur­chased on the open mar­ket.

Trump repeat­ed­ly promised dur­ing the pres­i­den­tial cam­paign that he would not cut Social Secu­ri­ty or Medicare to con­trol gov­ern­ment spend­ing and address long-term deficit prob­lems. “So, you’ve been pay­ing into Social Secu­ri­ty and Medicare...but we are not going to cut your Social Secu­ri­ty, and we’re not cut­ting your Medicare,” Trump said at a ral­ly in Iowa in Decem­ber 2015.

How­ev­er, pri­va­ti­za­tion of Medicare has long been a cen­tral fea­ture of House Speak­er Paul Ryan’s high­ly con­tro­ver­sial bud­get pro­pos­als that enjoyed sub­stan­tial GOP sup­port in the House but nev­er made it past the Sen­ate. Now Ryan and oth­er Repub­li­can House lead­ers believe that the elec­tion results are a man­date to push a bold agen­da includ­ing Medicare reform – much to the dis­may of advo­cates of the pro­gram.

“This is one case where there just seems to be a gross con­tra­dic­tion between some­thing that Trump clear­ly stat­ed and what the con­gres­sion­al Repub­li­cans are now talk­ing quite open­ly about doing next year,” said Paul N. Van de Water, a senior fel­low at the lib­er­al Cen­ter for Bud­get and Pol­i­cy Pri­or­i­ties. “I didn’t fol­low Trump’s promis­es ver­ba­tim over the cam­paign, but every­body cer­tain­ly seems to have picked up the notion that he promised not to cut Social Secu­ri­ty and Medicare.”

“It’s hard to see how one could square that with either pre­mi­um sup­port for exam­ple or cer­tain­ly rais­ing the Medicare age,” he added in an inter­view Fri­day. “Both of those are either reduc­ing ben­e­fits or requir­ing peo­ple to pay more for the same ben­e­fits, which is essen­tial­ly the same thing.”

For years dat­ing back to the admin­is­tra­tion of Pres­i­dent George W. Bush, Repub­li­cans have been advanc­ing pro­pos­als for replac­ing tra­di­tion­al Medicare with some pri­vate sys­tem, but those pro­pos­als have nev­er got­ten very far. The lat­est iter­a­tion of that plan – to pre­serve tra­di­tion­al Medicare for those cur­rent­ly in the sys­tem but to pres­sure younger Amer­i­cans to grad­u­al­ly shift to a vouch­er plan – was includ­ed in a major health care pol­i­cy paper Ryan released June 22 called “A Bet­ter Way– Our Vision for a Con­fi­dent Amer­i­ca.”

“Medicare . . . by many mea­sures has served seniors suc­cess­ful­ly since the1960s by pro­vid­ing access to health care for mil­lions and con­tribut­ing to longer life expectan­cies,” Ryan wrote. “Despite these suc­cess­es, the pro­gram faces notable chal­lenges, includ­ing a com­plex finan­cial struc­ture and pro­ject­ed spend­ing growth that make the pro­gram unsus­tain­able for the long term.”

“If we act now, this can mean that tra­di­tion­al Medicare will con­tin­ue for those cur­rent­ly on the pro­gram or near Medicare eli­gi­bil­i­ty,” he added.

Ryan said last week that Medicare would be up for review in the new Con­gress, although he did not sig­nal a pre­cise timetable or how he hoped to orches­trate pas­sage of leg­is­la­tion that is cer­tain to be met with a firestorm of oppo­si­tion from AARP and oth­er seniors’ advo­ca­cy groups, vet­er­ans and lib­er­al Democ­rats.

House and Sen­ate GOP lead­ers intend to use an obscure bud­get par­lia­men­tary maneu­ver called rec­on­cil­i­a­tion to push leg­is­la­tion through in Jan­u­ary to repeal Oba­macare by a sim­ple major­i­ty, with­out hav­ing to muster a 60-vote super­ma­jor­i­ty to over­come a Demo­c­ra­t­ic fil­i­buster.

House GOP lead­ers will like­ly use rec­on­cil­i­a­tion to push through a sec­ond bud­get res­o­lu­tion for fis­cal 2018 that includes their Medicare reform pack­age, accord­ing to Price. When asked by a reporter for the pub­li­ca­tion TPM about tim­ing for changes to Medicare, Price replied yes­ter­day: “I think that is prob­a­bly in the sec­ond phase of rec­on­cil­i­a­tion, which would have to be in the FY 18 bud­get res­o­lu­tion in the first six to eight months.”

Tam­per­ing with Medicare is polit­i­cal­ly risky at best. The fed­er­al­ly fund­ed health care pro­gram cov­ers much of the cost of hos­pi­tal care, physi­cian vis­its and drugs for those 65 and old­er. Medicare ben­e­fit pay­ments totaled $632 bil­lion in 2015 and account­ed for 15 per­cent of the fed­er­al bud­get. Medicare is fund­ed pri­mar­i­ly with gen­er­al rev­enues (42 per­cent), pay­roll tax­es (37 per­cent), and ben­e­fi­cia­ry pre­mi­ums (13 per­cent).

Medicare spend­ing growth has slowed in recent years, accord­ing to an analy­sis by the Kaiser Fam­i­ly Foun­da­tion. While costs are expect­ed to con­tin­ue to grow more slow­ly in the future com­pared to his­tor­i­cal trends, “there are signs that spend­ing growth could increase at a faster rate than in recent years,” in part because of ris­ing pre­scrip­tion drug spend­ing, grow­ing enroll­ment in Medicare, and increas­es in provider pay­ments.

How­ev­er, Ryan and oth­er deficit hawks have long argued that Medicare’s spend­ing tra­jec­to­ry is not sus­tain­able as the pop­u­la­tion ages and more and more baby boomers seek cov­er­age. He cites a Con­gres­sion­al Bud­get Office esti­mate that the Part A Hos­pi­tal Insur­ance trust fund will be insol­vent in 2026, four years ear­li­er than pre­vi­ous­ly pro­ject­ed.

The Repub­li­cans’ solu­tion, in part, is to raise the Medicare eli­gi­bil­i­ty age begin­ning in 2020 and mov­ing Medicare toward a “pre­mi­um sup­port” mod­el. Instead of con­tin­u­ing with Medicare’s cur­rent guar­an­tee of pay­ing for a cer­tain lev­el of cov­er­age – rough­ly 80 per­cent or more for a hos­pi­tal stay—a pre­mi­um sup­port or “vouch­er” plan would pro­vide seniors with a fixed sum to pur­chase health care cov­er­age on the pri­vate insur­ance mar­ket, accord­ing to an analy­sis by the Cen­ter for Bud­get and Pol­i­cy Pri­or­i­ties.

The size of the pre­mi­um sup­port would like­ly vary by region, to account for region­al dif­fer­ences in health care costs, accord­ing to the analy­sis. More­over, it would pro­vide enough of a sub­sidy to pur­chase a mod­est insur­ance plan, at least in the begin­ning.

Seniors could choose from a menu of pri­vate health care plans offer­ing a wide range of cov­er­age, and the gov­ern­ment would pay the Medicare pre­mi­um sup­ports direct­ly to the plan to sub­si­dize the cost. Seniors would have to pick up the rest of the cost.

...

Van de Water, who wrote the CBPP analy­sis, said Ryan’s lat­est pro­pos­al leaves many ques­tions unan­swered, includ­ing whether it would address mount­ing co-pay­ments and oth­er out-of-pock­et costs, or whether the vouch­ers would be tied to infla­tion to keep up with ris­ing health care costs.

“I don’t think we have any idea under the cur­rent plan how fast the vouch­ers grow,” he said.

That is an impor­tant ques­tion because it goes to the fears of many crit­ics that the vouch­er plan would fall far short of what seniors would need to pur­chase ade­quate cov­er­age, and that it would shift more and more health care costs away from the gov­ern­ment and to a rapid­ly aging pop­u­la­tion.

What’s more, as the gov­ern­ment makes it more expen­sive to remain in tra­di­tion­al Medicare, younger and health­i­er seniors would like­ly grav­i­tate to cheap­er, indi­vid­ual health care plans while old­er and sick­er seniors would con­tin­ue to cling to tra­di­tion­al Medicare. That would put more and more finan­cial pres­sure on the gov­ern­ment pro­gram, fur­ther under­min­ing its finan­cial sta­bil­i­ty.

“That’s the gen­er­al con­sen­sus on this,” Van de Water said. “Pre­mi­um sup­port would be a threat to tra­di­tion­al Medicare.”

“For years dat­ing back to the admin­is­tra­tion of Pres­i­dent George W. Bush, Repub­li­cans have been advanc­ing pro­pos­als for replac­ing tra­di­tion­al Medicare with some pri­vate sys­tem, but those pro­pos­als have nev­er got­ten very far. The lat­est iter­a­tion of that plan – to pre­serve tra­di­tion­al Medicare for those cur­rent­ly in the sys­tem but to pres­sure younger Amer­i­cans to grad­u­al­ly shift to a vouch­er plan – was includ­ed in a major health care pol­i­cy paper Ryan released June 22 called “A Bet­ter Way– Our Vision for a Con­fi­dent Amer­i­ca.””

Ooo...vouchers! What a nice replace­ment. So instead of Medicare cov­er­ing 80 per­cent of your health­care costs, you’ll get a fun fun fixed-val­ue sub­sidy and be liable for every­thing beyond that:

...

The Repub­li­cans’ solu­tion, in part, is to raise the Medicare eli­gi­bil­i­ty age begin­ning in 2020 and mov­ing Medicare toward a “pre­mi­um sup­port” mod­el. Instead of con­tin­u­ing with Medicare’s cur­rent guar­an­tee of pay­ing for a cer­tain lev­el of cov­er­age – rough­ly 80 per­cent or more for a hos­pi­tal stay—a pre­mi­um sup­port or “vouch­er” plan would pro­vide seniors with a fixed sum to pur­chase health care cov­er­age on the pri­vate insur­ance mar­ket, accord­ing to an analy­sis by the Cen­ter for Bud­get and Pol­i­cy Pri­or­i­ties.

The size of the pre­mi­um sup­port would like­ly vary by region, to account for region­al dif­fer­ences in health care costs, accord­ing to the analy­sis. More­over, it would pro­vide enough of a sub­sidy to pur­chase a mod­est insur­ance plan, at least in the begin­ning.

Seniors could choose from a menu of pri­vate health care plans offer­ing a wide range of cov­er­age, and the gov­ern­ment would pay the Medicare pre­mi­um sup­ports direct­ly to the plan to sub­si­dize the cost. Seniors would have to pick up the rest of the cost.

...

Van de Water, who wrote the CBPP analy­sis, said Ryan’s lat­est pro­pos­al leaves many ques­tions unan­swered, includ­ing whether it would address mount­ing co-pay­ments and oth­er out-of-pock­et costs, or whether the vouch­ers would be tied to infla­tion to keep up with ris­ing health care costs.

“I don’t think we have any idea under the cur­rent plan how fast the vouch­ers grow,” he said.

That is an impor­tant ques­tion because it goes to the fears of many crit­ics that the vouch­er plan would fall far short of what seniors would need to pur­chase ade­quate cov­er­age, and that it would shift more and more health care costs away from the gov­ern­ment and to a rapid­ly aging pop­u­la­tion.
...

“That is an impor­tant ques­tion because it goes to the fears of many crit­ics that the vouch­er plan would fall far short of what seniors would need to pur­chase ade­quate cov­er­age, and that it would shift more and more health care costs away from the gov­ern­ment and to a rapid­ly aging pop­u­la­tion.”

That’s what’s in store for the next gen­er­a­tion dur­ing their twi­light years: gov­ern­ment vouch­ers that will help cush­ion the finan­cial blow a tiny bit as you’re forced to liq­ui­date your sav­ings and assets to stay alive. Thanks Pres­i­dent-elect Trump!
So while those cur­rent­ly on or near Medicare eli­gi­bil­i­ty age should no doubt be giv­ing thanks for Medicare this Thanks­giv­ing, that does­n’t mean younger gen­er­a­tions don’t also have Medicare-care-relat­ed thanks to give. Because sell­ing off all your per­son­al assets and effec­tive­ly bank­rupt­ing your­self so you can qual­i­fy for Med­ic­aid is going to be the only way to cov­er an expen­sive med­ical con­di­tions after the GOP gets done gut­ting Medicare and phas­ing in “pre­mi­um sup­port” vouch­ers. At least that’s how it’s going to be for younger Amer­i­cans. So if you’re a younger Amer­i­can, give thanks for what you have. Because you aren’t going to be able to keep it. Every­thing you have is going to have to go. Or you go. So be thank­ful for what you have while you still have it!

And, of course, folks should be pret­ty thank­ful for Med­ic­aid. Although if you aren’t a cur­rent Med­ic­aid recip­i­ent, you should prob­a­bly just get used to being thank­ful for your future good health if you’re for­tu­nate enough to have that.

Good luck and hap­py Thanks­giv­ing!

Well, it’s get­ting about as offi­cial as it can get with­out being for­mal­ly offi­cial: Don­ald Trump and the GOP are plan­ning on repeal­ing Oba­macare with­out any mean­ing­ful replace­ment. And what makes this even­tu­al­i­ty unof­fi­cial­ly offi­cial? Rep. Tom Price, one of the biggest back­ers for pri­va­tiz­ing Medicare and repeal­ing Oba­macare com­plete­ly, just got nom­i­nat­ed to be the new sec­re­tary of Health and Human Ser­vices. Sor­ry Grand­ma!

And with­in two min­utes of Trump’s tran­si­tion team announc­ing that Price would be his nom­i­nee, Trump just hap­pened to declare that burn­ing the US flag should be pun­ished with a loss of cit­i­zen­ship. Yes, almost imme­di­ate­ly after Trump’s team announced a tru­ly ter­ri­fy­ing pick for HHS, Trump decides to ter­ri­fy the nation with a com­plete­ly dif­fer­ent lead­er­ship hor­ror show.

So the pres­i­dent-elect either just employed some sort of cow­ard­ly Machi­avel­lian pub­lic rela­tions scheme to dis­tract the pub­lic from the fact that Trump just strong­ly sig­naled that Oba­macare is going to be replaced with a joke and Medicare pri­va­ti­za­tion is on the agen­da, or the pres­i­dent-elect is just an unhinged dem­a­gogue with a Twit­ter account and lucky tim­ing who has no idea what he’s sup­posed to be doing as pres­i­dent and is just going to let the rest of the GOP run his admin­is­tra­tion. Either way, with Price as the head of HHS it’s now unof­fi­cial­ly offi­cial that Oba­macare isn’t going to be healed. It’s going to be killed...now look at this shiny object!:

Atlanta Jour­nal Con­sti­tu­tion

A first move to dump Oba­macare? Let’s talk about flag-burn­ing

Greg Bluestein
Jim Gal­loway

Novem­ber 29, 2016

At 6:53 a.m. today, the tran­si­tion machine of Don­ald Trump announced that U.S. Rep. Tom Price of Roswell would be the president-elect’s choice for sec­re­tary of the U.S. Depart­ment of Health and Human Ser­vices.

This is the Trump administration’s first con­crete move to ful­fill the candidate’s promise of dump­ing the Afford­able Care Act, per­haps the most volatile domes­tic aspect of the New York businessman’s vic­to­ry. For it could deprive mil­lions of a ben­e­fit, i.e. health care insur­ance, that is now in hand.

With­in two min­utes of his announce­ment, at 6:55 a.m., the pres­i­dent-elect decid­ed we real­ly ought to be talk­ing about some­thing else:

Nobody should be allowed to burn the Amer­i­can flag — if they do, there must be con­se­quences — per­haps loss of cit­i­zen­ship or year in jail!— Don­ald J. Trump (@realDonaldTrump) Novem­ber 29, 2016

Nev­er mind that flag-burn­ing isn’t much of an issue, and has been lit­i­gat­ed before the U.S. Supreme Court, which decid­ed it was pro­tect­ed by the First Amend­ment.

A shift away from the explo­sive could also be seen in Price’s for­mal response to the new job offer:

“There is much work to be done to ensure we have a health care sys­tem that works for patients, fam­i­lies, and doc­tors; that leads the world in the cure and pre­ven­tion of ill­ness; and that is based on sen­si­ble rules to pro­tect the well-being of the coun­try while embrac­ing its inno­v­a­tive spir­it.”

Nowhere in Price’s state­ment do the words “Oba­macare” or “repeal” or “replace” appear.

To be sure, this is a mat­ter of lan­guage, not intent. A quick assess­ment of the Price nom­i­na­tion at Vox.com con­cludes with these para­graphs::

The ques­tion right now isn’t whether Repub­li­cans have plans to repeal Oba­macare. It’s which parts of which plans they’ll pick — and how quick­ly they’ll coa­lesce around one option.

But in choos­ing Price, Trump is sig­nal­ing that he is seri­ous about dis­man­tling Oba­macare. He has found one of the law’s most ardent, knowl­edge­able, and pre­pared oppo­nents, and put him in charge of the effort.

...

“But in choos­ing Price, Trump is sig­nal­ing that he is seri­ous about dis­man­tling Oba­macare. He has found one of the law’s most ardent, knowl­edge­able, and pre­pared oppo­nents, and put him in charge of the effort.”

So long Oba­macare! We hard­ly knew thee...thanks in large part to the end­less right-wing suc­cess­es at under­cut­ting pro­vi­sions that would allow it to func­tion. And now we’ll get to see what mag­i­cal plan the GOP has to replace it. Hmmm...might it involve a lot of hand wav­ing and ref­er­ences to “the mar­ket” and assur­ances that “the mar­ket” will take care of every­thing if only we give it a chance? Yes, it might involve that.

Oh, and don’t for­get the pri­va­ti­za­tion of Medicare. That’s unof­fi­cial­ly offi­cial­ly hap­pen­ing too:

The Chris­t­ian Sci­ence Mon­i­tor

Tom Price and the Repub­li­can vision for replac­ing Oba­macare

The Repub­li­can sur­geon from Geor­gia, tapped to head the Depart­ment of Health and Human Ser­vices, espous­es a more pri­va­tized approach to health­care.

By Francine Kiefer, Staff writer
Novem­ber 29, 2016

Wash­ing­ton — Don­ald Trump is indeed seri­ous about repeal­ing and replac­ing the Afford­able Care Act. And to show just how seri­ous he is, on Tues­day he chose con­ser­v­a­tive Rep. Tom Price to lead the Depart­ment of Health and Human Ser­vices.

Rep­re­sen­ta­tive Price, a Repub­li­can doc­tor from Geor­gia, not only stri­dent­ly oppos­es Oba­macare. He has also put for­ward leg­is­la­tion to replace it in every Con­gress since the bill was passed in 2010.

If putting Price in charge of HHS is like “ask­ing the fox to guard the hen house,” as Sen. Chuck Schumer (D) of New York puts it, that’s fine with Repub­li­cans.

At last, under uni­fied GOP con­trol in Wash­ing­ton, Repub­li­cans have an oppor­tu­ni­ty to act on their vision of health­care for Amer­i­ca – a vision that great­ly reduces the role of the fed­er­al gov­ern­ment in health deci­sions.

“The Repub­li­can approach is designed to focus on the indi­vid­ual, the patient – not on a gov­ern­ment pro­gram,” says G. William Hoagland, senior vice pres­i­dent of the Bipar­ti­san Pol­i­cy Cen­ter. “It’s a very pri­vate-sec­tor ori­ent­ed approach to health­care.”

If the Sen­ate con­firms Price as sec­re­tary of HHS, he will over­see a $1 tril­lion bud­get, about 80,000 employ­ees, and near­ly a dozen divi­sions – from Medicare and Med­ic­aid to the Food and Drug Admin­is­tra­tion.

Price firm­ly sup­ports House Speak­er Paul Ryan’s effort to part­ly pri­va­tize Medicare, health­care for seniors. He also wants to strip Planned Par­ent­hood of fed­er­al fund­ing.

...

“This is the absolute per­fect choice,” said Speak­er Ryan in a state­ment.

Key changes

Repub­li­cans are expect­ed to attempt to repeal the ACA ear­ly next year, through a bud­getary process that requires only a major­i­ty vote in both hous­es for approval. They used the same process in 2015, gut­ting much of the law. Pres­i­dent Oba­ma vetoed it.

But the big­ger chal­lenge has always been to agree on a replace­ment. Repub­li­cans have cir­cu­lat­ed var­i­ous pro­pos­als for replac­ing the ACA over the years, but they have not come to a con­sen­sus.

In the House, at least, they now seem to have gen­er­al­ly set­tled on a series of points out­lined in a doc­u­ment called “A Bet­ter Way,” which Price sup­ports.

In the doc­u­ment, Repub­li­cans would keep pop­u­lar pro­vi­sions of the ACA, such as hav­ing pre-exist­ing con­di­tions cov­ered and allow­ing young peo­ple to stay on their par­ents’ insur­ance.

But they would drop the fed­er­al and state “mar­ket­place exchanges” set up under the ACA. As indi­vid­u­als and fam­i­lies begin 2018 enroll­ment in the exchanges, many of them are fac­ing sky­rock­et­ing pre­mi­ums and far less choice among plans – though they do get fed­er­al sub­si­dies to help bear the cost increas­es.

The Bet­ter Way out­line would instead help peo­ple pur­chase insur­ance on the open mar­ket with the help of refund­able tax cred­its. Price, Ryan, and Pres­i­dent-elect Trump also all favor health insur­ance that is avail­able across state lines. And they would pro­vide greater incen­tives for peo­ple to put away pre-tax dol­lars in health sav­ings accounts.

For those who are priced out of these poli­cies, the House Repub­li­can plan calls for fed­er­al­ly sub­si­dized “high-risk pools” and for Med­ic­aid (health­care for the poor) to be devolved to the states in the form of bloc grants or based on a state’s pop­u­la­tion.

...

Repeal first, then find a replace­ment

Crit­ics – and not just Democ­rats – point to weak­ness­es in the Bet­ter Way plan. Med­ic­aid grants to the states run the risk of fail­ing as a safe­ty net dur­ing times of reces­sion, for instance. States are required to bal­ance their bud­gets, yet the num­ber of poor peo­ple who would need Med­ic­aid increas­es dur­ing hard times.

Also, high-risk pools were tried before the ACA ful­ly took effect, and didn’t work par­tic­u­lar­ly well, says Derk­sen, who is a Repub­li­can. “It’s hard to make insur­ance work when you’re only cov­er­ing sick peo­ple,” he says.

He also wor­ries about insur­ers and Big Phar­ma hav­ing too much sway if the mar­ket­place exchanges are elim­i­nat­ed. He prefers to see the exchanges mod­eled along the lines of Tri­care, the mil­i­tary plan that goes out to bid among insur­ers.

Then there’s the ques­tion of whether the GOP promise to retain the pop­u­lar aspects of the ACA is doable with­out the var­i­ous man­dates to pur­chase or offer insur­ance, a point that Sen­a­tor Schumer rais­es.

Such crit­i­cisms will make it far more dif­fi­cult to replace the ACA than to repeal it.

That’s why House Repub­li­can major­i­ty leader Kevin McCarthy of Cal­i­for­nia told reporters on Tues­day that the plan is to repeal first, then set a tran­si­tion peri­od in which the law would still be in effect while law­mak­ers would hash out a replace­ment.

The replace­ment would have to be bipar­ti­san if it is to get past the 60-vote thresh­old in the Sen­ate that’s now required for most leg­is­la­tion, Rep. McCarthy said. A slew of Demo­c­ra­t­ic sen­a­tors from red states who face reelec­tion in 2018 may well feel pres­sure to com­pro­mise with the GOP on a replace­ment.

At the same time, not all Repub­li­cans in the Sen­ate may agree with their House col­leagues.

Big­ger fight: Medicare

Based on Demo­c­rat reac­tions on Tues­day, the big­ger fight is like­ly to be over changes to Medicare – which Price sees as a cost-cut­ting pri­or­i­ty for the next Con­gress. He and Ryan want to raise the eli­gi­bil­i­ty age to 67 and tran­si­tion it to a “pre­mi­um sup­port” pro­gram where seniors are pro­vid­ed vouch­ers to help them buy health insur­ance.

On the cam­paign trail, Don­ald Trump promised not to touch Medicare. Now his tran­si­tion web­site says it will “mod­ern­ize Medicare” to pre­serve it for future gen­er­a­tions.

“We are going to fight tooth and nail any attempt to pri­va­tize, voucher­ize, or any oth­er ‘ize’ you can think of when it comes to Medicare,” said Sen­a­tor Schumer, in remarks to reporters on Tues­day.

In 2012, when Ryan was Mitt Romney’s vice pres­i­den­tial run­ning mate, Democ­rats ran a mem­o­rable ad based on Ryan’s plan to turn Medicare into a par­tial vouch­er sys­tem. The “granny” ad, which depict­ed a Ryan look-alike push­ing an elder­ly woman in a wheel­chair over a cliff, was polit­i­cal­ly dev­as­tat­ing for Repub­li­cans.

“Vot­ers are large­ly insured. So talk­ing about the ACA is one thing. But mess­ing with Medicare is anoth­er,” says Demo­c­ra­t­ic poll­ster Celin­da Lake in an email.

There is a rea­son Trump had to say oth­er­wise on the cam­paign trail, says Ms. Lake. “Medicare’s favor­a­bil­i­ty is 65–66 per­cent – sig­nif­i­cant­ly high­er than most of the politi­cians who want to cut or do away with it.”

“On the cam­paign trail, Don­ald Trump promised not to touch Medicare. Now his tran­si­tion web­site says it will “mod­ern­ize Medicare” to pre­serve it for future gen­er­a­tions.”

Oh my. Could it be that Don­ald Trump lied on the cam­paign trail about not touch­ing Medicare? Imag­ine that. Well, enjoy your vouch­ers, every­one:

...
Based on Demo­c­rat reac­tions on Tues­day, the big­ger fight is like­ly to be over changes to Medicare – which Price sees as a cost-cut­ting pri­or­i­ty for the next Con­gress. He and Ryan want to raise the eli­gi­bil­i­ty age to 67 and tran­si­tion it to a “pre­mi­um sup­port” pro­gram where seniors are pro­vid­ed vouch­ers to help them buy health insur­ance.
...

Yes, let’s remove the gov­ern­men­t’s bar­gain­ing pow­er that’s a crit­i­cal aspect to Medicare’s cost sav­ings, and instead just throw all seniors into the pri­vate mar­ket­place. With a vouch­er. What could pos­si­bly go wrong?

But, hey, maybe it won’t be that bad. After all, as the above arti­cle sug­gest­ed, any sort of Medicare over­haul is going to have to be a bipar­ti­san affair to over­come the fil­i­buster in the Sen­ate:

...
The replace­ment would have to be bipar­ti­san if it is to get past the 60-vote thresh­old in the Sen­ate that’s now required for most leg­is­la­tion, Rep. McCarthy said. A slew of Demo­c­ra­t­ic sen­a­tors from red states who face reelec­tion in 2018 may well feel pres­sure to com­pro­mise with the GOP on a replace­ment.
...

Maybe there’s going to be a slew of Democ­rats eager to join the GOP is pass­ing what could be the most polit­i­cal­ly tox­ic act in a gen­er­a­tion and gut Medicare. We’ll see!

But, of course, there are oth­er options. Options that would allow the GOP to do what­ev­er it wants to Medicare with­out any bipar­ti­san sup­port. Options recent­ly advo­cat­ed by Tom Price:

Talk­ing Points Memo
Livewire

Rep. Tom Price Reveals Repub­li­cans Eye­ing Medicare Over­haul In 2017

By Lau­ren Fox
Pub­lished Novem­ber 17, 2016, 12:13 PM EDT

Rep. Tom Price (R‑GA), the chair­man of the bud­get com­mit­tee, told reporters on Thurs­day that Repub­li­cans are eye­ing major changes to Medicare in 2017.

Price, who is being float­ed as a pos­si­ble Health and Human Ser­vices Sec­re­tary in the next admin­is­tra­tion, said that he expects Repub­li­can in the House to move on Medicare reforms “six to eight months” into the Trump admin­is­tra­tion.

Pri­va­ti­za­tion of Medicare has been a cen­tral fea­ture of Speak­er of the House Paul Ryan’s bud­get pro­pos­al for years, and the House GOP has vot­ed in favor of it mul­ti­ple times. Ryan him­self said last week that Medicare would be on the table in the new Con­gress, sig­nal­ing it could be tak­en up ear­ly in the new year. Price’s com­ments sug­gest pri­va­ti­za­tion won’t be part of the first round of leg­isla­tive ini­tia­tives rolled out by the Trump admin­is­tra­tion and GOP-con­trolled Con­gress.

Price also not­ed that Repub­li­cans are eye­ing using a tac­tic known as bud­get rec­on­cil­i­a­tion to make the change. That process allows Repub­li­cans to pass bills with a sim­ple major­i­ty in the U.S. Sen­ate.

When asked by TPM about tim­ing for changes to Medicare, Price said “I think that is prob­a­bly in the sec­ond phase of rec­on­cil­i­a­tion, which would have to be in the FY 18 bud­get res­o­lu­tion in the first 6–8 months.”

Repub­li­cans plan to tack­le the Afford­able Care Act in the first bud­get rec­on­cil­i­a­tion process, which could take place as ear­ly as Jan­u­ary. Tack­ling Medicare reform and Oba­macare repeal at the same time could prove too high a risk for Repub­li­cans who have yet to reveal a clear plan to replace Oba­macare with.

...

“Price also not­ed that Repub­li­cans are eye­ing using a tac­tic known as bud­get rec­on­cil­i­a­tion to make the change. That process allows Repub­li­cans to pass bills with a sim­ple major­i­ty in the U.S. Sen­ate.”

As Price makes clear, the GOP is plan­ning on killing Oba­macare in the first half of 2017, and then killing Medicare in the sec­ond half. And no fil­i­buster is going to be able to stop it. That was Tom Price’s mes­sage to the world at a time when he was open­ly being con­sid­ered for Sec­re­tary of HHS.

It all rais­es a moun­tain of ques­tions. Not so much ques­tions about what the GOP is going to do. They’ve made that pret­ty clear even if the details need to be worked out.

No, the big ques­tion raised at this point is what exact­ly is the Trump admin­is­tra­tion plan­ning on doing to keep the Amer­i­can pub­lic dis­tract­ed from the fact that his admin­is­tra­tion is going to spend its first year flip-flop­ping on one of his key cam­paign pledges and instead killing one of the most beloved gov­ern­ment pro­grams in US his­to­ry. He already sug­gest­ed strip­ping flag burn­ers of their cit­i­zen­ship and that was just a one day dis­trac­tion from the announce­ment of Price as his HHS nom­i­nee! And when you con­sid­er­ing that almost all of Trump’s bizarre, dis­tract­ing tweets and antics seem to cen­ter around him behav­ing like an out of con­trol wannabe dic­ta­tor with a major per­son­al­i­ty dis­or­der, it’s not like there isn’t a dis­trac­tion-tem­plate at this point. So what sort of giant, end­less “don’t look at the Medicare pri­va­ti­za­tion” dis­trac­tion does Trump and the GOP have in store for us? We’ll unfor­tu­nate­ly find out! And we’ll learn a very unfor­tu­nate les­son in the process: As bad as the Trump admin­is­tra­tion seems, it’s actu­al­ly much, much worse because all the bad stuff you’re see­ing is just a dis­trac­tion from even worse stuff. Sad!

Sur­prise! A key House GOP­er, the chair of the House Ways and Means sub­com­mit­tee on Social Secu­ri­ty, Sam John­son, is propos­ing major cuts to Social Secu­ri­ty. Oh wait, that’s not a sur­prise at all. Although the fact that they’re open­ly com­ing out and call­ing for such cuts with­out more smoke and mir­rors and hand wav­ing is a lit­tle sur­pris­ing. The “reforms” are also almost exclu­sive­ly in the form of ben­e­fit cuts, with no addi­tion­al rev­enues com­ing into the sys­tem. So that’s also a lit­tle sur­pris­ing giv­en the polit­i­cal tox­i­c­i­ty of such a move. Could­n’t they tack on at least some sort of tiny increase in rev­enue? Nope, appar­ent­ly.

So, sur­prise! The unsur­pris­ing Social Secu­ri­ty cuts are com­ing in a sur­pris­ing­ly overt man­ner. which means the unsur­pris­ing gut­ting of Social Secu­ri­ty it com­ing to a retire­ment (or lack there­of) near you:

Talk­ing Points Memo
DC

Key House GOP­er Intro­duces Bill With Major Cuts To Social Secu­ri­ty

By Tier­ney Sneed
Pub­lished Decem­ber 9, 2016, 4:23 PM EDT

A key House Repub­li­can on the issue of Social Secu­ri­ty intro­duced a bill Thurs­day that would impose major cuts to the pro­gram. The bill, the Social Secu­ri­ty Reform Act of 2016, was intro­duced by Rep. Sam John­son (R‑TX), the chair of the House Ways and Means sub­com­mit­tee on Social Secu­ri­ty.

It would, among oth­er things, grad­u­al­ly raise the retire­ment age from 67 to 69 on Amer­i­cans 49 or younger at the present. It would change the for­mu­la that deter­mines the size of a retiree’s ini­tial pay­ments. And it would switch the pro­gram to a less gen­er­ous for­mu­la for rais­ing pay­ments accord­ing to cost of liv­ing increas­es.

Big pic­ture, the most con­cern­ing ele­ment for many experts is that its approach to make the pro­gram more sol­vent rest entire­ly on cuts, and does not raise rev­enues for the Social Secu­ri­ty Trust Fund, as some bipar­ti­san pro­pos­als have. Across the polit­i­cal spec­trum, solu­tions for long term sol­ven­cy range from cuts-only approach­es like John­son’s bill to plans that achieve 75-year sol­ven­cy by rais­ing the cur­rent income cap on social secu­ri­ty tax­es.

“Ulti­mate­ly, we are going to need some­thing that’s a lit­tle more bal­anced between ben­e­fits sav­ing and rev­enue changes in order to get a pro­pos­al that could pass Con­gress and get approved by the pres­i­dent,” said Shai Akabas, direc­tor fis­cal pol­i­cy at the Bipar­ti­san Pol­i­cy Cen­ter.

The cuts in the bill lean more heav­i­ly on high income-earn­ers, but most work­ers would see cuts — some of them dras­tic — if John­son’s bill became law.

The ini­tial cuts come in the form of the two-year retire­ment age increase, which accord­ing to Paul Van de Water, a senior fel­low at the left-lean­ing Cen­ter on Bud­get and Pol­i­cy Pri­or­i­ties, amounts to a sev­en per­cent cut each year.

The changes to the for­mu­la to deter­mine the ini­tial ben­e­fit — known as the Pri­ma­ry Insur­ance Amount (PIA) — are more com­pli­cat­ed and involve mul­ti­ple mov­ing parts. In gen­er­al though, they neg­a­tive­ly impact high­er earn­ers the most.

“The change in the for­mu­la, it’s struc­tured so that it pro­duces the largest decreas­es on ben­e­fits for the peo­ple with the high­est pre-retire­ment earn­ings,” Van de Water said.

Almost all ben­e­fi­cia­ries, how­ev­er, would see reduc­tions as time went on when com­pared to cur­rent law, due to the leg­is­la­tion’s use of a less gen­er­ous infla­tion met­ric.

“That’s anoth­er cut in ben­e­fits, and one that grows the longer the per­son is on the ben­e­fit rolls,” Van de Water said.

Some low wage earn­ers — par­tic­u­lar­ly those who have par­tic­i­pat­ed in the work­force the longest — are shield­ed from these cuts due to an increase min­i­mum ben­e­fit the leg­is­la­tion includes that acts as a floor for those at the bot­tom of the scale.

A let­ter from the Social Secu­ri­ty Admin­is­tra­tion’s Chief Actu­ary gives a more con­crete pic­ture of what the leg­is­la­tion would like if imple­ment­ed. On the low end of the scale, for retirees who have been in the work­force the longest, a 65-year-old who made an aver­age of $12,280 (accord­ing to an estab­lished for­mu­la called AIME) after being in the work­force for 30 years would see his ben­e­fits increase by 9 per­cent when he retired in 2030, as com­pared to the cur­rent law. A 65-year-old retiree at the earn­ing lev­el who was only in the work­force for 20 years would see 19 per­cent decrease, how­ev­er, in 2030. That cut would be 32 per­cent, if the 65-year-old was retir­ing in 2050.

Up the earn­ing scale, the reduc­tions con­tin­ue. A 65-year-old mid­dle-income earn­er, some­one who earned an aver­age of $49,121 after 44 years in the work­force, would see a reduc­tion in her ben­e­fits of 11 per­cent when she retired in 2030, com­pared to the cur­rent law. The amount of reduc­tion would increase the longer she stayed on the rolls: when she was 75 years old, for instance, the reduc­tion would be 14 per­cent com­pared to cur­rent law, and 16 per­cent when she was 85 years old.

And the cuts get more severe the lat­er a mid­dle-income earn­er is retir­ing. If a 65-year-old at that earn­ing lev­el retired in 2050, her ben­e­fits would be 17 per­cent less than cur­rent law. By the time that retiree was 75 years old, they would be 19 per­cent less, and when she was 85, 22 per­cent less.

A 65-year-old at the top of the scale, a $118,500 aver­age earn­er, would see his ben­e­fits cut by 25 per­cent when he retired in 2030, com­pared to the cur­rent law, and that reduc­tion would grow to 55 per­cent com­pared to cur­rent law by the time the retiree was 85 years old. Like­wise, those cuts get larg­er the longer the law is in place. The 65 year-old at the top of scale who retires in 2050 will see a 43 per­cent cut in his ben­e­fits, com­pared to cur­rent law, that will grow to a 74 per­cent reduc­tion by the time he is 85.

Addi­tion­al­ly the John­son’s bill makes some notable cuts to spousal ben­e­fits, while intro­duc­ing some means-test­ing pro­vi­sions.

The Repub­li­can pro­pos­al comes as GOP law­mak­ers are in the midst of fig­ur­ing out a plan to imple­ment an Oba­macare repeal, which, accord­ing to health pol­i­cy experts stands to kick mil­lions of their insur­ance. Hints that Repub­li­cans may con­sid­er Medicare pri­va­ti­za­tion were met with a swift rebuke by Democ­rats, who vowed to go to war over the pro­gram. Many point­ed out that Pres­i­dent-elect Don­ald Trump cam­paigned on pro­tect­ing social safe­ty net pro­grams.

...

“Almost all ben­e­fi­cia­ries, how­ev­er, would see reduc­tions as time went on when com­pared to cur­rent law, due to the leg­is­la­tion’s use of a less gen­er­ous infla­tion met­ric.”

Yep, the longer you live, the big­ger your cut giv­en that one of the main cuts comes in the form of a less gen­er­ous infla­tion met­ric. Also, the younger you are, the big­ger your cut too. So if you’re plan­ning on liv­ing a long life which, you know, costs mon­ey to do, you might not want to plan on retir­ing.

Keep in mind that it’s pos­si­ble this is all some sort of bait and switch where the GOP is set­ting up a dra­con­ian plan that Don­ald Trump swoops in to blocks as part of some sort of elab­o­rate GOP the­atrics for the 2020 elec­tion — the­atrics that rely on turn­ing the GOP into a mon­ster for Trump to slay in order to con­vince vot­ers to vote for Trump and that mon­ster in upcom­ing elec­tions. Except that gut­ting Social Secu­ri­ty has long been one of the par­ty’s goals and this is a once-in-a-gen­er­a­tion chance for the GOP to pass vir­tu­al­ly all of its long-held Koch Brothers/Paul Ryan fas­cist agen­da that they’re not going to casu­al­ly pass up.

And don’t for­get that if this comes to pass, it would hap­pen under an admin­is­tra­tion and Con­gress that’s about to pass a mas­sive tax cut for the super-rich. The fact that pro­pos­als like gut­ting social secu­ri­ty are are hap­pen­ing side by side mas­sive tax cuts for rich is, in itself, an indi­ca­tion of what kind of tac­tics the GOP is going to be rely­ing on: the same tac­tic is always relies on...act like a bunch of fas­cists and hope the right-wing media envi­ron­ment can keep the rubes dis­tract­ed and con­fused. It’s worked pret­ty well so far!

Could that same tac­tic work even when the GOP ful­ly puts its agen­da into prac­tice and does­n’t have the Democ­rats to blame? We’ll see! If the GOP is oper­at­ing on the assump­tion that the major­i­ty of vot­ers are brain-dead buf­foons, there’s no rea­son a GOP Dark Age isn’t what we should expect next, even in this day an age of com­plete GOP con­trol. They’re not pass­ing up this oppor­tu­ni­ty if that’s the con­clu­sion they’ve come to and the fact that this Social Secu­ri­ty “reform” plan is com­ing at the same time that the par­ty is plan­ning mas­sive tax cuts for the rich is a pret­ty big indi­ca­tion that they real­ly have come to the con­clu­sion that they can basi­cal­ly do any­thing and large­ly get away with it. Any­thing. Like con­vert­ing the Social Secu­ri­ty Trust Fund into a tax cut for Trump’s bil­lion­aire bud­dies:

Talk­ing Points Memo
Edi­tor’s Blog

Going for the Big Enchi­la­da

By Josh Mar­shall
Pub­lished Decem­ber 9, 2016, 1:18 PM EDT

Repub­li­cans appar­ent­ly aren’t going to be sat­is­fied with phas­ing out Medicare. They’re going to try to pass huge cuts to Social Secu­ri­ty this year too. Not Bush-style par­tial phase­out but just big, big cuts. And you’re out of luck even if you’re a cur­rent ben­e­fi­cia­ry.

More short­ly.

We’ll have more on this short­ly. But review­ing the sum­ma­ry of the GOP bill, keep the fol­low­ing in mind. If you’ve been work­ing for any num­ber of years, but espe­cial­ly if you’ve been work­ing for two or three decades, you’ve been pay­ing in not only mon­ey for cur­rent ben­e­fi­cia­ries but addi­tion­al mon­ey which was invest­ed in US gov­ern­ment bonds to make it pos­si­ble for Social Secu­ri­ty to pay ben­e­fits of Baby Boomers and Gen-Xers. The addi­tion­al mon­ey was required since there will be more seniors rel­a­tive to the work­ing age pop­u­la­tion.

This plan appears to fore­see the gov­ern­ment nev­er pay­ing that back to Social Secu­ri­ty. In oth­er words, your pay­roll tax­es have been sock­ing away addi­tion­al mon­ey to cov­er the grow­ing senior pop­u­la­tion. But this bill says too bad. That mon­ey goes for high income tax cuts.

“This plan appears to fore­see the gov­ern­ment nev­er pay­ing that back to Social Secu­ri­ty. In oth­er words, your pay­roll tax­es have been sock­ing away addi­tion­al mon­ey to cov­er the grow­ing senior pop­u­la­tion. But this bill says too bad. That mon­ey goes for high income tax cuts.”

That’s one big enchi­la­da.

While the GOP’s plan for replac­ing Oba­macare is still a mys­tery, it’s not entire­ly a mys­tery. This is a GOP plan, after all. And like all GOP plans, we know the only thing it’s going to accom­plish is a fur­ther­ance of the far-right’s end­less quest to cre­ate a joke soci­ety run by and for oli­garchs. It’s just a ques­tion of how it goes about fur­ther­ing that over­ar­ch­ing goal.

Well, here’s one hint of how the Oba­macare repeal and “replace­ment” will fur­ther that goal: by for­mal­ly get­ting rid of the goal of uni­ver­sal health­care cov­er­age and under­cut the insur­ance mar­ket in the process:

The Fis­cal Times

The GOP’s ‘Uni­ver­sal Access’ Health Care Plan Leaves Much to the Imag­i­na­tion

By Rob Garv­er
Decem­ber 16, 2016

Repub­li­cans on Capi­tol Hill, vow­ing to repeal the Afford­able Care Act the moment the next Con­gress is gaveled in, are fight­ing back against grim warn­ings that doing so will mean mil­lions of peo­ple will lose their health insur­ance poli­cies. A senior House lead­er­ship aide, in a brief­ing with reporters Thurs­day, con­ced­ed that the Repub­li­can plan would like­ly result in few­er Amer­i­cans hav­ing health cov­er­age — but that will be because they choose not to pur­chase it.

One of the key under­pin­nings of the Oba­macare and its most con­tro­ver­sial ele­ment is the indi­vid­ual man­date that requires Amer­i­cans to either car­ry health insur­ance or pay the penal­ty. (The law includes large sub­si­dies for many low and mod­er­ate-income peo­ple in order to make health insur­ance afford­able.) The point of the man­date is to come as close as pos­si­ble to uni­ver­sal cov­er­age — a world in which vir­tu­al­ly every­one is insured.

While uni­ver­sal cov­er­age has a very obvi­ous warm-and-fuzzy appeal to those who believe that health care should be avail­able to every­one who lives in the world’s wealth­i­est coun­try, it also has a pow­er­ful under­ly­ing eco­nom­ic ratio­nale based on the real­i­ties of the insur­ance mar­ket. By requir­ing every­one to buy into the health insur­ance mar­ket, the healthy, who on aver­age con­sume less health care than the sick, effec­tive­ly sub­si­dize their cov­er­age.

Many oppo­nents of the ACA, par­tic­u­lar­ly those with a lib­er­tar­i­an bent, see this as an unac­cept­able coer­cive “tak­ing” by the gov­ern­ment, argu­ing that peo­ple should not be forced to pur­chase some­thing they may not want. Sup­port­ers of the law have claimed that because of the unpre­dictabil­i­ty of ill­ness and acci­dent, nobody can tru­ly opt out of the health insur­ance mar­ket and that the man­date is the best solu­tion to the free-rid­er prob­lem — unin­sured peo­ple seek­ing emer­gency care that they often can­not pay for but that hos­pi­tals are oblig­at­ed to pro­vide.

While the details of what the Repub­li­cans intend to replace the ACA with remain sketchy, one of the goals expressed in Thursday’s brief­ing, as report­ed by The New York Times, will be to replace the prin­ci­ple of uni­ver­sal cov­er­age with some­thing quite dif­fer­ent: uni­ver­sal access.

The idea is that hav­ing health insur­ance will not be a require­ment, the unnamed aide said, but will be a viable option for any­one who wants it.

“Our goal here is to make sure that every­body can buy cov­er­age or find cov­er­age if they choose to,” the aide report­ed­ly said.

The details remain to be worked out, and that will be no small task if indeed it is achiev­able at all.

The prob­lem lies in the basic eco­nom­ics of the health insur­ance mar­ket. With­out a man­date to pur­chase insur­ance, the peo­ple who see the least val­ue in it — younger, health­i­er con­sumers — are like­ly to decline to buy it. The result is a pool of insured peo­ple who are old­er and sick­er on aver­age than the pop­u­la­tion as a whole.

That is a more expen­sive group of peo­ple to cov­er, and health insur­ers used to have two options for deal­ing with a pool of poten­tial cus­tomers who were sick­er than the pop­u­la­tion as a whole: raise prices or deny cov­er­age to sick or high-risk patients.

How­ev­er, the ACA removed that sec­ond option, requir­ing insur­ers sell­ing poli­cies through the health insur­ance exchanges to extend cov­er­age to all appli­cants. (Indeed, the indi­vid­ual man­date was the trade-off that insur­ers accept­ed in exchange for drop­ping lim­i­ta­tions on pre-exist­ing con­di­tions.) Repeal­ing that part of the law would be wild­ly unpop­u­lar, and indeed Pres­i­dent-elect Don­ald Trump has said that he does not sup­port doing so.

This leaves price increas­es as insur­ers’ only option — short of leav­ing the exchanges com­plete­ly — for deal­ing with a sick­er pop­u­la­tion. Sup­port­ers of the ACA argue that this is just the first step in a vicious cycle. As costs go up, health­i­er peo­ple start to ques­tion whether the val­ue they receive from their insur­ance pol­i­cy is worth the cost and more of them will drop their poli­cies, lead­ing to fur­ther pre­mi­um increas­es for those who remain, and so on and so on.

How Repub­li­cans plan to address this prob­lem is unclear. Over the past few years, pro­pos­als for sub­si­dized high-risk pools meant to take the sick­est patients out of the gen­er­al insur­ance pool have been float­ed, but whether they would be viable remains a ques­tion.

...

What isn’t imme­di­ate­ly known is how the next Con­gress will han­dle the indi­vid­ual man­date. Leav­ing it in place dur­ing the tran­si­tion peri­od would be seen by many of the ACA’s most ardent oppo­nents as a betray­al. But elim­i­nat­ing it could cause insur­ers oper­at­ing in the health care exchanges to rush for the exits, cre­at­ing a major cov­er­age cri­sis for mil­lions of Amer­i­cans and result­ing, at least in the near term, in the exact oppo­site of “uni­ver­sal access.”

“Repub­li­cans on Capi­tol Hill, vow­ing to repeal the Afford­able Care Act the moment the next Con­gress is gaveled in, are fight­ing back against grim warn­ings that doing so will mean mil­lions of peo­ple will lose their health insur­ance poli­cies. A senior House lead­er­ship aide, in a brief­ing with reporters Thurs­day, con­ced­ed that the Repub­li­can plan would like­ly result in few­er Amer­i­cans hav­ing health cov­er­age — but that will be because they choose not to pur­chase it.”

Yes, at the same time the GOP is laugh­ing­ly try­ing to dis­miss fears that their Oba­macare replace­ment is going to lead to a loss of health­care cov­er­age, we now have word com­ing from the House lead­er­ship that the new plan cen­ters on repeal­ing the goal of uni­ver­sal cov­er­age and replac­ing it with a goal of uni­ver­sal access.

And yet there’s no clear GOP plan for doing this. Not just because the GOP has­n’t giv­en any indi­ca­tion of how it plans on achiev­ing this new uni­ver­sal cov­er­age goal, but also because such a goal implies that the GOP will keep the pop­u­lar pro­vi­sion of Oba­macare pre­vents peo­ple from being denied cov­er­age due to pre-exist­ing con­di­tions. And keep­ing such a pro­vi­sion while drop­ping the man­date that peo­ple get cov­er­age sort of defies the eco­nom­ics of health care:

...

The idea is that hav­ing health insur­ance will not be a require­ment, the unnamed aide said, but will be a viable option for any­one who wants it.

“Our goal here is to make sure that every­body can buy cov­er­age or find cov­er­age if they choose to,” the aide report­ed­ly said.

The details remain to be worked out, and that will be no small task if indeed it is achiev­able at all.

The prob­lem lies in the basic eco­nom­ics of the health insur­ance mar­ket. With­out a man­date to pur­chase insur­ance, the peo­ple who see the least val­ue in it — younger, health­i­er con­sumers — are like­ly to decline to buy it. The result is a pool of insured peo­ple who are old­er and sick­er on aver­age than the pop­u­la­tion as a whole.

That is a more expen­sive group of peo­ple to cov­er, and health insur­ers used to have two options for deal­ing with a pool of poten­tial cus­tomers who were sick­er than the pop­u­la­tion as a whole: raise prices or deny cov­er­age to sick or high-risk patients.

How­ev­er, the ACA removed that sec­ond option, requir­ing insur­ers sell­ing poli­cies through the health insur­ance exchanges to extend cov­er­age to all appli­cants. (Indeed, the indi­vid­ual man­date was the trade-off that insur­ers accept­ed in exchange for drop­ping lim­i­ta­tions on pre-exist­ing con­di­tions.) Repeal­ing that part of the law would be wild­ly unpop­u­lar, and indeed Pres­i­dent-elect Don­ald Trump has said that he does not sup­port doing so.

This leaves price increas­es as insur­ers’ only option — short of leav­ing the exchanges com­plete­ly — for deal­ing with a sick­er pop­u­la­tion. Sup­port­ers of the ACA argue that this is just the first step in a vicious cycle. As costs go up, health­i­er peo­ple start to ques­tion whether the val­ue they receive from their insur­ance pol­i­cy is worth the cost and more of them will drop their poli­cies, lead­ing to fur­ther pre­mi­um increas­es for those who remain, and so on and so on.

...

“This leaves price increas­es as insur­ers’ only option — short of leav­ing the exchanges com­plete­ly — for deal­ing with a sick­er pop­u­la­tion.”

Yep, that appears to be the GOP’s solu­tion: keep Oba­macare’s pre-exist­ing con­di­tion man­date, drop the cov­er­age man­date, and then...well, and then some­thing else that will some­how pre­vent a pre­mi­um price death-spi­ral. And there’s noth­ing that can real­is­ti­cal­ly pre­vent that pre­mi­um death-spi­ral that does­n’t some­how involve sub­si­diz­ing insur­ers who are going to be forced to take on high-risk patients with pre-exist­ing con­di­tions. And as the arti­cle below notes, once Oba­macare is repealed, the tax-increas­ing that are cur­rent­ly used to finance those insur­er sub­si­dies dis­ap­pear too, which means if the GOP is going to avoid that pre­mi­um price death-spi­ral it’s going to have to raise tax­es. And that, of course, means there isn’t actu­al­ly a GOP solu­tion for avoid­ing a pre­mi­um price death-spi­ral

Talk­ing Points Memo
DC

Why The GOP’s Oba­macare Repeal May Doom Their Replace­ment

By Tier­ney Sneed
Pub­lished Decem­ber 15, 2016, 6:00 AM EST

The GOP’s most like­ly path for repeal­ing Oba­macare imme­di­ate­ly elim­i­nates hun­dreds of bil­lions of dol­lars in tax rev­enue that would oth­er­wise be avail­able to fund their replace­ment plan.

The large tax cut, which would go dis­pro­por­tion­ate­ly to high earn­ers, will seri­ous­ly hand­cuff law­mak­ers as they try to cob­ble togeth­er a replace­ment plan to cov­er the mil­lions of Amer­i­cans depen­dent on Oba­macare for health insur­ance, health care pol­i­cy experts say.

With Repub­li­can Par­ty’s strict anti-tax ortho­doxy, it is dif­fi­cult to envi­sion the new GOP-con­trolled Con­gress rais­ing tax­es down the road to fund their Oba­macare replace­ment. So while the cur­rent plan of repeal and delay con­tem­plates a future replace­ment plan, the lost tax rev­enues is per­haps the most telling sign that a viable replace­ment may be either impos­si­ble to achieve or a mea­ger sub­sti­tute.

So far, con­gres­sion­al lead­ers have sig­naled they’re eying a ver­sion of the 2015 bill that delayed some aspects of Oba­macare repeal for two years, but dis­man­tled its tax­es right away.

Not only would that mean a major tax break for the high-earn­ers, with cuts that are direct­ed towards indi­vid­u­als mak­ing more than $200,000. It would also shut down right off the bat a poten­tial rev­enue source for what­ev­er alter­na­tive — if there ever is one — that GOP law­mak­ers set­tle on.

“If all the tax­es in the ACA are repealed as part of a rec­on­cil­i­a­tion bill, that could be huge­ly con­se­quen­tial,” said Lar­ry Levitt, vice pres­i­dent at the Kaiser Fam­i­ly Foun­da­tion. “If you take all that rev­enue off the table, it means a replace­ment bill has to be very scaled back rel­a­tive to the ACA or they have to find mon­ey from some­where else to pay for it, both of which would involve dif­fi­cult trade offs.”

The tax cuts for the high-earn­ers come in the form of an addi­tion­al Medicare tax on high-earn­ers and a tax on net invest­ment income, which would be repealed imme­di­ate­ly, under the 2015 rubric. The leg­is­la­tion, which was passed via the pro­ce­dur­al maneu­ver known as rec­on­cil­i­a­tion, also repealed tax­es on the health care indus­try. All told, $680 bil­lion in tax rev­enue would be elim­i­nat­ed if GOP law­mak­ers pushed through the same bill they used a year ago, accord­ing to a Brook­ings report.

From a polit­i­cal sense, it’s easy to see why get­ting rid of the tax­es is appeal­ing to Repub­li­cans.

As a Ryan Ellis, for­mer tax pol­i­cy direc­tor for Grover Norquist’s Amer­i­cans for Tax Reform, put it to Politi­co, the tax cuts are “the best part about repeal­ing Oba­macare.”

“Because on the health care side of it, you have this com­pli­cat­ed ‘replace’ that you have to turn to after that, but on tax­es, it’s all easy — it’s all dessert,” he said.

From a pol­i­cy stand­point, it puts an addi­tion­al hur­dle in front of GOP law­mak­ers as they ham­mer out a replace­ment plan. Not only will they have to agree on what that plan should look like, but how to fund it.

“It’s so often the case with health care leg­is­la­tion that the dis­agree­ments come with how to pay for it, rather than what to spend the mon­ey on,” Levitt said.

It’s not like Repub­li­cans are typ­i­cal­ly com­fort­able with rais­ing tax­es, mean­ing they could land on a plan that would be paid for with cuts to oth­er pro­grams or that wouldn’t cost that that much in the first place.

“They are acknowl­edg­ing by say­ing that, that they have no inten­tion of replac­ing with some­thing that will pro­vide the equiv­a­lent cov­er­age and afford­abil­i­ty, because they won’t have the dol­lars to sup­port it,” said John McDo­nough, a Har­vard pub­lic health pro­fes­sor who wrote the 2011 book “Inside Nation­al Health Reform.”

“So what they’re look­ing at it will be a sub­stan­tial­ly degrad­ed replace­ment plan in terms of the num­bers of peo­ple who get cov­er­age and the ben­e­fits for which they can get access to med­ical care,” he said.

Some of the replace­ment pro­pos­als that have been float­ed by Repub­li­cans include tax cred­its sim­i­lar to the ACA’s sub­si­dies that could cost bil­lions. But fund­ing the Afford­able Care Act was no easy feat, and depend­ed on a log­ic that those new tax­es were jus­ti­fied for those who would be pay­ing them.

“You’re expand­ing the mar­ket for health care, so some insur­ance com­pa­nies and providers, like device­mak­ers, will make some mon­ey so it made some sense to tax them,” said Alice Rivlin, a for­mer Clin­ton admin­is­tra­tion Office of Man­age­ment and Bud­get who is now a fel­low at the Brook­ings Insti­tute.

...

“With Repub­li­can Par­ty’s strict anti-tax ortho­doxy, it is dif­fi­cult to envi­sion the new GOP-con­trolled Con­gress rais­ing tax­es down the road to fund their Oba­macare replace­ment. So while the cur­rent plan of repeal and delay con­tem­plates a future replace­ment plan, the lost tax rev­enues is per­haps the most telling sign that a viable replace­ment may be either impos­si­ble to achieve or a mea­ger sub­sti­tute.”

That’s right, the GOP’s most like­ly replace­ment for Oba­macare is ...*drum roll* ...a tax cut for the rich!

Also keep in mind that increas­ing cov­er­age so peo­ple get their health con­di­tions addressed ear­ly on before they become far more severe and peo­ple end up in the emer­gency room at much high­er expense is the only real way of low­er long-term health­care costs for indi­vid­u­als and soci­ety. Keep­ing peo­ple health­i­er is actu­al­ly the path to low­er­ing health care costs over the life­time of an indi­vid­ual and soci­ety at large. Imag­ine that! At least it’s the only way to keep cost down that does­n’t aban­don the notion that soci­ety should­n’t aban­don peo­ple in need of med­ical care. But it looks like the GOP is going to be pur­su­ing the lat­ter option.

Also keep in mind that, based on the vague­ness of the “uni­ver­sal access” lan­guage the GOP is using, it’s pos­si­ble that their plan for allow­ing peo­ple with pre-exist­ing con­di­tions to get access to insur­ance cov­er­age is by forc­ing insur­ance at least some sort of plan to every­one, includ­ing plans that cov­er almost no con­di­tions. Or any oth­er con­di­tions exac­er­bat­ed by their pre-exist­ing con­di­tions Don’t for­get that, before Oba­macare, some peo­ple with expen­sive pre-exist­ing con­di­tions were not just forced to pay more for cov­er­age but, in some instances, could­n’t find insur­ers that were will­ing to cov­er them at all. That being the case, the GOP could still sort of claim that their replace­ment actu­al­ly does some­thing to achieve “uni­ver­sal access” even if it sim­ply man­dates that every­one, regard­less of their pre-exist­ing con­di­tions, gets offered some sort of plan by insur­ers, includ­ing a real­ly crap­py plan that cov­ers almost noth­ing.

So while the GOP’s and Supreme Court’s act of ‘rip­ping off the Med­ic­aid Bandaid’ three years ago by elim­i­nat­ing the Med­ic­aid expan­sion man­date might have seemed like a dis­as­ter for the US’s health care sys­tem, get ready for the next phase in the GOP’s war on Amer­i­can health­care: insur­ance poli­cies that only cov­er an bandaid. With guar­an­teed access. At least that’s a pos­si­b­li­ty we should watch out for. It hard to say what exact­ly the GOP’s plan is at this point. Except that a lot more peo­ple are going to lose their health care cov­er­age. Even the GOP is admit­ting that at this point. Even as they deny it.

Oh, and we can also be sure that there’s going to be anoth­er tax cut for the rich. Of course.

Stu­pid or evil? That’s the meta ques­tion of the day. Every day. At least when the GOP is in com­plete con­trol of things. Although as the GOP’s grow­ing self-inflict­ed ‘repeal and replace’ Oba­macare dis­as­ter con­tin­ues to unfold with no escape in sight, it’s worth keep­ing in mind that stu­pid and evil is a viable option too when­ev­er you’re deal­ing with the GOP:

Talk­ing Points Memo
Edi­tor’s Blog

Is GOP Get­ting Half A Clue On Its Oba­macare Mess?

By David Kurtz
Pub­lished Jan­u­ary 4, 2017, 1:50 PM EDT

In what may be an impor­tant shift, the over­all impres­sion that Repub­li­cans on the Hill are giv­ing today is that they’re begin­ning to grap­ple at long last with some of the myr­i­ad polit­i­cal and pol­i­cy down­sides of Oba­macare repeal. It’s still ear­ly, and we need more evi­dence of a real shift before we draw any firm con­clu­sions. But this report­ing from Lau­ren Fox sug­gests that one of the imme­di­ate con­se­quences of grow­ing GOP wari­ness may be a push from some mem­bers to ensure that some sort of replace­ment plan is passed at the same time as repeal.

Those who know the ins and outs of health care pol­i­cy will quick­ly tell you that the replace­ment plan is the hard part and that it can’t be devised, debat­ed, or passed quick­ly. We have sev­en years of no GOP replace­ment plans as Exhib­it A for why it’s so hard. So if you’re a GOP mem­ber of Con­gress now say­ing you want to see a replace­ment plan along with a repeal plan, then you’re essen­tial­ly say­ing, inten­tion­al­ly or not, that you want to push off repeal for a while.

Steven Den­nis at Bloomberg reports this very telling exchange with an unnamed GOP sen­a­tor:

A Repub­li­can sen­a­tor on con­di­tion of anonymi­ty said the details of the repeal bill remain very uncer­tain. Orig­i­nal­ly, Repub­li­cans were plan­ning to sim­ply bring back the bill they put on Obama’s desk last year for his veto.

But that bill was writ­ten know­ing it wouldn’t become law, and now some Repub­li­cans want to make tweaks to soft­en the blow of repeal.

“Even peo­ple who vot­ed for this before are, ‘Wait a minute, wait a minute, we knew that wasn’t going to hap­pen,’” said the sen­a­tor. “There were no con­se­quences.” He said there’s a grow­ing sense among some of his col­leagues that they need to have a replace­ment for Oba­macare ready soon “because we’re going to own this.”

The key ele­ment here is time. Com­ing up with a replace­ment takes time. Push­ing off repeal for long risks not hav­ing the polit­i­cal juice down the road to take it up again, or hav­ing to do so on less favor­able terms. Doing health care pol­i­cy right isn’t a mat­ter of good polit­i­cal mes­sag­ing and well-applied bandaids to obscure what you’re real­ly doing. It’s slow-going, and Repub­li­cans have boxed them­selves in with promis­es of imme­di­ate repeal. Some of them seem to be fig­ur­ing that out.

...

““Even peo­ple who vot­ed for this before are, ‘Wait a minute, wait a minute, we knew that wasn’t going to hap­pen,’” said the sen­a­tor. “There were no con­se­quences.” He said there’s a grow­ing sense among some of his col­leagues that they need to have a replace­ment for Oba­macare ready soon “because we’re going to own this.””

Uh oh. The Repub­li­cans are begin­ning to real­ize that their cam­paign pledge to ‘repeal and replace Omabacare’ was in real­i­ty a cam­paign pledge to break US health­care for the fore­see­able future. And maybe they’ll have to “own” it.

So what’s the GOP going to do giv­en that the GOP is ide­o­log­i­cal­ly com­mit­ted to reject­ing any pos­si­ble Oba­macare replace­ment that might actu­al­ly work? Will we see a sur­prise imme­di­ate replace­ment plan that at least avoids the sce­nario of leav­ing Oba­macare in place for years with no planned alter­na­tive? It’s hard to see how that hap­pens with the com­plete lack of any viable replace­ment mod­els thus far and the time it takes to come up with a new one.

But there is anoth­er option, and it sounds like the option Don­ald Trump is already get­ting behind: the GOP can go ahead with the ‘repeal and replace (years from now)’ plan now, cross their fin­gers and hope it does­n’t turn out to be a total dis­as­ter, and it if does end up a dis­as­ter try to ensure the pub­lic blames the Democ­rats:

Talk­ing Points Memo
Livewire

Trump Warns GOP To Make Sure Dems ‘Own’ Oba­macare Fail­ure: ‘Be Care­ful!’

By Esme Cribb
Pub­lished Jan­u­ary 4, 2017, 10:25 AM EDT

Pres­i­dent-elect Don­ald Trump told Repub­li­cans in a series of tweets Wednes­day morn­ing to “be care­ful!” and make sure that Democ­rats take own­er­ship of any fail­ures of the Afford­able Care Act, as the GOP takes its first steps towards repeal­ing the health­care law.

“Repub­li­cans must be care­ful in that the Dems own the failed Oba­maCare dis­as­ter,” Trump tweet­ed, appar­ent­ly warn­ing Repub­li­cans to avoid act­ing in undue haste that might lead to poor optics. “Dems are to blame for the mess. It will fall of its own weight — be care­ful!”

Repub­li­cans must be care­ful in that the Dems own the failed Oba­maCare dis­as­ter, with its poor cov­er­age and mas­sive pre­mi­um increas­es......— Don­ald J. Trump (@realDonaldTrump) Jan­u­ary 4, 2017

like the 116% hike in Ari­zona. Also, deductibles are so high that it is prac­ti­cal­ly use­less. Don’t let the Schumer clowns out of this web...— Don­ald J. Trump (@realDonaldTrump) Jan­u­ary 4, 2017

mas­sive increas­es of Oba­maCare will take place this year and Dems are to blame for the mess. It will fall of its own weight — be care­ful!— Don­ald J. Trump (@realDonaldTrump) Jan­u­ary 4, 2017

House Repub­li­cans on Tues­day intro­duced and approved new cham­ber rules that includ­ed a spe­cial glide path for their efforts to dis­man­tle Oba­macare. Sen­ate Bud­get Com­mit­tee Chair­man Mike Enzi (R‑WY) also intro­duced a bud­get res­o­lu­tion to kick-start the bud­get rec­on­cil­i­a­tion process Repub­li­can law­mak­ers will like­ly use to scrap major parts of the bill and avoid a Demo­c­ra­t­ic fil­i­buster.

...

““Repub­li­cans must be care­ful in that the Dems own the failed Oba­maCare dis­as­ter,” Trump tweet­ed, appar­ent­ly warn­ing Repub­li­cans to avoid act­ing in undue haste that might lead to poor optics. “Dems are to blame for the mess. It will fall of its own weight — be care­ful!””

Yep, if the GOP repeals Oba­macare but does­n’t actu­al­ly have a replace­ment, and this mar­ket uncer­tain­ty leads to all sorts of prob­lems like insur­ers drop­ping out of the mar­ket or ris­ing pre­mi­ums, that’s all the Democ­rats’ fault. And Trump actu­al­ly feels the need to pub­licly instruct the GOP about this tac­tic going for­ward. As if the rest of the GOP need­ed to be remind­ed of this. And, of course, he decides to send the GOP this sage advice via Twit­ter, so we can all see his tips on how to improve the GOP’s optics in their plans to sab­o­tage the coun­try (he seems to enjoy the pub­lic tweets pro­mot­ing bet­ter GOP cor­rup­tion optics of late).

So we’ll see if that’s the plan the GOP ends up going with but it seems unlike­ly at this point that it isn’t the plan giv­en the immense dif­fi­cul­ties in com­ing up with a real replace­ment. The time required for the GOP to have a real replace­ment (that isn’t much, much worse for the pub­lic than Oba­macare) sim­ply isn’t there. That time has past. But there’s plen­ty of time for the ‘repeal and replace (lat­er)’ plan to do all sort of dam­age in the future that some­one is going to own. Bigly:

The Atlantic

‘Repeal and Delay’ Won’t Pre­vent Oba­macare Repeal Chaos

Repub­li­can plans to phase out the Afford­able Care Act slow­ly still might upend health insur­ance mar­kets in the short-term.
Lucy Nichol­son / Reuters

Vann R. Newkirk II
1/4/2017 11:21 AM ET

Over the next few weeks, Repub­li­cans will prob­a­bly vote to repeal Oba­macare. Though Repub­li­cans and vice pres­i­dent-elect Mike Pence are hud­dling to come up with replace­ment plans, the gen­er­al frame­work of action over the imme­di­ate term seems clear. Repub­li­cans will like­ly delay its phase-out so as to not imme­di­ate­ly can­cel mil­lions of plans and “cre­ate a tran­si­tion and bridge so that no one is left out in the cold,” as per Speak­er Ryan. Bar­ring defec­tions, Democ­rats have lit­tle pow­er to stop them.

There’s one big prob­lem with this approach, how­ev­er. While the “repeal and delay” tac­tic seems like a way to keep peo­ple from becom­ing sud­den­ly unin­sured or hav­ing to make incon­ve­nient changes—or to keep kick­ing the can down the road—in real­i­ty the mere announce­ment of a legal­ly-bind­ing repeal or pledge to end gov­ern­ment sup­port for fed­er­al­ly-backed mar­kets could cause severe dis­rup­tions in how those mar­kets oper­ate. And those dis­rup­tions could mean tur­moil for mil­lions of peo­ple.

The sec­ondary cur­ren­cy of any insur­ance mar­ket is risk—or the amount plans can be expect­ed to pay in claims for each ben­e­fi­cia­ry. Orig­i­nal­ly, insur­ers hedged against risk by find­ing healthy patients and charg­ing sick­er patients more or deny­ing them cov­er­age alto­geth­er. Oba­macare effec­tive­ly elim­i­nat­ed many of those hedges by cre­at­ing qual­i­fy­ing health plans, by remov­ing life­time spend­ing caps, and by pro­hibit­ing com­pa­nies from refus­ing to insure based on pre-exist­ing con­di­tions bans. In order to make the health plans work work and entice health insur­ance com­pa­nies to par­tic­i­pate in the health insur­ance exchanges, Oba­macare man­dates health­i­er peo­ple to join and off­set sick­er people’s costs, and also uses fed­er­al mon­ey to off­set­ting risky bets in sev­er­al dif­fer­ent ways. Those shop­ping for plans on the exchanges are often inher­ent­ly risky bets, and only fed­er­al fund­ing and the promise of more such fund­ing in the future keeps insur­ers insur­ing them.

Even in 2016 before Don­ald Trump’s pres­i­den­cy became viable and the threat of an Oba­macare repeal became real, the exchanges had grown increas­ing­ly unsta­ble and brit­tle. The admin­is­tra­tion had dif­fi­cul­ty in attract­ing younger, health­i­er peo­ple to sign up, so enrollees were sick­er and riski­er than expect­ed. Although stake­hold­ers expect­ed risk to be high as the coun­try adjust­ed to a brand-new health­care par­a­digm and the indi­vid­ual man­date pushed strag­glers into exchanges, Con­gress lat­er autho­rized low­er pay­ments than expect­ed to off­set that risk. The high­ly-pub­li­cized pre­mi­um increas­es of exchange plans and the with­draw­al of major insur­ers like Aet­na were signs of this inher­ent insta­bil­i­ty. Although they are cer­tain­ly fix­able prob­lems, fix­ing them requires mon­ey, which requires action by Con­gress.

Though some of this insta­bil­i­ty can be attrib­uted to hype from insur­ers seek­ing to max­i­mize gov­ern­ment sub­si­dies and pay­ments to off­set risk, sev­er­al firms do run in the red now with the expec­ta­tion that they’ll be in good posi­tion to make mon­ey when the mar­ket set­tles down.

What’s the incen­tive for them to con­tin­ue to insure peo­ple if they believe the mar­ket will no longer exist—or if they believe that the tax cred­its in a Repub­li­can replace­ment plan are less than what they receive now? Insur­ance plans have to decide by May of 2017 if they’ll par­tic­i­pate in the exchanges, and it might not be a sur­prise to see insur­ers with small­er enrollee bases or high­er loss­es bow out. Also, those plans that do stay can pass on the costs of increased uncer­tain­ty in the mar­kets in the form of increased pre­mi­ums, which would cost the fed­er­al gov­ern­ment and enrollees even more mon­ey.

At Mar­ket­Watch, for­mer health-insur­ance exec­u­tive J.B. Sil­vers explains how this might all work in prac­tice:

Some in Con­gress seem to think that pass­ing the “repeal” part imme­di­ate­ly but delay­ing its imple­men­ta­tion for two or three years will some­how leave every­thing as it is now. But this naive notion miss­es the fact that the risk­i­ness of the Oba­macare indi­vid­ual insur­ance exchange mar­kets will have been ramped up to such a lev­el that con­tin­u­ing makes no sense.

Even if a com­pa­ny reach­es break-even in the “delay” years, it will lose when the repeal is effec­tive. If the pre­mi­um sub­si­dies now avail­able to low­er-income enrollees go away imme­di­ate­ly and the man­date to sign up for an insur­ance plan dis­ap­pears, then the num­ber of peo­ple pur­chas­ing indi­vid­ual poli­cies on the exchanges will drop like a rock. In fact, it is clear that even debat­ing this sce­nario is like­ly to be self-ful­fill­ing, since insur­ers must decide on their par­tic­i­pa­tion for 2018 by the late spring of 2017. Look for many to leave then.

A plan to repeal and delay would also like­ly have some effects on the indi­vid­ual man­date to pur­chase insur­ance. If that plan imme­di­ate­ly elim­i­nates the man­date, the final lever to main­tain the health of exchange risk pools evap­o­rates, and there will be much less impe­tus for health­i­er, younger peo­ple to par­tic­i­pate in them. Even if the plan phas­es the man­date out over time, news of a repeal might be eas­i­ly mis­con­strued as elim­i­nat­ing the man­date, which could still spur mil­lions of healthy peo­ple to leave the exchanges and penal­ize them at tax time next year for doing so. At the same time, even the rumor of a repeal can send mil­lions of sick­er peo­ple into the exchanges to receive some kind of vital ser­vices before the well runs dry, which are bound by law to cov­er them. In fact, this may already have hap­pened. As long as an indef­i­nite pur­ga­to­ry between repeal and replace­ment exists, adverse selec­tion will be impos­si­ble to fix, as would be the “death spi­ral.”

The worst-case sce­nario would be the large-scale with­draw­al of insur­ers from mar­kets and the inver­sion of risk pyra­mids, with sick­er and sick­er patients seek­ing cov­er­age while they can. With­out avail­able insur­ers or a pub­lic option, peo­ple with­out employ­er cov­er­age or who make too much to qual­i­fy for Med­ic­aid might just not have any insur­ance to buy. If Con­gress and state gov­ern­ments don’t active­ly enforce “rate review” and med­ical-loss ratio rules that give states over­sight over large pre­mi­um increas­es and man­date that insur­ance plans spend a cer­tain per­cent­age of pre­mi­ums on health­care, insur­ers could enter mar­kets that don’t have plans and raise pre­mi­ums for vul­ner­a­ble peo­ple who need insur­ance most. Alter­na­tive­ly, short-term insurers—which already prof­it on the man­date despite pro­vid­ing bare­bones ser­vices that don’t qual­i­fy as full plans—could con­tin­ue to fill in the gaps.

Mil­lions of peo­ple in the exchanges may have to change insur­ance or enter the ranks of the unin­sured. And though the delay may not imme­di­ate­ly affect peo­ple with employ­er cov­er­age or pub­lic cov­er­age, down­stream chal­lenges for insur­ers in exchanges could affect the prod­ucts they offer for those mar­kets. None of this would be good polit­i­cal­ly for Repub­li­cans, who already have to con­tend with a vot­er base that actu­al­ly kind of likes hav­ing insur­ance. Com­pare that sce­nario to the polit­i­cal dam­age that Democ­rats suf­fered in the 2016 elec­tions over much less dire and far-reach­ing prob­lems. Repub­li­cans could pin these woes on Oba­macare itself, but then their inabil­i­ty to fix those woes despite cam­paign­ing on promis­es to do just that could come back to haunt them.

...

“Mil­lions of peo­ple in the exchanges may have to change insur­ance or enter the ranks of the unin­sured. And though the delay may not imme­di­ate­ly affect peo­ple with employ­er cov­er­age or pub­lic cov­er­age, down­stream chal­lenges for insur­ers in exchanges could affect the prod­ucts they offer for those mar­kets. None of this would be good polit­i­cal­ly for Repub­li­cans, who already have to con­tend with a vot­er base that actu­al­ly kind of likes hav­ing insur­ance. Com­pare that sce­nario to the polit­i­cal dam­age that Democ­rats suf­fered in the 2016 elec­tions over much less dire and far-reach­ing prob­lems. Repub­li­cans could pin these woes on Oba­macare itself, but then their inabil­i­ty to fix those woes despite cam­paign­ing on promis­es to do just that could come back to haunt them.”

Yep, all the uncer­tain­ty (i.e. addi­tion­al risk) that the GOP’s ‘repeal and replace (at some unde­ter­mined point in some unde­ter­mined form)’ scheme intro­duces into the insur­ance mar­ket­place might not only lead to ris­ing pre­mi­ums, few­er options, and dropped cov­er­age in Oba­macare. That chaos could start bleed­ing into the rest of the insur­ance mar­kets. All that blame that Trump warned the GOP to make the Democ­rats “own” could be a lot more blame than the GOP is cur­rent­ly expect­ing. And prob­a­bly a lot more blame than Trump is expect­ing too since he does­n’t appear to actu­al­ly know any­thing mean­ing­ful about health care or pol­i­cy in gen­er­al.

And that all points to a rather fas­ci­nat­ing polit­i­cal dynam­ic that we could see emerge: The GOP knows it’s about to cre­ate a bad sit­u­a­tion that’s set to get worse and it knows it might get the blame but also might be able to trans­fer that blame onto the Democ­rats if it’s gets the optics right. And that means the GOP knows it’s going to have to ded­i­cate a good deal of its polit­i­cal mes­sag­ing on cre­at­ing the kinds of memes that will cause the pub­lic to blame Oba­ma and the Democ­rats when things pre­dictably go awry. And that means we just might see a sit­u­a­tion where the GOP repeals Oba­macare soon and then spends the next four years cam­paign­ing against Oba­macare like they’ve done for the last sev­en years. Sure, that would seem real­ly odd giv­en the sit­u­a­tion, but it’s an odd sit­u­a­tion. But if the GOP does pur­sue that course of action (or, rather, course of inac­tion), the sit­u­a­tion gets weird­er and more per­ilous for the GOP. Why? Because the GOP is going to have a big incen­tive to keep talk­ing about how things were get­ting worse with Oba­macare before Trump and the GOP took over...without remind­ing the pub­lic of all the ways the GOP worked to ensure things would get worse for Oba­macare

...
Even in 2016 before Don­ald Trump’s pres­i­den­cy became viable and the threat of an Oba­macare repeal became real, the exchanges had grown increas­ing­ly unsta­ble and brit­tle. The admin­is­tra­tion had dif­fi­cul­ty in attract­ing younger, health­i­er peo­ple to sign up, so enrollees were sick­er and riski­er than expect­ed. Although stake­hold­ers expect­ed risk to be high as the coun­try adjust­ed to a brand-new health­care par­a­digm and the indi­vid­ual man­date pushed strag­glers into exchanges, Con­gress lat­er autho­rized low­er pay­ments than expect­ed to off­set that risk. The high­ly-pub­li­cized pre­mi­um increas­es of exchange plans and the with­draw­al of major insur­ers like Aet­na were signs of this inher­ent insta­bil­i­ty. Although they are cer­tain­ly fix­able prob­lems, fix­ing them requires mon­ey, which requires action by Con­gress.

...

“Although stake­hold­ers expect­ed risk to be high as the coun­try adjust­ed to a brand-new health­care par­a­digm and the indi­vid­ual man­date pushed strag­glers into exchanges, Con­gress lat­er autho­rized low­er pay­ments than expect­ed to off­set that risk. The high­ly-pub­li­cized pre­mi­um increas­es of exchange plans and the with­draw­al of major insur­ers like Aet­na were signs of this inher­ent insta­bil­i­ty.”

Yep, those ris­ing pre­mi­ums that the GOP loved to com­plain about were due, in large part, to the fact that Con­gress killed the sub­si­dies designed to avoid large hikes in pre­mi­ums. But, of course, it was­n’t “Con­gress” that did do that. It was the GOP. And while Sen­a­tor Mar­co Rubio was fond of tak­ing sole cred­it dur­ing his pres­i­den­tial run for the loss of the sub­si­dies that made be pre­mi­um hikes a cer­tain­ty, it was actu­al­ly a GOP group effort that ensured those pre­mi­um hikes:

The Wash­ing­ton Post

Rubio’s inac­cu­rate claim that he ‘insert­ed’ a pro­vi­sion restrict­ing Oba­macare ‘bailout’ funds

By Glenn Kessler
Decem­ber 23, 2015

“On Oba­macare, some Repub­li­cans gave up. Some talked tough but got nowhere. For all the Repub­li­can talk about dis­man­tling the Afford­able Care Act, one Repub­li­can hope­ful has actu­al­ly done some­thing.”

— voiceover of new ad by pro-Sen. Mar­co Rubio group, Con­ser­v­a­tive Solu­tions PAC

“I’m the only one run­ning for pres­i­dent that’s ever scored a vic­to­ry against Oba­macare. And I didn’t do it with a lot of fan­fare, I just did it.… Last year, these com­pa­nies lost mon­ey and they came to the gov­ern­ment and said, where’s the bailout mon­ey you promised us in the law? It would’ve been about two and half bil­lion dol­lars. And the gov­ern­ment said, ‘We don’t have that mon­ey because Mar­co Rubio insert­ed, in the end-of-the-year bud­get, a pro­vi­sion. He was able to work to ensure this pro­vi­sion got in, that took away the bailout mon­ey.’”

— Rubio, speech in Mus­ca­tine, Iowa, Dec. 17, 2015

This is a sto­ry about a media nar­ra­tive, abet­ted by a pres­i­den­tial cam­paign, that has unfair­ly mis­di­rect­ed the cred­it for one of the most impor­tant blows against the Afford­able Care Act.

Indeed, the sec­ond part of the voiceover in the Super PAC ad comes direct­ly from a New York Times arti­cle that, in its first sen­tence, said that Rubio had “slipped into a giant spend­ing bill” in 2014 a “lit­tle-noticed health care pro­vi­sion” that had under­mined con­fi­dence in Oba­macare. The ad quotes oth­er news reports as well.

Mean­while, Rubio also has claimed that he insert­ed key lan­guage in the bud­get bill.

In real­i­ty, in the sausage mak­ing of the law, Rubio didn’t make the sausage that has wound­ed the law. He had want­ed to make a dif­fer­ent sausage. But through deft mar­ket­ing, he man­aged to slap his name on this one.

So far, with the excep­tion of a care­ful report in the Asso­ci­at­ed Press, much of the media have got­ten this sto­ry wrong.

The Facts

At issue is some­thing called “risk cor­ri­dors” — a pro­vi­sion of the mas­sive law that was intend­ed to pro­tect insur­ance com­pa­nies from loss­es if they did not prop­er­ly esti­mate pre­mi­ums in the ini­tial three years of the law. Com­pa­nies that esti­mat­ed cor­rect­ly — and had what were deemed as excess prof­its — would pay fees to help under­write at least some of the cost of help­ing the insur­ance com­pa­nies that had stum­bled.

While some health-care experts say risk cor­ri­dors are an impor­tant fea­ture to smooth out the tran­si­tion to the new law, Repub­li­cans opposed such pay­ments as a bailout for poor­ly run insur­ance com­pa­nies — or ones that delib­er­ate­ly under­priced their prod­ucts, know­ing they would get gov­ern­ment funds. Rubio in 2013 intro­duced a bill to elim­i­nate the pro­vi­sion, but like oth­er Oba­macare repeal efforts, his pro­pos­al went nowhere.

It’s worth not­ing that Rubio does not sit on any com­mit­tees involved with health-care pol­i­cy. And it is in the com­mit­tees that the real busi­ness of leg­is­la­tion often is done.

On Feb. 5, 2014, the House Com­mit­tee on Over­sight and Gov­ern­ment Reform held a hear­ing on the “insur­ance com­pa­ny bailout.” Rubio tes­ti­fied on behalf of the bill he had filed. In a blow to GOP efforts, the Con­gres­sion­al Bud­get Office released an esti­mate the day before the hear­ing that the risk cor­ri­dor pro­vi­sion would earn $8 bil­lion for the U.S. gov­ern­ment.

But a House probe that year actu­al­ly sug­gest­ed claims would exceed pay­ments. Mean­while, Sen. Jeff Ses­sions (R‑Ala.), then rank­ing mem­ber of the Bud­get Com­mit­tee, and Rep. Fred Upton (R‑Mich.), chair­man of the Ener­gy and Com­merce Com­mit­tee, came up with a new strat­e­gy of attack­ing the legal­i­ty of the pay­ments. They also enlist­ed the help of then-Rep. Jack Kingston (R‑Ga.), who chaired the appro­pri­a­tions pan­el that funds the Depart­ment of Health and Human Ser­vices and the Labor Depart­ment.

The law­mak­ers ques­tioned whether the pay­ments were actu­al­ly appro­pri­at­ed cor­rect­ly — forc­ing the admin­is­tra­tion to make changes that ulti­mate­ly allowed the law­mak­ers to check­mate the admin­is­tra­tion. In effect, the Cen­ters for Medicare and Med­ic­aid Ser­vices (CMS) was forced to admit that the ACA did not auto­mat­i­cal­ly appro­pri­ate the funds, but it was sub­ject to dis­cre­tion of Con­gress. (A Gov­ern­ment Account­abil­i­ty Office opin­ion request­ed by Ses­sions and Upton backed up much of the GOP con­tention.)

So the admin­is­tra­tion, which had assert­ed that the risk-cor­ri­dor funds came from manda­to­ry spend­ing, des­ig­nat­ed the mon­ey as dis­cre­tionary. Offi­cials made a num­ber of oth­er changes, such as clas­si­fy­ing the pay­ments as “user fees,” in an effort retain the author­i­ty to spend the mon­ey. But if col­lec­tions fell short, as Repub­li­cans expect­ed, then the admin­is­tra­tion would need approval for the mon­ey from Con­gress.

“Suc­cess­ful­ly argu­ing that the ACA did not appro­pri­ate mon­ey for the risk-cor­ri­dor pro­gram is what ulti­mate­ly restrict­ed pay­ments to insur­ers,” said Paul Win­free, at the time a Ses­sions staff aide.

The stage was set for Kingston to slip in a sen­tence — Sec­tion 227 — in mas­sive spend­ing bill that said that no funds in the spend­ing bill could be used for risk-cor­ri­dor pay­ments. This blocked the admin­is­tra­tion from obtain­ing the nec­es­sary funds from oth­er pro­grams.

Kingston says the con­fer­ence nego­ti­a­tion con­sist­ed of basi­cal­ly him and his Sen­ate coun­ter­part, then-Sen. Tom Harkin (D‑Iowa). “I think it was not seen as a big issue,” Kingston said. “He had won on so many things,” par­tic­u­lar­ly on labor issues. So Kingston offered up a health-care request. “Part of these nego­ti­a­tions is you don’t get every­thing you want­ed.”

Indeed, law­mak­ers and staff mem­bers say, stealth was essen­tial for suc­cess, which is why they kept qui­et about their achieve­ment. Ses­sions, Upton and Kingston did not issue news releas­es — but Rubio did, say­ing the pro­vi­sion was “a step in the right direc­tion.”

Kingston’s maneu­ver ulti­mate­ly left a $2.5 bil­lion short­fall in the risk-cor­ri­dor pro­gram in 2015, as the admin­is­tra­tion only col­lect­ed $362 mil­lion in user fees — and insur­ers who mis­judged the mar­ket sought near­ly $2.9 bil­lion in pay­ments. Near­ly a dozen non­prof­it insur­ance coop­er­a­tives have failed as a result.

...

“Indeed, law­mak­ers and staff mem­bers say, stealth was essen­tial for suc­cess, which is why they kept qui­et about their achieve­ment. Ses­sions, Upton and Kingston did not issue news releas­es — but Rubio did, say­ing the pro­vi­sion was “a step in the right direc­tion.””

That’s right, stealth was essen­tial for the suc­cess of the GOP move to neuter one of the key Oba­macare pro­vi­sions that kept pre­mi­ums in check, and that same stealth is going to be required going for­ward if the GOP does­n’t have a replace­ment soon. Those pre­mi­ums are going to keep on ris­ing extra fast until there’s a replace­ment plan and it’s all thanks to the GOP’s stealth move. But because there’s been almost no cov­er­age of the role the GOP played in kneecap­ping Oba­macare, pre­vent­ing the pub­lic from dis­cov­er­ing that fun-fact is going to be a key object for the GOP going for­ward. And the GOP is still going to have to keep talk­ing about how bad things were going for Oba­macare before Trump won in order to deflect the blame for future prob­lems.

If they spend too much time “look­ing back” at Oba­macare they risk bring­ing light to the dom­i­nant role the GOP played in the plans fail­ures but if they don’t invest time and pub­lic mes­sag­ing in con­tin­u­ing to decry Oba­macare they risk the oppor­tu­ni­ty to make the Democ­rats “own” the fore­see­able dis­as­ter that ‘repeal and replace (with some­thing hor­ri­ble)’ is going to be. The GOP is pret­ty adept at thread­ing a nee­dle of lies but this is going to be a tricky one.

Oh isn’t this pre­cious: Grover Norquist was cel­e­brat­ing the repeal of Oba­macare on “Morn­ing Joe” recent­ly and said some­thing that real­ly needs to be high­light­ed. Not because it’s true but one of the biggest ele­ments of the grand GOP scam that’s about to be pulled off with the repeal of Oba­macare: Grover Norquist actu­al­ly claimed that once Oba­macare is repealed there will not be the “con­tin­u­ing increase of the debt decades in and decades out”. He actu­al­ly said that with a straight face:

News­max

Grover Norquist: Cut­ting Oba­macare Means Cut­ting Tax­es

By Sandy Fitzger­ald | Tues­day, 10 Jan 2017 12:34 PM

Repeal­ing all the tax­es on Oba­macare could mark the the major reform of an “enti­tle­ment,” Grover Norquist, pres­i­dent of Amer­i­cans for Tax Reform, said Tues­day morn­ing.

“Oba­ma is 20 tax­es with a stetho­scope attached to it,” Norquist told MSNBC’s “Morn­ing Joe” pro­gram. “It’s $1 tril­lion in tax­es and more than $1 tril­lion in spend­ing that was going to con­tin­ue to blow out the debt.”

And once Oba­macare is repealed, as is expect­ed with Repub­li­can majori­ties in both con­gres­sion­al cham­bers and the White House, there will not be the “con­tin­u­ing increase of the debt decades in and decades out,” said Norquist.

“That is a reform of an enti­tle­ment,” he told the pro­gram. “It’s repeal­ing the enti­tle­ment that Oba­ma put in with two mis­state­ments, one that you’d still be able to keep your doc­tor and your insur­ance, which was­n’t true, and the oth­er was that he would­n’t pay for it with tax­es on mid­dle-income peo­ple. The tax­es to pay for Oba­macare dra­mat­i­cal­ly hit mid­dle-income peo­ple, flex­i­ble sav­ings accounts and so on.”

...

“And once Oba­macare is repealed, as is expect­ed with Repub­li­can majori­ties in both con­gres­sion­al cham­bers and the White House, there will not be the “con­tin­u­ing increase of the debt decades in and decades out,” said Norquist.”

Did you hear about Oba­macare is just destroy­ing the deficit? Yeah, prob­a­bly not. Of all the evils the GOP ascribed to Oba­macare over the years, whether they claimed it’s destroy­ing the econ­o­my or destroy health care, you did­n’t actu­al­ly hear them claim Oba­macare was destroy­ing the bud­get deficit. And there’s a good rea­son you did­n’t hear them make such a claim: if left in place, Oba­macare is on track to save the gov­ern­ment tril­lions of dol­lars in com­ing years. Which prob­a­bly has some­thing to do with the fact that the GOP just banned the Con­gres­sion­al Bud­get Office from report­ing on the cost of repeal­ing Oba­macare:

Politi­cusUSA

GOP Pro­hibits CBO From Report­ing How Much ACA Repeal Blows Up the Deficit

The new Repub­li­can rule implic­it­ly instructs the CBO not to say how much it will cost tax­pay­ers to repeal Oba­macare, because it is fright­en­ing.

By Rmuse on Wed, Jan 11th, 2017 at 6:43 pm

Some Amer­i­cans may recall that dur­ing the cam­paign Trump pledged to change libel laws to silence jour­nal­ists who write sto­ries that expose his lies or “run afoul of his ide­o­log­i­cal agen­da.” Repub­li­cans in the House, not to be out­done by the likes of a big-time wrestling celebri­ty like Trump, res­ur­rect­ed an old rule that gives them, includ­ing indi­vid­ual leg­is­la­tors, unchal­lenged author­i­ty to inter­ro­gate, fire or slash any fed­er­al employee’s salary to $1 for even dar­ing to run afoul of their “ide­o­log­i­cal agen­da.” It is curi­ous that Repub­li­cans hate rules, reg­u­la­tions, and laws unless they serve to either silence dis­sent and oppo­si­tion or con­ceal their devi­ous machi­na­tions that are detri­men­tal to the pop­u­la­tion.

That is exact­ly the case of House Repub­li­cans who insert­ed two short para­graphs into their “new rules” that for­bid a fed­er­al agency from doing the job it was cre­at­ed to do. Before Koch Repub­li­cans took con­trol of both hous­es of Con­gress, the once non-par­ti­san and “inde­pen­dent” Con­gres­sion­al Bud­get Office’s (CBO) role was per­form­ing an accu­rate and unbi­ased cost analy­sis of any kind of leg­is­la­tion or pol­i­cy imple­men­ta­tion to the Amer­i­can tax­pay­ers. It was about the only means of keep­ing Con­gress hon­est about leg­is­la­tion regard­ing any kind of cut­ting or spend­ing.

Not that any­one cared at the time, that impor­tant CBO task was dimin­ished last year when House Speak­er Paul Ryan changed the CBO’s rules forc­ing them to use a “trick­le down” account­ing scam to con­ceal the out­ra­geous cost to tax­pay­ers of tax cuts for the rich and cor­po­ra­tions about to be imple­ment­ed. This lat­est “change” seri­ous­ly neuters the CBO and pro­hibits them from even exam­in­ing, much less report­ing to tax­pay­ers, the very sig­nif­i­cant cost the tax­pay­ers will bear for repeal­ing the Afford­able Care Act (Oba­macare).

Buried on page 25 of the Repub­li­cans’ new rules (pdf) for the Koch-era Con­gress is a sub­sec­tion with explic­it instruc­tions to the direc­tor of the CBO to per­form a 10-year cost analy­sis of each bill report­ed by the House.

“The Direc­tor of the Con­gres­sion­al Bud­get Office shall, to the extent prac­ti­ca­ble, pre­pare an esti­mate of whether a bill or joint res­o­lu­tion report­ed by a com­mit­tee (oth­er than the Com­mit­tee on Appro­pri­a­tions), or amend­ment there­to or con­fer­ence report there­on, would cause, rel­a­tive to cur­rent law, a net increase in direct spend­ing in excess of $5,000,000,000 in any of the 4 con­sec­u­tive 10 fis­cal year peri­ods begin­ning with the first fis­cal year that is 10 fis­cal years after the cur­rent fis­cal year.”

There is real­ly noth­ing new in those instruc­tions except for one new Repub­li­can “lim­i­ta­tion” that says:

“This sub­sec­tion shall not apply to any bill or joint res­o­lu­tion, or amend­ment there­to or con­fer­ence report there­on—

(A) repeal­ing the Patient Pro­tec­tion and Afford­able Care Act and title I and sub­ti­tle B of title II of the Health Care and Edu­ca­tion Afford­abil­i­ty Rec­on­cil­i­a­tion Act of 2010;

(B) reform­ing the Patient Pro­tec­tion and Afford­able Care Act and the Health Care and Edu­ca­tion Afford­abil­i­ty Rec­on­cil­i­a­tion Act of 2010.” (author bold)

What that means in a lit­tle plain­er lan­guage is that the new Repub­li­can rule “specif­i­cal­ly instructs the CBO not to say how much it will cost tax­pay­ers to repeal Oba­macare.” The rea­son Repub­li­cans have offi­cial­ly pro­hib­it­ed the CBO from report­ing how cost­ly repeal­ing the ACA (Oba­macare) is because the last CBO “cost analy­sis of repeal­ing Oba­macare” (2015) found it would increase the deficit by $353 bil­lion. It is an impor­tant point because besides unnec­es­sar­i­ly strip­ping health­care from tens-of-mil­lions of Amer­i­cans and increas­ing the deficit, Repub­li­cans will use “bud­get rec­on­cil­i­a­tion” to repeal the health­care law that requires any leg­is­la­tion that increas­es the deficit to expire after 10 years. It is pre­cise­ly why the Bush-era tax cuts for the rich had to expire after 10 years; they blew up the deficit and Repub­li­cans knew it was going to hap­pen just like they know that repeal­ing the ACA will.

If there is no CBO cost analy­sis on the repeal and how much it increas­es the deficit, there is no “require­ment” for the legislation’s expi­ra­tion after 10 years. And, if there is no inde­pen­dent analy­sis, Amer­i­cans will nev­er learn how dev­as­tat­ing “Oba­macare” repeal will be to Medicare’s long term sol­ven­cy that was extend­ed a cou­ple of decades because of the Afford­able Care Act’s exe­cu­tion.

In fact, the Fis­cal Times report­ed that repeal­ing the Afford­able Care Act is the death knell for Medicare and could spur its bank­rupt­cy; exact­ly what Repub­li­cans want as part of their “lie” that any gov­ern­ment pro­gram except defense is a fail­ure and cost­ly.

The last thing deceit­ful Repub­li­cans want Amer­i­cans to learn is that not only will 20-plus mil­lion Amer­i­cans lose their access to health­care with the health law’s repeal, it will cost them dear­ly now and increase the deficit to sat­is­fy their nasty “ide­o­log­i­cal agen­da.” This stunt is beyond just “omit­ting incon­ve­nient infor­ma­tion” tax­pay­ers deserve to know, and it is not “fis­cal reck­less­ness;” it is sheer and delib­er­ate deceit which is appar­ent­ly a manda­to­ry require­ment to serve as a Repub­li­can politi­cian.

“What that means in a lit­tle plain­er lan­guage is that the new Repub­li­can rule “specif­i­cal­ly instructs the CBO not to say how much it will cost tax­pay­ers to repeal Oba­macare.” The rea­son Repub­li­cans have offi­cial­ly pro­hib­it­ed the CBO from report­ing how cost­ly repeal­ing the ACA (Oba­macare) is because the last CBO “cost analy­sis of repeal­ing Oba­macare” (2015) found it would increase the deficit by $353 bil­lion. It is an impor­tant point because besides unnec­es­sar­i­ly strip­ping health­care from tens-of-mil­lions of Amer­i­cans and increas­ing the deficit, Repub­li­cans will use “bud­get rec­on­cil­i­a­tion” to repeal the health­care law that requires any leg­is­la­tion that increas­es the deficit to expire after 10 years. It is pre­cise­ly why the Bush-era tax cuts for the rich had to expire after 10 years; they blew up the deficit and Repub­li­cans knew it was going to hap­pen just like they know that repeal­ing the ACA will.”

If the Con­gres­sion Bud­get Office con­cludes that repeal­ing Oba­macare would increase the deficit by $353 bil­lion annu­al­ly, just ban that agency from mak­ing such a con­clu­sion again. And trot out deceivers like Grover Norquist to lie to Amer­i­cans in the media. That’s the Repub­li­can way. And now the Amer­i­can way. For now at least.

Although it’s worth not­ing that there is actu­al­ly one sce­nario where the repeal of Oba­macare does end up sav­ing the gov­ern­ment mon­ey: Don’t repeal it entire­ly. Yes, repeal things like the Med­ic­aid expan­sion or more mon­ey for chil­dren’s health care. But don’t repeal one crit­i­cal ele­ment that’s help­ing to save tril­lions in the long run and shore up Medicare: the reduced Medicare pay­ments that came as a com­pro­mise for expand­ed cov­er­age. That was part of the grand bar­gain with the health care indus­try to low­er long-term growth: Medicare pay­ments would be reduced per patient, but more peo­ple would be cov­ered so health care providers would have high­er vol­ume and few­er unin­sured peo­ple. So if the GOP decides to repeal all the ben­e­fits like the Med­ic­aid expan­sion and chil­dren’s health care, but keeps the Medicare cuts, that could save some mon­ey by turn­ing the Oba­macare repeal into a rever­sion to the pre-Obamacare-era...with a return to much high­er lev­els of unin­sured peo­ple. And addi­tion­al mas­sive Medicare cuts on top of it:

The Wash­ing­ton Exam­in­er

CBO: Repeal­ing Oba­macare parts would save $1.2 tril­lion

By Robert King • 12/8/16 4:26 PM

Repeal­ing the insur­ance cov­er­age parts of Oba­macare would save the fed­er­al gov­ern­ment $1.2 tril­lion over the next decade, accord­ing to a report from the Con­gres­sion­al Bud­get Office.

The non­par­ti­san office released a report Thurs­day that found repeal­ing the health­care law’s sub­si­dies for health insur­ance cov­er­age and pay­ing for the Med­ic­aid expan­sion would save mon­ey. How­ev­er, the num­ber of unin­sured would soar from 28 mil­lion to 51 mil­lion in 2026.

The CBO report­ed that the largest amounts of sav­ings would come from reduc­ing fed­er­al spend­ing for Med­ic­aid and the Chil­dren’s Health Insur­ance Pro­gram at $950 bil­lion. Repeal­ing Oba­macare’s pre­mi­um sub­si­dies could save the fed­er­al gov­ern­ment about $794 bil­lion over a decade. In total, the fed­er­al gov­ern­ment would be expect­ed to save about $1.7 tril­lion by elim­i­nat­ing the Med­ic­aid spend­ing and pre­mi­um sub­si­dies.

How­ev­er, it would lose near­ly $500 bil­lion in rev­enue from the indi­vid­ual man­date’s penal­ty for not get­ting insur­ance and the penal­ties on employ­ers for not giv­ing insur­ance to every employ­ee.

Even though the esti­mate only focus­es on Oba­macare insur­ance cov­er­age, the law also includ­ed cuts to pro­ject­ed Medicare spend­ing. Repeal­ing the law in its entire­ty — thus tak­ing away those cuts as well as addi­tion­al tax increas­es — would change the deficit cal­cu­la­tions. A 2015 CBO report said full repeal would add $353 bil­lion to deficits.

...

Sev­er­al top Repub­li­cans have said they want to use a pro­ce­dur­al move called rec­on­cil­i­a­tion that would allow the Sen­ate to pass a repeal bill and avoid a fil­i­buster. Con­gress would give itself two to three years to adopt a replace­ment, but Repub­li­cans haven’t reached a con­sen­sus on a replace­ment plan.

“The CBO report­ed that the largest amounts of sav­ings would come from reduc­ing fed­er­al spend­ing for Med­ic­aid and the Chil­dren’s Health Insur­ance Pro­gram at $950 bil­lion. Repeal­ing Oba­macare’s pre­mi­um sub­si­dies could save the fed­er­al gov­ern­ment about $794 bil­lion over a decade. In total, the fed­er­al gov­ern­ment would be expect­ed to save about $1.7 tril­lion by elim­i­nat­ing the Med­ic­aid spend­ing and pre­mi­um sub­si­dies.”

Well there we go! Grover Norquist’s fan­ta­sy of the Oba­macare repeal actu­al­ly reduc­ing the deficit real­ly can come true. As long as we’re will­ing to take the expan­sion Med­ic­aid from the work­ing poor and slash­ing fund­ing for poor chil­dren. And, for course, also tak­ing away the Oba­macare pre­mi­um sub­si­dies for the rest of the work­ing poor that weren’t cov­ered by Med­ic­aid. And keep­ing those Medicare cuts too, so health­care providers will get the reduced per-patient pay­ments but with­out the increased vol­ume to make up for the reduced pay­ments. As long as we do that, repeal­ing Oba­macare by aban­don­ing the poor and keep­ing the Medicare cuts might actu­al­ly save mon­ey. But if those Medicare cuts are repealed too, that project $1.2 tril­lion in sav­ings over a decade turns into an addi­tion­al $353 bil­lion annu­al­ly to the deficit (or $3.5 tril­lion over a decade):

...
Even though the esti­mate only focus­es on Oba­macare insur­ance cov­er­age, the law also includ­ed cuts to pro­ject­ed Medicare spend­ing. Repeal­ing the law in its entire­ty — thus tak­ing away those cuts as well as addi­tion­al tax increas­es — would change the deficit cal­cu­la­tions. A 2015 CBO report said full repeal would add $353 bil­lion to deficits.

...

So that’s all some­thing to keep in mind when you hear folks like Grover Norquist talk about how repeal­ing Oba­macare could save the gov­ern­ment mon­ey. Sure, it could, but only as long as you repeal every­thing but the Medicare cuts and turn the “Oba­macare repeal” into an “Oba­macare repeal plus Medicare cuts”.

One of the inter­est­ing ques­tions raised by the GOP’s deci­sion to ban the Con­gres­sion­al Bud­get Office (CBO) from fore­cast­ing the bud­get con­se­quences of the GOP’s repeal and replace­ment plans for Oba­macare is whether or not that move by the GOP was a sig­nal that the GOP’s replace­ment is going to swell the deficit pri­mar­i­ly because of the tax cuts that come with repeal­ing Oba­macare or if the GOP is plan­ning on replac­ing it with a plan that real­ly would harm the deficit because of both the tax cuts plus addi­tion­al Oba­macare ben­e­fits they keep.

It’s an inter­est­ing ques­tion but a ques­tion urgent­ly in need of an answer. And fol­low­ing the recent inter­view of Don­ald Trump where he promised that there would be ‘insur­ance for every­one’ that would be ‘bet­ter and cheap­er’ every­one while pledg­ing to use the pow­ers of twit­ter to com­pel the Con­gress to repeal and replace Oba­macare soon it’s a much more urgent:

The Wash­ing­ton Post

Trump vows ‘insur­ance for every­body’ in Oba­macare replace­ment plan

By Robert Cos­ta and Amy Gold­stein
Jan­u­ary 15 at 10:00 PM

Pres­i­dent-elect Don­ald Trump said in a week­end inter­view that he is near­ing com­ple­tion of a plan to replace Pres­i­dent Obama’s sig­na­ture health-care law with the goal of “insur­ance for every­body,” while also vow­ing to force drug com­pa­nies to nego­ti­ate direct­ly with the gov­ern­ment on prices in Medicare and Med­ic­aid.

Trump declined to reveal specifics in the tele­phone inter­view late Sat­ur­day with The Wash­ing­ton Post, but any pro­pos­als from the incom­ing pres­i­dent would almost cer­tain­ly dom­i­nate the Repub­li­can effort to over­haul fed­er­al health pol­i­cy as he pre­pares to work with his party’s con­gres­sion­al majori­ties.

Trump’s plan is like­ly to face ques­tions from the right, after years of GOP oppo­si­tion to fur­ther expan­sion of gov­ern­ment involve­ment in the health-care sys­tem, and from those on the left, who see his ideas as dis­rup­tive to changes brought by the Afford­able Care Act that have extend­ed cov­er­age to tens of mil­lions of Amer­i­cans.

In addi­tion to his replace­ment plan for the ACA, also known as Oba­macare, Trump said he will tar­get phar­ma­ceu­ti­cal com­pa­nies over drug prices.

“They’re polit­i­cal­ly pro­tect­ed, but not any­more,” he said of phar­ma­ceu­ti­cal com­pa­nies.

The objec­tives of broad­en­ing access to insur­ance and low­er­ing health-care costs have always been in con­flict, and it remains unclear how the plan that the incom­ing admin­is­tra­tion is design­ing — or ones that will emerge on Capi­tol Hill — would address that ten­sion.

In gen­er­al, con­gres­sion­al GOP plans to replace Oba­macare have tend­ed to try to con­strain costs by reduc­ing gov­ern­ment require­ments, such as the med­ical ser­vices that must be pro­vid­ed under health plans sold through the law’s mar­ket­places and through states’ Med­ic­aid pro­grams. House Speak­er Paul D. Ryan (R‑Wis.) and oth­er Repub­li­cans have been talk­ing late­ly about pro­vid­ing “uni­ver­sal access” to health insur­ance, instead of uni­ver­sal insur­ance cov­er­age.

Trump said he expects Repub­li­cans in Con­gress to move quick­ly and in uni­son in the com­ing weeks on oth­er pri­or­i­ties as well, includ­ing enact­ing sweep­ing tax cuts and begin­ning the build­ing of a wall along the Mex­i­can bor­der.

Trump warned Repub­li­cans that if the par­ty splin­ters or slows his agen­da, he is ready to use the pow­er of the pres­i­den­cy — and Twit­ter — to ush­er his leg­is­la­tion to pas­sage.

“The Con­gress can’t get cold feet because the peo­ple will not let that hap­pen,” Trump said dur­ing the inter­view with The Post.

Trump said his plan for replac­ing most aspects of Obama’s health-care law is all but fin­ished. Although he was coy about its details — “low­er num­bers, much low­er deductibles” — he said he is ready to unveil it along­side Ryan and Sen­ate Major­i­ty Leader Mitch McConnell (R‑Ky.).

“It’s very much for­mu­lat­ed down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump said. He not­ed that he is wait­ing for his nom­i­nee for sec­re­tary of health and human ser­vices, Rep. Tom Price (R‑Ga.), to be con­firmed. That deci­sion rests with the Sen­ate Finance Com­mit­tee, which hasn’t sched­uled a hear­ing.

Trump’s dec­la­ra­tion that his replace­ment plan is ready comes after many Repub­li­cans — mod­er­ates and con­ser­v­a­tives — expressed anx­i­ety last week about the party’s lack of a for­mal pro­pos­al as they held votes on repeal­ing the law. Once his plan is made pub­lic, Trump said, he is con­fi­dent that it could get enough votes to pass in both cham­bers. He declined to dis­cuss how he would court wary Democ­rats.

So far, Repub­li­cans have tak­en the first steps toward repeal­ing the law through bud­get rec­on­cil­i­a­tion, a process by which only a sim­ple major­i­ty is need­ed in the Sen­ate. The process would enable them to dis­man­tle aspects of the law that involve fed­er­al spend­ing.

The plan that Trump is prepar­ing will come after the House has tak­en more than 60 votes in recent years to kill all or parts of the ACA to adopt more con­ser­v­a­tive health-care poli­cies, which tend to rely more heav­i­ly on the pri­vate sec­tor.

“I think we will get approval. I won’t tell you how, but we will get approval. You see what’s hap­pened in the House in recent weeks,” Trump said, ref­er­enc­ing his tweet dur­ing a House Repub­li­can move to gut their inde­pen­dent ethics office, which along with wide­spread con­stituent out­rage was cit­ed by some mem­bers as a rea­son the gam­bit failed.

As he has devel­oped a replace­ment pack­age, Trump said he has paid atten­tion to crit­ics who say that repeal­ing Oba­macare would put cov­er­age at risk for more than 20 mil­lion Amer­i­cans cov­ered under the law’s insur­ance exchanges and Med­ic­aid expan­sion.

“We’re going to have insur­ance for every­body,” Trump said. “There was a phi­los­o­phy in some cir­cles that if you can’t pay for it, you don’t get it. That’s not going to hap­pen with us.” Peo­ple cov­ered under the law “can expect to have great health care. It will be in a much sim­pli­fied form. Much less expen­sive and much bet­ter.”

Repub­li­can lead­ers have said that they will not strand peo­ple who gained insur­ance under the ACA with­out cov­er­age. But it remains unclear from either Trump’s com­ments in the inter­view or recent remarks by GOP lead­ers on Capi­tol Hill how they intend to accom­plish that.

For con­ser­v­a­tive Repub­li­cans dubi­ous about his pledge to ensure cov­er­age for mil­lions, Trump point­ed to sev­er­al inter­views he gave dur­ing the cam­paign in which he promised to “not have peo­ple dying on the street.”

“It’s not going to be their plan,” he said of peo­ple cov­ered under the cur­rent law. “It’ll be anoth­er plan. But they’ll be beau­ti­ful­ly cov­ered. I don’t want sin­gle-pay­er. What I do want is to be able to take care of peo­ple,” he said Sat­ur­day.

Trump did not say how his pro­gram over­laps with the com­pre­hen­sive plan authored by House Repub­li­cans. Ear­li­er this year, Price sug­gest­ed that a Trump pres­i­den­cy would advance the House GOP’s health-care agen­da.

When asked in the inter­view whether he intends to cut ben­e­fits for Medicare as part of his plan, Trump said “no,” a posi­tion that was reit­er­at­ed Sun­day on ABC by Reince Priebus, Trump’s incom­ing chief of staff. He did not elab­o­rate on that view or how it would affect his pro­pos­al. He expressed that view through­out the cam­paign.

Tim­ing could be dif­fi­cult as Trump puts an empha­sis on speed. Obama’s law took more than 14 months of debate and hun­dreds of hear­ings. To urge law­mak­ers on, Trump plans to attend a con­gres­sion­al Repub­li­can retreat in Philadel­phia this month.

Mov­ing ahead, Trump said that low­er­ing drug prices is cen­tral to reduc­ing health-care costs nation­al­ly — and that he will make it a pri­or­i­ty as he uses his bul­ly pul­pit to shape pol­i­cy. When asked how exact­ly he would force drug man­u­fac­tur­ers to com­ply, Trump said that part of his approach would be pub­lic pres­sure “just like on the air­plane,” a nod to his tweets about Lock­heed Martin’s F‑35 fight­er jet, which Trump said was too cost­ly.

Trump waved away the sug­ges­tion that such activ­i­ty could lead to mar­ket volatil­i­ty on Wall Street. “Stock drops and Amer­i­ca goes up,” he said. “I don’t care. I want to do it right or not at all.” He added that drug com­pa­nies “should pro­duce” more prod­ucts in the Unit­ed States.

The ques­tion of whether the gov­ern­ment should start nego­ti­at­ing how much it pays drug­mak­ers for old­er Amer­i­cans on Medicare has long been a par­ti­san dis­pute, ever since the 2003 law that cre­at­ed Medicare drug ben­e­fits pro­hib­it­ed such nego­ti­a­tions.

Trump’s goal is uncer­tain, how­ev­er, with respect to Med­ic­aid, the insur­ance for low-income Amer­i­cans run joint­ly by the fed­er­al gov­ern­ment and states. Under what is known as a Med­ic­aid “best price” rule, phar­ma­ceu­ti­cal com­pa­nies already are required to sell drugs to Med­ic­aid as the low­est price they nego­ti­ate with any oth­er buy­er.

On his plan for tax cuts, Trump said that “we’re get­ting very close” to putting togeth­er leg­is­la­tion. His advis­ers and Ryan met last week and have been work­ing from his campaign’s plan and from con­gres­sion­al pro­pos­als to slash cur­rent rates. “It’ll prob­a­bly be 15 to 20 per­cent for cor­po­ra­tions. For indi­vid­u­als, prob­a­bly low­er. Great ­mid­dle-class tax cuts,” Trump said.

...

“Trump warned Repub­li­cans that if the par­ty splin­ters or slows his agen­da, he is ready to use the pow­er of the pres­i­den­cy — and Twit­ter — to ush­er his leg­is­la­tion to pas­sage.”

Yes, get ready for Twit­ter becom­ing the lubri­ca­tion of choice for ram­ming through Trump’s agen­da. We can’t say we weren’t warned.

And kind of demands of Con­gress will Trump be Tweet­ing? Well, the details remain unclear, but it appears to involve replac­ing Oma­macare health care cov­er­age with cheap­er, crap­pi­er cov­er­age. And also prob­a­bly repeal­ing the Med­ic­aid expan­sion. And pre­sum­ably giv­ing those peo­ple the cheap crap­py cov­er­age too. It’s unclear giv­en the lack of details:

...
Trump declined to reveal specifics in the tele­phone inter­view late Sat­ur­day with The Wash­ing­ton Post, but any pro­pos­als from the incom­ing pres­i­dent would almost cer­tain­ly dom­i­nate the Repub­li­can effort to over­haul fed­er­al health pol­i­cy as he pre­pares to work with his party’s con­gres­sion­al majori­ties.
...

As he has devel­oped a replace­ment pack­age, Trump said he has paid atten­tion to crit­ics who say that repeal­ing Oba­macare would put cov­er­age at risk for more than 20 mil­lion Amer­i­cans cov­ered under the law’s insur­ance exchanges and Med­ic­aid expan­sion.

“We’re going to have insur­ance for every­body,” Trump said. “There was a phi­los­o­phy in some cir­cles that if you can’t pay for it, you don’t get it. That’s not going to hap­pen with us.” Peo­ple cov­ered under the law “can expect to have great health care. It will be in a much sim­pli­fied form. Much less expen­sive and much bet­ter.”

Repub­li­can lead­ers have said that they will not strand peo­ple who gained insur­ance under the ACA with­out cov­er­age. But it remains unclear from either Trump’s com­ments in the inter­view or recent remarks by GOP lead­ers on Capi­tol Hill how they intend to accom­plish that.

For con­ser­v­a­tive Repub­li­cans dubi­ous about his pledge to ensure cov­er­age for mil­lions, Trump point­ed to sev­er­al inter­views he gave dur­ing the cam­paign in which he promised to “not have peo­ple dying on the street.”

“It’s not going to be their plan,” he said of peo­ple cov­ered under the cur­rent law. “It’ll be anoth­er plan. But they’ll be beau­ti­ful­ly cov­ered. I don’t want sin­gle-pay­er. What I do want is to be able to take care of peo­ple,” he said Sat­ur­day.

Trump did not say how his pro­gram over­laps with the com­pre­hen­sive plan authored by House Repub­li­cans. Ear­li­er this year, Price sug­gest­ed that a Trump pres­i­den­cy would advance the House GOP’s health-care agen­da.
...

So peo­ple sub­si­dized by Oba­macare, either through the insur­ance exchanges or the Med­ic­aid expan­sion, will get some oth­er plan that will leave them “beau­ti­ful­ly cov­ered.” And also “Much less expen­sive and much bet­ter”. That sure sounds like Trump’s plan is a lot like the GOP’s plans, which almost always revolve around reduc­ing gov­ern­ment spend­ing on health care not by low­er­ing the cost of health care, but by low­er­ing the gov­ern­men­t’s share of health care by trans­fer­ring the costs to con­sumers and the pub­lic with crap­py insur­ance cov­er­age and reduced Medicare/Medicaid cov­er­age:

...

The objec­tives of broad­en­ing access to insur­ance and low­er­ing health-care costs have always been in con­flict, and it remains unclear how the plan that the incom­ing admin­is­tra­tion is design­ing — or ones that will emerge on Capi­tol Hill — would address that ten­sion.

In gen­er­al, con­gres­sion­al GOP plans to replace Oba­macare have tend­ed to try to con­strain costs by reduc­ing gov­ern­ment require­ments, such as the med­ical ser­vices that must be pro­vid­ed under health plans sold through the law’s mar­ket­places and through states’ Med­ic­aid pro­grams. House Speak­er Paul D. Ryan (R‑Wis.) and oth­er Repub­li­cans have been talk­ing late­ly about pro­vid­ing “uni­ver­sal access” to health insur­ance, instead of uni­ver­sal insur­ance cov­er­age.
...

“Uni­ver­sal access” to crap­py, high deductible cov­er­age. That’s the GOP’s explic­it plan, and based on Trump’s skimpy details it sure sounds like it’s his plan too. Which why when you read:

...

Mov­ing ahead, Trump said that low­er­ing drug prices is cen­tral to reduc­ing health-care costs nation­al­ly — and that he will make it a pri­or­i­ty as he uses his bul­ly pul­pit to shape pol­i­cy. When asked how exact­ly he would force drug man­u­fac­tur­ers to com­ply, Trump said that part of his approach would be pub­lic pres­sure “just like on the air­plane,” a nod to his tweets about Lock­heed Martin’s F‑35 fight­er jet, which Trump said was too cost­ly.
...

you should prob­a­bly expect reduced drug cov­er­age to be as big a part of his plan to reduce health care costs as reduced drug cost will be in his plan. Reduced drug costs that pre­sum­ably come via a week of Trump Twit­ter-sham­ing the drug indus­try.
.

Also note that one of the ideas behind expand­ing qual­i­tyhealth care cov­er­age is that it can save mon­ey in the long run if you catch and address health care issues ear­li­er and treat them more cheap­ly. Or avoid them entire­ly. With qual­i­ty health care. That’s part of how Oba­macare was sup­posed to pay for itself in the long run and how sin­gle-pay­er would help pay for itself. Health care bends the health care cost curve. It’s neat how that works. So when you read:

...
The objec­tives of broad­en­ing access to insur­ance and low­er­ing health-care costs have always been in con­flict, and it remains unclear how the plan that the incom­ing admin­is­tra­tion is design­ing — or ones that will emerge on Capi­tol Hill — would address that ten­sion.

...

keep in mind that broad­en­ing access and low­er­ing health care costs aren’t in con­flict with each oth­er as long as the health care is of a qual­i­ty that catch­es and address­es issues now pre­vents them in the future. Qual­i­ty health care. But if health care qual­i­ty is low and not pre­ven­tive and health care cost reduc­tion is a zero-sum game of lia­bil­i­ty hot-pota­to, then broad­en­ing access to insur­ance and low­er­ing costs is prob­a­bly going to come pri­mar­i­ly to low­er­ing qual­i­ty of cov­er­age fur­ther.

That’s all some­thing to keep in mind as the junk pol­i­cy Trump­care gets rolled out. And don’t be sur­prised if Con­gress pass­es anoth­er spe­cial rule for the CBO: one that allows the CBO to count real­ly crap­py insur­ance as real health care insur­ance:

The Fis­cal Times

Oba­macare Repeal Will Test the Def­i­n­i­tion of ‘Insur­ance’

By Rob Garv­er
Jan­u­ary 1, 2017

Con­gres­sion­al Repub­li­cans, deter­mined to repeal the Afford­able Care Act and replace it with an as-yet unde­fined alter­na­tive, are like­ly to find them­selves wan­der­ing through a mine­field of dif­fi­cult pol­i­cy prob­lems when they return to Wash­ing­ton for the next Con­gress. These range from the fun­da­men­tal ques­tion of what actu­al­ly con­sti­tutes “health insur­ance cov­er­age” to thorny ques­tions about whether refund­able tax cred­its would actu­al­ly cre­ate the nec­es­sary incen­tive to encour­age the unin­sured to pur­chase cov­er­age.

While the Repub­li­can plan to replace the ACA isn’t ful­ly-formed yet, it seems safe to assume that it will abol­ish the indi­vid­ual man­date that requires all indi­vid­u­als to have health insur­ance, repeal the expan­sion of Med­ic­aid, slash min­i­mum cov­er­age require­ments for plans sold in the non-group mar­ket, and allow insur­ers to sell poli­cies across state lines.

Democ­rats have been warn­ing for years that the impact of this com­bi­na­tion of poli­cies could be dis­as­trous for the health insur­ance mar­ket. The indi­vid­ual man­date cre­ates a risk pool that is much health­i­er — and there­fore cheap­er to insure — than a mar­ket where those least like­ly to need health care are free to opt out.

Cut­ting min­i­mum cov­er­age require­ments will inspire health insur­ers to offer bare-bones poli­cies that do lit­tle to insu­late con­sumers from finan­cial risk relat­ed to major health prob­lems but pro­vide just enough cov­er­age to qual­i­fy for the refund­able tax cred­it cov­er­ing the pre­mi­ums. Remov­ing state-lev­el reg­u­la­tion of health insur­ance, experts warn, could accel­er­ate that race to the bot­tom.

In late Decem­ber, the Con­gres­sion­al Bud­get Office issued a warn­ing to Repub­li­cans in the form of a post to the agency’s blog. In it, authors Susan Yeh Bey­er and Jared Mae­da not­ed that the var­i­ous pro­pos­als cur­rent­ly float­ing around Capi­tol Hill would be judged by both CBO and the Joint Com­mit­tee on Tax­a­tion, which score leg­is­la­tion for law­mak­ers as great­ly reduc­ing the num­ber of Amer­i­cans with health insur­ance.

This includes the Empow­er­ing Patients First Act, put for­ward by Geor­gia Con­gress­man Tom Price, a physi­cian him­self and Pres­i­dent-elect Don­ald Trump’s nom­i­nee to run the Depart­ment of Health and Human Ser­vices.

CBO, which scores leg­is­la­tion for law­mak­ers to esti­mate costs and ben­e­fits, would not count some­one as “insured” unless they had sig­nif­i­cant pro­tec­tion against major finan­cial risk, they wrote. The pro­pos­als being aired by the GOP, by mak­ing it pos­si­ble for com­pa­nies to issue low-cov­er­age poli­cies, would like­ly leave many peo­ple out­side that cat­e­go­ry.

“If there were no clear def­i­n­i­tion of what type of insur­ance prod­uct peo­ple could use their tax cred­it to pur­chase,” they wrote, “some of those insur­ance prod­ucts would prob­a­bly not pro­vide enough finan­cial pro­tec­tion against high med­ical costs to meet the broad def­i­n­i­tion of cov­er­age that CBO and JCT have typ­i­cal­ly used in the past—that is, a com­pre­hen­sive major med­ical pol­i­cy that, at a min­i­mum, cov­ers high-cost med­ical events and var­i­ous ser­vices, includ­ing those pro­vid­ed by physi­cians and hos­pi­tals.”

Bot­tom line, they said, “CBO and JCT would not count those peo­ple with lim­it­ed health ben­e­fits as hav­ing cov­er­age.”

Some Oba­macare poli­cies are also on shaky ground in terms of con­sumers hav­ing ade­quate insur­ance cov­er­age with­out expos­ing them to major finan­cial risk. Insur­ance pre­mi­ums are ris­ing an aver­age 25 per­cent this year and deductibles for sil­ver plans will aver­age $3,572 for indi­vid­u­als, while fam­i­lies will have to cov­er $7,474 before insur­ance pays a dime.. The cheap­est Bronze plans will cost indi­vid­u­als an aver­age $6,000, while fam­i­lies will shell out $12,393 before insur­ance kicks in.

While this may seem triv­ial, a find­ing from CBO and JCT that an Oba­macare replace­ment plan would result in few­er Amer­i­cans hav­ing health insur­ance would be a polit­i­cal prob­lem for Repub­li­cans, from Trump on down, who have promised that their new plan would cov­er the same num­ber of peo­ple, but for less mon­ey.

But whether or not par­tic­u­lar poli­cies that qual­i­fy for a tax refund are actu­al­ly insur­ance in the real sense of the word is only one of the ques­tions that would have to be answered under an ACA repeal pro­gram. Anoth­er is whether refund­able tax cred­its would induce con­sumers to pur­chase health cov­er­age in the first place.

In a blis­ter­ing edi­to­r­i­al this month, the edi­tors of the New Eng­land Jour­nal of Med­i­cine argued that, at least in the con­text of Price’s Empow­er­ing Patients First Act, they would not.

The plan pro­pos­es elim­i­nat­ing the ACA’s expan­sion of Med­ic­aid and replac­ing it with tax cred­its based on age. For exam­ple, peo­ple aged 18-to-35 would receive a cred­it of $1,200 per year, while peo­ple 50 and over would receive $3,000. The pro­pos­al, accord­ing to NJEM’s edi­tors, would leave younger con­sumers pay­ing more than $2,500 out of pock­et for the most basic plan, while the bill for old­er con­sumers would approach $6,000. What’s more, the tax cred­its are not scaled to recip­i­ents’ income, mean­ing that low-earn­ing con­sumers would pay a much larg­er share of their dis­pos­able income in health insur­ance costs than high-earn­ers.

The Price tax cred­its, NJEM argues, are far too mea­ger to encour­age mass par­tic­i­pa­tion in the indi­vid­ual health insur­ance mar­ket.

“To put the plan’s sub­si­dies into per­spec­tive, con­sid­er that in 1992 when per capi­ta health expen­di­tures were just one-third of what they are today, Pres­i­dent Bush and HHS Sec­re­tary Sul­li­van pro­posed a slight­ly larg­er indi­vid­ual tax cred­it ($1,250) for the pur­chase of insur­ance than Price pro­pos­es today. Even in 1992, ana­lysts report­ed that the cred­it would be insuf­fi­cient to induce most peo­ple to buy cov­er­age.”

The editorial’s crit­i­cism of the Price plan was not lim­it­ed to the tax cred­it. It blast­ed the plan as a give­away to doc­tors at the cost of reduc­ing con­sumer pro­tec­tions.

“In sum,” they wrote, “Price’s replace­ment pro­pos­al would make it much more dif­fi­cult for low-income Amer­i­cans to afford health insur­ance. It would divert fed­er­al tax dol­lars to peo­ple who can already buy indi­vid­ual cov­er­age with­out sub­si­dies and sub­stan­tial­ly reduce pro­tec­tions for those with pre­ex­ist­ing con­di­tions. The end result would be a shaky mar­ket dom­i­nat­ed by health plans that offer lim­it­ed cov­er­age and high-cost shar­ing.”

...

“CBO, which scores leg­is­la­tion for law­mak­ers to esti­mate costs and ben­e­fits, would not count some­one as “insured” unless they had sig­nif­i­cant pro­tec­tion against major finan­cial risk, they wrote. The pro­pos­als being aired by the GOP, by mak­ing it pos­si­ble for com­pa­nies to issue low-cov­er­age poli­cies, would like­ly leave many peo­ple out­side that cat­e­go­ry.”

Yep, the GOP Con­gress is def­i­nite­ly going to need some new rules for the CBO. And say good­bye to your sub­si­dized Oba­macare insur­ance for the poor and the Med­ic­aid expan­sion and say hel­lo to crap vouch­ers and joke poli­cies.

And since Trump is basi­cal­ly fol­low­ing the GOP’s lead on this, and almost all poli­cies, and went as far as choos­ing Con­gress­man Tom Price as his Health and Human Ser­vices Sec­re­tary, it’s prob­a­bly not too soon to start say­ing good bye to most of the rest of Med­ic­aid too. And Medicare.

When Don­ald Trump select­ed Con­gress­man Tom Price as his Sec­re­tary for Health and Human Ser­vices it was pret­ty clear that mar­ket­ing was going to be a crit­i­cal ele­ment of the GOP’s replace­ment for the Afford­able Care Act (a.k.a Oba­macare). Specif­i­cal­ly, mar­ket­ing the idea to the pub­lic that hav­ing “access” to health insur­ance (i.e. there are no rules pre­vent­ing you from buy­ing coverage...but also no guar­an­tee that you’ll be able to afford it) and hav­ing “access” to “afford­able” joke insur­ance to cov­ers almost noth­ing is an ade­quate goal to sub­sti­tute for the cur­rent goal of Oba­macare which is to guar­an­tee that peo­ple have access to mean­ing­ful cov­er­age and can actu­al­ly afford it. While Oba­macare has had plen­ty of stum­bles on ensur­ing that twin goal of afford­abil­i­ty and qual­i­ty of cov­er­age, those were at least the goals of the pro­gram. And large­ly the accom­plish­ment too when you fac­tor in the Med­ic­aid expan­sion that made afford­able health care in reach for millions...at least for the states that accept­ed the Med­ic­aid expan­sion. And when Tom Price got the job at HHS it became clear that “afford­able mean­ing­ful health care ” was going to be replaced with “afford­able joke cov­er­age along with access to any­thing you can afford” on the list of pri­or­i­ty for health care reform. The only ques­tion is how they spin it to the pub­lic.

But keep in mind that most of the Amer­i­can pub­lic has­n’t actu­al­ly been direct­ly impact­ed by Oba­macare because most Amer­i­cans get their health insur­ance through their employ­er and haven’t gen­er­al­ly had to strug­gle with issues like pre-exist­ing con­di­tions block­ing access to insur­ance or a lack of afford­abil­i­ty because their employ­ers were tak­ing the lead in cov­er those costs. And that means that, sad­ly, most Amer­i­cans — those with employ­er based health insur­ance — don’t real­ly have an imme­di­ate short-term per­son­al incen­tive to real­ly care all that much what hap­pens to the peo­ple who might see their access to afford­able health insur­ance col­lapse after Trump and the GOP gets done repeal­ing and replac­ing Oba­macare. And that lack of imme­di­ate short-term per­son­al incen­tive to real­ly care could end up mak­ing the suc­cess­ful spin­ning of “afford­abil­i­ty” to “access” that much eas­i­er. Sure, basic empa­thy should be an imme­di­ate short-term per­son­al incen­tive to real­ly care, but it prob­a­bly won’t be in many cas­es.

So if the Trump and the GOP real­ly do decides to press ahead with any health care reform pack­age that is in keep­ing with all the pre­vi­ous GOP health care reform pack­ages they’ve been propos­ing in recent years, they’re going to have to do this “afford­able quality”-“affordable junk and access to qual­i­ty if you can afford it” switcha­roo and they just might be able to pull it off since what­ev­er they do will still only direct­ly affect a minor­i­ty the US pop­u­la­tion.

Of course, if it turns out that Trump and the GOP are also plan­ning on reform­ing employ­er-based health care as part of their health care over­haul, that could end up cre­at­ing a very dif­fer­ent polit­i­cal envi­ron­ment when it comes to mar­ket­ing that “afford­abil­i­ty = access” spin job that’s cru­cial for the GOP’s suc­cess. Espe­cial­ly if those plans for reform­ing employ­er-based health insur­ance focus on end­ing employ­er-based health insur­ance:

Talk­ing Points Memo
DC

Before His HHS Nom, Price Had Employ­er Health Insur­ance In His Sights

By Tier­ney Sneed
Pub­lished Jan­u­ary 19, 2017, 6:00 AM EST

For years Repub­li­can cri­tiques of the Afford­able Care Act have zeroed in on the effect it has had on the indi­vid­ual heath insur­ance mar­ket. But the GOP law­mak­er who will like­ly lead the Depart­ment of Health and Human Ser­vices has long cham­pi­oned a major over­haul to the much big­ger employ­er-based insur­ance sys­tem in order to push con­sumers to buy their own plans.

The leg­is­la­tion HHS nom­i­nee Rep. Tom Price (R‑GA) has offered over the years include main­stays of GOP plans that would ush­er in a dras­tic change in how most peo­ple receive their health care cov­er­age. The employ­er-based insur­ance mar­ket cov­ers sev­en times more peo­ple than the indi­vid­ual mar­ket.

“What he’s get­ting at here, and a lot of Repub­li­cans feel pret­ty strong­ly about this, to get a func­tion­ing insur­ance mar­ket, you have to get away from busi­ness­es buy­ing the insur­ance,” explained Joe Antos, a health pol­i­cy schol­ar at the right-lean­ing Amer­i­can Enter­prise Insti­tute. “The phi­los­o­phy is, ulti­mate­ly, you want to tran­si­tion, in some order­ly way, to where every­body is buy­ing their own insur­ance.

Price’s pro­pos­al for doing this, via his Empow­er­ing Patients First Act, would make employ­er-plans less finan­cial­ly appeal­ing while incen­tiviz­ing work­ers to buy their own plans in the indi­vid­ual mar­kets. It’s in the same spir­it of Speak­er Paul Ryan’s Bet­ter Way out­line for health care reform released last year as well as oth­er GOP pro­pos­als, but per­haps is more rel­e­vant in that, as actu­al leg­is­la­tion, it lays down con­crete mark­ers. Price, a for­mer Bud­get Com­mit­tee chair, has played down his past leg­is­la­tion as he has gone through the nom­i­na­tion process. Nev­er­the­less, his plan high­lights the stark dif­fer­ences between the Repub­li­can approach to health care and the mid­dle ground sought by the Afford­able Care Care.

The goal of the con­ser­v­a­tive approach, accord­ing to Urban Insti­tute health pol­i­cy schol­ar Lin­da Blum­berg, is “to move away from more shar­ing of risks and towards more seg­ment­ing and sep­a­ra­tion of risks.”

“What this does is it helps you when you are young, when you are per­fect­ly healthy. But we don’t stay that way,” Blum­berg said. “The costs go up tremen­dous­ly and access decreas­es tremen­dous­ly when you have health care needs.”

Price’s plan would tweak the way insur­ance plans are offered by employ­ers from two dif­fer­ent angles. First, he would cap the amount employ­ers can con­tribute to health plans with­out it being taxed as if it were income. This lim­it is known as a tax exclu­sion cap, and the idea is not dis­sim­i­lar from the Cadil­lac tax includ­ed in the Afford­able Care Act. It is also a sta­ple among GOP Oba­macare replace­ment pro­pos­als, includ­ing Ryan’s. Price’s 2015 leg­is­la­tion, how­ev­er, placed the cap at $20,000 annu­al­ly for fam­i­ly plans, not far above the cur­rent aver­age, $17,000. The cap would rise accord­ing to CPI, the infla­tion index, but because health care costs increase at a faster rate, more and more employ­er plans would be sub­ject to tax­es.

“Effec­tive­ly, the real val­ue of the exclu­sion would drop over time until at some point, there would effec­tive­ly not be a sub­stan­tial sub­sidy through that route,” Antos said, while point­ing to tax sub­si­dies Price’s plan offers on the indi­vid­ual mar­ket. “At some point there is no ques­tion: it does­n’t make any sense to stay with employ­er plans from a finan­cial stand­point.”

The sec­ond notable pro­pos­al in Price’s leg­is­la­tion is one that would let employ­ers, on a vol­un­tary basis, offer to their work­ers the amount of mon­ey they would have spent on their employ­er-based plan for work­er to use to buy their own insur­ance on the indi­vid­ual mar­ket. That’s on top of a tax cred­it Price’s plan offers for the indi­vid­ual mar­ket which would grow by age but not by income — mean­ing its avail­able for any­one.

“If you cap the exclu­sion, that sort of incen­tivizes one to go some­place else,” said Karen Pol­litz, a senior fel­low at the Kaiser Fam­i­ly Foun­da­tion. “Sec­ond­ly, you then allow employ­ers to offer you mon­ey to go some­place else and to include that in the def­i­n­i­tion of what counts as a qual­i­fied group plan under fed­er­al tax law.”

Push­ing more peo­ple into the indi­vid­ual mar­kets fits in with the broad strokes of rhetoric GOP law­mak­ers have used to describe their plans for replac­ing Oba­macare. They have stressed “access” and “choice” and “afford­abil­i­ty,” but not uni­ver­sal cov­er­age.

The idea is that, by hav­ing more peo­ple choos­ing their own plans — and by hav­ing insur­ers freed of many of the ACA’s reg­u­la­tions — younger and health­i­er peo­ple will be able to get cheap­er, but skimpi­er plans.

Part of the point, accord­ing to Antos, is “to real­ly get con­sumer involve­ment” in select­ing health care plans, as opposed to their employ­ers. That, in turn, sends “the mes­sage to insur­ance com­pa­nies about what’s a good plan, what’s not a good plan.”

How­ev­er, that approach comes with its down­sides. With younger and health­i­er peo­ple shift­ing to more mea­ger plans, the risk pools for peo­ple who need more com­pre­hen­sive care — the old­er and the sick­er — decrease in size while grow­ing in aver­age cost. For them, Price pro­pos­es a high-risk pool set-up by the states, though the amount of fed­er­al mon­ey he’s will­ing to invest in them is dwarfed by what it’s expect­ed they’d cost.

“There’s a lot here that is ori­ent­ed towards sep­a­rat­ing the cost of peo­ple who have health issues from peo­ple who don’t,” Blum­berg said.

Under the cur­rent sys­tem, employ­er plans fun­nel young and healthy peo­ple into the same risk pools as old­er and sick­er peo­ple on the basis of where they work. The Afford­able Care Act, in turn, sought to grow the risk pool of the non-group mar­ket through its indi­vid­ual man­date as well as reg­u­la­tions to ensure that sick­er peo­ple weren’t blocked from get­ting cov­er­age.

“[Employ­er plans are a] con­ve­nient way to share health care risks,” Blum­berg said. “The non-group mar­ket is not a nat­ur­al way to do that, which is why all the reforms were put into place by the ACA to force that pool­ing.”

At a hear­ing Wednes­day in front of the Sen­ate Com­mit­tee on Health, Edu­ca­tion, Labor and Pen­sions, Price stressed his role as a cab­i­net sec­re­tary would be to admin­is­trate what­ev­er law Con­gress pass­es, though he will still be in charge of the reg­u­la­tions that deter­mine the shape of both employ­er-based and non-group plans.

...

“Push­ing more peo­ple into the indi­vid­ual mar­kets fits in with the broad strokes of rhetoric GOP law­mak­ers have used to describe their plans for replac­ing Oba­macare. They have stressed “access” and “choice” and “afford­abil­i­ty,” but not uni­ver­sal cov­er­age.”

Yep, if we look at the GOP’s past plans for reform­ing US health care, replac­ing Oba­macare with a scheme that guar­an­tees “afford­abil­i­ty” (for plans that don’t actu­al­ly grant you insur­ance-cov­ered access to the health care ser­vices you need) cou­pled with “access” (to qual­i­ty plans most peo­ple can’t afford) for peo­ple with­out employ­er-based insur­ance is prob­a­bly only part of the plan. The oth­er part of the plan is the move peo­ple out of employ­er-based insur­ance. Pri­mar­i­ly by shift­ing the incen­tives for employ­ers to offer cov­er­age and allow­ing them to just offer a lump-sum sub­sidy to employ­ees that they can use on the indi­vid­ual-mar­ket instead:

...

Price’s plan would tweak the way insur­ance plans are offered by employ­ers from two dif­fer­ent angles. First, he would cap the amount employ­ers can con­tribute to health plans with­out it being taxed as if it were income. This lim­it is known as a tax exclu­sion cap, and the idea is not dis­sim­i­lar from the Cadil­lac tax includ­ed in the Afford­able Care Act. It is also a sta­ple among GOP Oba­macare replace­ment pro­pos­als, includ­ing Ryan’s. Price’s 2015 leg­is­la­tion, how­ev­er, placed the cap at $20,000 annu­al­ly for fam­i­ly plans, not far above the cur­rent aver­age, $17,000. The cap would rise accord­ing to CPI, the infla­tion index, but because health care costs increase at a faster rate, more and more employ­er plans would be sub­ject to tax­es.

“Effec­tive­ly, the real val­ue of the exclu­sion would drop over time until at some point, there would effec­tive­ly not be a sub­stan­tial sub­sidy through that route,” Antos said, while point­ing to tax sub­si­dies Price’s plan offers on the indi­vid­ual mar­ket. “At some point there is no ques­tion: it does­n’t make any sense to stay with employ­er plans from a finan­cial stand­point.”

The sec­ond notable pro­pos­al in Price’s leg­is­la­tion is one that would let employ­ers, on a vol­un­tary basis, offer to their work­ers the amount of mon­ey they would have spent on their employ­er-based plan for work­er to use to buy their own insur­ance on the indi­vid­ual mar­ket. That’s on top of a tax cred­it Price’s plan offers for the indi­vid­ual mar­ket which would grow by age but not by income — mean­ing its avail­able for any­one.

...

“The sec­ond notable pro­pos­al in Price’s leg­is­la­tion is one that would let employ­ers, on a vol­un­tary basis, offer to their work­ers the amount of mon­ey they would have spent on their employ­er-based plan for work­er to use to buy their own insur­ance on the indi­vid­ual mar­ket. That’s on top of a tax cred­it Price’s plan offers for the indi­vid­ual mar­ket which would grow by age but not by income — mean­ing its avail­able for any­one.”

Remem­ber how cor­po­rate Amer­i­ca had this grand idea to replace pen­sions (defined ben­e­fit) retire­ment pack­ages with 401ks (defined con­tri­bu­tions)? Well, get ready for that with employ­er-based health insur­ance. You’ll get a lump sum from your employ­er, and if you have unex­pect­ed­ly high health care costs the rest is on you:

Soci­ety for Human Resource Man­age­ment

How Tom Price Could Trans­form Employ­er Health Cov­er­age

HHS Sec­re­tary nom­i­nee oppos­es an employ­er cov­er­age man­date, favors cap­ping the tax exclu­sion for employ­er plans

By Stephen Miller, CEBS Dec 1, 2016

Pres­i­dent-elect Don­ald Trump announced on Nov. 29 he has select­ed House Bud­get Com­mit­tee Chair­man Tom Price, R‑Ga., a for­mer ortho­pe­dic sur­geon, to be sec­re­tary of Health and Human Ser­vices (HHS). If con­firmed by the U.S. Sen­ate, Price—a staunch crit­ic of the Afford­able Care Act (ACA)—will over­see the new admin­is­tra­tion’s efforts to repeal and replace Pres­i­dent Barack Oba­ma’s sig­na­ture health care reform law.

“With real, patient-cen­tered reforms we can build a more inno­v­a­tive and respon­sive health care system—one that empow­ers patients and ensures they and their doc­tor have the free­dom to make health care deci­sions with­out bureau­crat­ic inter­fer­ence or influ­ence,” Price said on his con­gres­sion­al web­site.

While the details of any process for replac­ing the ACA are yet to be deter­mined, Price’s past leg­isla­tive activ­i­ty may indi­cate what the incom­ing admin­is­tra­tion and GOP con­gres­sion­al lead­ers have in mind. Begin­ning in 2009, Price has spon­sored the Empow­er­ing Patients First Act, a bill he has rein­tro­duced, with mod­i­fi­ca­tions, in every sub­se­quent Con­gress. That leg­is­la­tion seeks to pro­mote health care cov­er­age but does not include a man­date requir­ing employ­ers to pro­vide insur­ance to employ­ees. Among its many pro­vi­sions, the act would:

* Pro­vide refund­able, age-adjust­ed tax cred­its for peo­ple to buy insur­ance if they don’t have access to cov­er­age through an employ­er or gov­ern­ment pro­gram.

* Pro­mote the use of health sav­ings accounts (HSAs) by pro­vid­ing a one-time $1,000 tax cred­it for HSA con­tri­bu­tions and increas­ing the allow­able HSA con­tri­bu­tion so that it’s equal to the max­i­mum IRA con­tri­bu­tion lev­el.

* Make health insur­ance avail­able to those with pre-exist­ing med­ical con­di­tions by help­ing states set up new high-risk pools or oth­er pro­grams for such enrollees.

* Set new rules to allow insur­ers to sell poli­cies across state lines.

On many key points, Price’s ACA alter­na­tive mir­rors the pro­vi­sions in House Speak­er Paul Ryan’s blue­print for health reform released in June, includ­ing an empha­sis on expand­ing the use of HSAs, allow­ing employ­ers to pro­vide a defined con­tri­bu­tion health care ben­e­fit and, con­tro­ver­sial­ly, cap­ping the deduc­tion for pre­mi­ums in employ­er-spon­sored group health plans.

...

Defined Con­tri­bu­tion Health Care

Price’s Empow­er­ing Patients First Act would also allow employ­ers to grant employ­ees, on a nondis­crim­i­na­to­ry basis, pre­tax dol­lars to select either an employ­er-spon­sored plan or to pur­chase a pol­i­cy on the indi­vid­ual (non­group-plan) mar­ket—giv­ing a big push to the so-called defined con­tri­bu­tion health care con­cept.

Cur­rent­ly, employ­ers can only use this approach when employ­ees are select­ing among employ­er-pro­vid­ed group plan options, as on a pri­vate health care exchange. Employ­ers are barred, from instance, from pro­vid­ing employ­ees with pre­tax funds in a health reim­burse­ment arrange­ment to pur­chase health poli­cies on a pub­lic exchange, through a bro­ker or direct­ly from an insur­ance provider.

“This would be a real rever­sal,” said Pin­heiro. “Many employ­ers were upset when the Oba­ma admin­is­tra­tion shut down the abil­i­ty for employ­ers to just pro­vide mon­ey on a pre­tax basis for employ­ees to pur­chase their own health insur­ance on the open market—a trend that many saw as the wave of the future.”

For orga­ni­za­tions that present­ly self-fund their health cov­er­age, he added, “It’s about pre­dictabil­i­ty. If you say, as an employ­er, we’re going to pro­vide employ­ees with $8,000 a year to pur­chase a plan, you then know what your health care spend­ing is going to be at the begin­ning of the year” regard­less of the med­ical costs that work­ers may incur. “That makes the defined con­tri­bu­tion approach much safer for a lot of employ­ers.”

Orga­ni­za­tions offer­ing ful­ly insured cov­er­age would have more lee­way to pro­vide a flat-dol­lar sub­sidy to employ­ees rather than pay­ing a per­cent­age of plan pre­mi­ums, giv­ing employ­ers greater con­trol over their spend­ing and future bud­get­ing.

If the Trump admin­is­tra­tion opens up defined con­tri­bu­tion health care under an enact­ed ACA replace­ment, “I’d expect many employ­ers will even­tu­al­ly go that route,” Pin­heiro said.

...

“Price’s Empow­er­ing Patients First Act would also allow employ­ers to grant employ­ees, on a nondis­crim­i­na­to­ry basis, pre­tax dol­lars to select either an employ­er-spon­sored plan or to pur­chase a pol­i­cy on the indi­vid­ual (non­group-plan) mar­ket—giv­ing a big push to the so-called defined con­tri­bu­tion health care con­cept.”

401ks for health care here were come! Or, rather, 401k dis­as­ters for health care here we come!

...

For orga­ni­za­tions that present­ly self-fund their health cov­er­age, he added, “It’s about pre­dictabil­i­ty. If you say, as an employ­er, we’re going to pro­vide employ­ees with $8,000 a year to pur­chase a plan, you then know what your health care spend­ing is going to be at the begin­ning of the year” regard­less of the med­ical costs that work­ers may incur. “That makes the defined con­tri­bu­tion approach much safer for a lot of employ­ers.”

Orga­ni­za­tions offer­ing ful­ly insured cov­er­age would have more lee­way to pro­vide a flat-dol­lar sub­sidy to employ­ees rather than pay­ing a per­cent­age of plan pre­mi­ums, giv­ing employ­ers greater con­trol over their spend­ing and future bud­get­ing.

If the Trump admin­is­tra­tion opens up defined con­tri­bu­tion health care under an enact­ed ACA replace­ment, “I’d expect many employ­ers will even­tu­al­ly go that route,” Pin­heiro said.

...

Employ­er-based health care insur­ance is set to become employ­er-based health care vouch­ers. And don’t for­get that one of the con­se­quence of this sys­tem for mov­ing peo­ple out of employ­er-based group-plans (where risks are pooled between healthy and less healthy employ­ees) onto indi­vid­ual mar­kets (where high risk and low risk are in sep­a­rate pools) that might help when you’re young and healthy and don’t have many health care costs. But that’s also means you’re going to be pay­ing a lot more when you’re old­er, sick­er, and thrown into the indi­vid­ual mar­ket’s high­er-risk pools. Unless you’re plan­ning on dying young and healthy, it’s not actu­al­ly a good deal. Except for employ­ers. Espe­cial­ly since they prob­a­bly won’t even have to increase their vouch­ers annu­al­ly to cov­er the increas­ing costs of insur­ance:

Soci­ety for Human Resource Man­age­ment

Time for Defined Con­tri­bu­tion Health Ben­e­fits?

A com­mon thread is pre­sent­ing the ben­e­fit as a set dol­lar amount
By Joanne Sam­mer and Stephen Miller, CEBS Sep 25, 2013

When the defined con­tri­bu­tion 401(k) plan appeared on the retire­ment scene in the ear­ly 1980s, employ­ers eager­ly embraced it as a way to replace or sup­ple­ment tra­di­tion­al defined ben­e­fit pen­sions, char­ac­ter­ized by their high­er costs and less pre­dictable expens­es. Now, employ­ers are eye­ing the defined con­tri­bu­tion con­cept as a way to rein in anoth­er cost­ly employ­ee ben­e­fit: health insur­ance.

“Employ­ers want to under­stand and start to pre­dict what their health ben­e­fits costs are like­ly to be,” said John Hen­nessy, a senior con­sul­tant at the Hay Group in Dal­las. “They are think­ing that the plans and approach­es avail­able in the past aren’t going to fit in the future.”

A New Take on an Old Idea

Defined con­tri­bu­tion health care can take many forms, but a com­mon thread is refram­ing how health ben­e­fits are pre­sent­ed. “With tra­di­tion­al employ­er-pro­vid­ed health care, you are build­ing your ben­e­fit around cer­tain plans; with a defined con­tri­bu­tion approach, you’re build­ing it around a set dol­lar amount,” explained Brad Davis, CEBS, a ben­e­fits attor­ney at Wraith, Scar­lett & Ran­dolph Insur­ance Ser­vices in Wood­land, Calif. (Davis is also fea­tured in an archived 2013 SHRM web­cast, Health Care Con­sumerism: From a Par­ent­ing to a Part­ner­ing Approach.)

Basi­cal­ly, “The employ­er gives the employ­ee a set amount in a vir­tu­al gift card—or call it a ben­e­fit bank, a wal­let or flex credit—and then allows the employ­ee to take that amount and shop for their own insur­ance off a menu that the employ­er pro­vides,” Davis explained. “The employ­er nego­ti­ates prices and con­tracts with car­ri­ers, and the avail­able options are pre­sent­ed in one com­pre­hen­sive pack­age.”

With the defined con­tri­bu­tion approach, the menu can be as sim­ple as the mul­ti­ple options under a Sec­tion 125 cafe­te­ria plan, Davis not­ed, or can involve a ded­i­cat­ed online plat­form or, increas­ing­ly, use of a pri­vate health care exchange, as described below. What’s dif­fer­ent is that “the employ­er is now say­ing, ‘This is how much mon­ey we are giv­ing you to shop on this menu, and you can pick what­ev­er suits you best.’ It’s a dif­fer­ent style.”

Adapt­ing a defined con­tri­bu­tion approach does not nec­es­sar­i­ly mean greater cost shift­ing or chang­ing the ben­e­fits being offered, Davis added. Rather, instead of fram­ing it as the orga­ni­za­tion and the employ­ee both pay­ing a per­cent­age of the pre­mi­um each month (which to most employ­ees is far from trans­par­ent, as they tend to see just the deduc­tions tak­en from their salary), com­pa­nies tell their employ­ees that now they will receive a set dol­lar amount to go toward month­ly pre­mi­ums.

“Your ‘vir­tu­al gift card’ may be $300 per month, but to sign up for the insur­ance ben­e­fit may cost the employ­ee $360 per month,” Davis not­ed. “The employ­ee will then have to pay $60 out of pock­et. When employ­ees see the gross month­ly rate of their insur­ance and the gross month­ly con­tri­bu­tion that you’re mak­ing toward that, it’s enlight­en­ing. They are exposed to the true costs.”

“If you cur­rent­ly con­tribute 80 per­cent of employ­ee pre­mi­ums, con­vert that to a dol­lar amount for year one,” Davis explained. “Then in years two and beyond, as pre­mi­um costs increase, you can increase your con­tri­bu­tion based on the dol­lar amount that you estab­lished back in year one. You’re still only cov­er­ing what­ev­er per­cent you were in pre­vi­ous years.”

More­over, at renew­al time, busi­ness­es have the option of increas­ing their con­tributed amount to cov­er some or all of the annu­al pre­mi­um cost increase. But employ­ees are less like­ly to view the employ­er as “cut­ting back” if it boosts its con­tri­bu­tion by $10 a month, for instance, even if the plan pre­mi­um ris­es by much more.

Employ­ers won’t have to tell their staff, “We have to reduce our share of the pre­mi­um from 85 per­cent to 70 per­cent.” That could still mean the com­pa­ny is spend­ing more mon­ey (if the pre­mi­um increase is more than 5 per­cent), “but it often doesn’t look that way to employ­ees,” Davis point­ed out.

...

“More­over, at renew­al time, busi­ness­es have the option of increas­ing their con­tributed amount to cov­er some or all of the annu­al pre­mi­um cost increase. But employ­ees are less like­ly to view the employ­er as “cut­ting back” if it boosts its con­tri­bu­tion by $10 a month, for instance, even if the plan pre­mi­um ris­es by much more.”

That’s right, as long as employ­ers just don’t increase their ‘vir­tu­al gift card’ in pro­por­tion to the annu­al rise in health care costs, the effec­tive share of the pre­mi­um cov­ered by employ­ers can go down year after year. And there’s a good chance employ­ees won’t even notice. So all Trump and the GOP would have to do to pull this off is ensure no one finds out about this “fea­ture” before Con­gress pass­es it and Trump signs it into law. That should do won­ders for ris­ing health care costs. At least for busi­ness­es. And prob­a­bly for politi­cians who can then tout how they’ve brought down health care costs and expen­di­tures (by pric­ing peo­ple out of the mar­ket for ser­vices while keep­ing them “insured” with crap poli­cies)

It’s all a reminder that one of the best ways to reduce health care costs is to con­vince the pub­lic one way or anoth­er to just use less health care ser­vices. One way is to keep peo­ple health­i­er (the Oba­macare approach). But not keep­ing peo­ple health­i­er and just pric­ing them out the mar­ket when they get sick works too. As long as the peo­ple in charge can spin it. And, sure, reduc­ing health care costs by reduc­ing access to health care will exac­er­bate the exist­ing cri­sis in peo­ple not get­ting the care they need and will prob­a­bly lead to a greater push for reform down the line. But the Tom Price ver­sion of health care reform can still buy the GOP time and get them out of this cur­rent Oba­macare death trap they’ve found them­selves in. They don’t actu­al­ly need a solu­tion. They need good mar­ket­ing for what­ev­er crap idea they come up with to kick the can down the run. Kick it with an ample about of spin. In oth­er words, the GOP does­n’t need a real solu­tion to the US health care sys­tems many needs. They need just need a well exe­cut­ed punt:

CNN

There’s not enough ‘care’ in Tom Price’s Oba­macare alter­na­tive

By Ford Vox

Updat­ed 6:56 AM ET, Thu Decem­ber 1, 2016

(CNN)You might remem­ber Pres­i­dent-elect Don­ald Trump telling us that he’d like to keep some parts of Oba­macare. That was two weeks ago. With his announce­ment Tues­day that Rep. Tom Price, R‑Georgia, will be his pick for Health and Human Ser­vices sec­re­tary, any type of preser­va­tion is high­ly unlike­ly. Price is one of the law’s arch­en­e­mies.

Sev­en years ago, dur­ing the heat of com­mit­tee debates over the ACA, Price deliv­ered a blis­ter­ing speech con­demn­ing Democ­rats for an unwill­ing­ness to nego­ti­ate with him and oth­er Repub­li­cans amid their har­ried push to get the Afford­able Care Act through Con­gress.

Price did­n’t have a ful­ly artic­u­lat­ed alter­na­tive back then, but he knew what he did­n’t like about Oba­macare. “What you all are plan­ning is to increase dras­ti­cal­ly the intru­sion of the fed­er­al gov­ern­ment into the prac­tice of med­i­cine and the care of patients,” he said.

Of course Price was right. But we need­ed that “intru­sion” of the fed­er­al gov­ern­ment due to the cri­sis pre­cip­i­tat­ed by the fail­ures of med­ical pro­fes­sion­als, the health care indus­try and the insur­ance indus­try to get the job done for tens of mil­lions of Amer­i­cans who had no access to care. Indi­vid­ual clin­i­cians and hos­pi­tals may not be pub­lic util­i­ties, but the sys­tem as a whole requires over­sight to make sure it serves that func­tion.
Oba­macare and its Med­ic­aid expan­sion are by no means ele­gant solu­tions, but they get the job done for tens of mil­lions of Amer­i­cans who did­n’t have cov­er­age before, and offer impor­tant new pro­tec­tions for every­one else.

Price did­n’t just sit and fes­ter over the years. He’s got a plan now

But it’s not writ­ten with the unin­sured and the poor at the fore­front. No, the dri­ving con­cept behind Price’s Empow­er­ing Patients First Act is pro­tect­ing the choic­es of patients who have mon­ey. If you have the mon­ey to shop around, you’ll be able to choose from a broad nation­al mar­ket of insur­ance plans. There’s no man­date to buy insur­ance at all, unlike Oba­macare, and if you do buy insur­ance, you can pick from a thread­bare plan that’s cheap­er because it excludes large cat­e­gories of care — like mater­ni­ty care, repro­duc­tive care, or reha­bil­i­ta­tion, for exam­ple. Oba­macare required holis­tic health insur­ance cov­er­ing all the major cat­e­gories of events that we know can hap­pen to any­one.

Price is also look­ing out for any well-to-do patients on Medicare who would like to be able to use Medicare dol­lars to off­set more expen­sive fees from doc­tors and clin­ics who don’t par­tic­i­pate in Medicare. This rule change alone would rock health care by encour­ag­ing an exo­dus of providers out of Medicare’s core cost-con­tain­ment bar­gain: to treat Medicare patients, providers have always had to agree to take what­ev­er reim­burse­ment Medicare offers for the priv­i­lege of serv­ing its ben­e­fi­cia­ries.

What about cov­er­age for pre-exist­ing con­di­tions? Trump told “60 Min­utes” and the Wall Street Jour­nal he real­ly liked that aspect of Oba­macare, but for Price, your pre-exist­ing con­di­tion isn’t a pri­or­i­ty. Price’s plan will allow sick patients to stay in the reg­u­lar mar­ket so long as they can keep pay­ing their pre­mi­ums.

If a patient gets so sick she can’t work to pay her pre­mi­ums, insur­ers can jack up her rates 150%. If she becomes too poor to afford that, then she is rel­e­gat­ed to high risk pools that will vary in qual­i­ty state by state. These are small mar­kets that need fed­er­al sub­si­dies to work, and those sub­si­dies are capped. If the high risk pools fill up, using up all its funds, then new patients sim­ply can’t enroll.

Sud­den­ly, “Empow­er­ing Patients” begins to look a lot more like “Empow­er­ing Insur­ance Com­pa­nies.” Indeed, insur­ers can charge what they like for the one pre-exist­ing con­di­tion we all may be so for­tu­nate to devel­op: old age. As you get into the age brack­ets where you’re more like­ly to need health care, you’ll pay what­ev­er insur­ers think the mar­ket can bear. Price wants our health care access to depend on how much com­pe­ti­tion we can fos­ter between insur­ance com­pa­nies to get new cus­tomers. In oth­er high­ly reg­u­lat­ed mar­kets, like the air­line indus­try, that con­cept isn’t work­ing out too well. Your only pro­tec­tion against those extra costs will be a capped tax deduc­tion.

...

“What about cov­er­age for pre-exist­ing con­di­tions? Trump told “60 Min­utes” and the Wall Street Jour­nal he real­ly liked that aspect of Oba­macare, but for Price, your pre-exist­ing con­di­tion isn’t a pri­or­i­ty. Price’s plan will allow sick patients to stay in the reg­u­lar mar­ket so long as they can keep pay­ing their pre­mi­ums.”

Lose your job, lose your “pre-exist­ing con­di­tion waiv­er” sta­tus for what­ev­er con­di­tions you have at that point. For the rest of your life. That was Price’s plan. So if this comes to fruition, don’t piss off the boss. That’s also part of the pack­age. Byt hey, if you end up devel­op­ing a pre-exist­ing con­di­tion and either los­ing your pre-exist­ing con­di­tion waiv­er at some point because you sud­den­ly lost cov­er­age for some rea­son at some point in your life (like may you were unem­ployed), maybe a poten­tial employ­er will decide to cov­er your extra health care costs to cov­er your pre-exist­ing con­di­tion med­ical ser­vices that you can’t afford. Just don’t ask for a raise. And get bet­ter soon because if you’re pre-exist­ing con­di­tion leaves you a less than ide­al employ­ee your employ­er may not decide to keep cov­er­ing those extra costs. And this could hap­pen even if you keep your pre-exist­ing con­di­tion waiv­er your entire life and remain employed the entire time if the med­ical ser­vice you need isn’t afford­able after your employ­er’s defined ben­e­fit con­tri­bu­tion whit­tles away. Wel­come to your new death pan­el.

Also keep in mind that there are plen­ty of good argu­ments for sep­a­rat­ing employ­ers from the oblig­a­tion to pro­vide health insur­ance. It could make a lot of sense. It’s just, as Tom Price and the rest of the GOP’s pro­posed replace­ments also show us, the only real solu­tion to replace the dom­i­nant role employ­er-based health insur­ance plays in Amer­i­ca’s econ­o­my is sin­gle-pay­er health care like Medicare for all. Unless you have an unhealthy fix­a­tion on cut­ting costs at the cost of cut­ting health and are ok with a sick social con­tract, in which case access to afford­able junk cov­er­age and pre-exist­ing con­di­tion pro­tec­tions with life­time gotcha-claus­es for los­ing cov­er­age once might seem like a healthy health care sys­tem.

Here’s an arti­cle about a rather embar­rass­ing sit­u­a­tion. On the sur­face it’s most­ly embar­rass­ing for Trump. Although since it’s embar­rass­ing for Trump due large­ly to what appear to be real men­tal health issues that the man can’t con­trol, that should­n’t real­ly be a source of embar­rass­ment. No one choos­es to have a men­tal dis­or­der. So if it’s an embar­rass­ing sit­u­a­tion, it’s most­ly embar­rass­ing for a cer­tain nation that hap­pened to elect him:

New York Mag­a­zine

Trump Aides Keep Leak­ing Embar­rass­ing Sto­ries About How He Can’t Han­dle Embar­rass­ment

By Eric Levitz

Jan­u­ary 24, 2017 11:02 a.m.

The pres­i­dent is a 70-year-old child whose TV time must be close­ly mon­i­tored — because any news sto­ry that upsets his ego will trig­ger a tem­per tantrum fol­lowed by irra­tional demands that his indul­gent, over­whelmed guardians will be help­less to refuse.

Or so Don­ald Trump’s aides keep con­fid­ing to the near­est avail­able reporter.

On Sun­day, one of the president’s con­fi­dantes told Politi­co that his staffers have to “con­trol infor­ma­tion that may infu­ri­ate him,” a task made dif­fi­cult by the fact that the leader of the free world “gets bored and likes to watch TV.”

That same day, some Trump aides pro­vid­ed the New York Times with a por­trait of the pres­i­dent as a moody ado­les­cent.

Mr. Trump grew increas­ing­ly angry on Inau­gu­ra­tion Day after read­ing a series of Twit­ter mes­sages point­ing out that the size of his inau­gur­al crowd did not rival that of Mr. Obama’s in 2009. But he spent his Fri­day night in a whirl­wind of cel­e­bra­tion and affir­ma­tion. When he awoke on Sat­ur­day morn­ing, after his first night in the Exec­u­tive Man­sion, the glow was gone, sev­er­al peo­ple close to him said, and the new pres­i­dent was filled anew with a sense of injury.

“The lack of dis­ci­pline trou­bled even senior mem­bers of Mr. Trump’s cir­cle,” the paper wrote, “some of whom had urged him not to indulge his sim­mer­ing resent­ment at what he saw as unfair news cov­er­age.”

And then, on Mon­day night, Trump’s staffers whis­pered an even more vivid account of his rough week­end to the Wash­ing­ton Post.

Pres­i­dent Trump had just returned to the White House on Sat­ur­day from his final inau­gu­ra­tion event, a tran­quil inter­faith prayer ser­vice, when the flash­es of anger began to build.

Trump turned on the tele­vi­sion to see a jar­ring jux­ta­po­si­tion — mas­sive demon­stra­tions around the globe protest­ing his day-old pres­i­den­cy and footage of the spars­er crowd at his inau­gu­ra­tion, with large patch­es of white emp­ty space on the Mall. As his press sec­re­tary, Sean Spicer, was still unpack­ing box­es in his spa­cious new West Wing office, Trump grew increas­ing­ly and vis­i­bly enraged…Over the objec­tions of his aides and advis­ers — who urged him to focus on pol­i­cy and the broad­er goals of his pres­i­den­cy — the new pres­i­dent issued a decree: He want­ed a fiery pub­lic response, and he want­ed it to come from his press sec­re­tary.

The Post’s sto­ry is chock-full of remark­able details. To list just a few:

1. After forc­ing Spicer to bald­ly lie to the White House press corps about the size of his inau­gu­ra­tion crowd, the pres­i­dent fumed that his press secretary’s per­for­mance was “not force­ful enough.” Accord­ing to Axios, Trump was also incensed by Spicer’s poor taste in suits, and is already con­sid­er­ing treat­ing the for­mer RNC staffer to his sig­na­ture catch­phrase.

2. Trump already “feels demor­al­ized that the public’s per­cep­tion of his pres­i­den­cy so far does not nec­es­sar­i­ly align with his own sense of accom­plish­ment.”

3. Some Trump aides think Kellyanne Con­way is try­ing to under­mine Spicer so as to steal his job.

4. Jared Kush­n­er tried to pre­vent Con­way from being invit­ed into the White House at all, because he viewed her “as a pos­si­ble threat to his role as Trump’s chief con­sigliere.”

...

Ulti­mate­ly, though, the most astound­ing sen­tence in the Post’s write-up might be the fol­low­ing:

This account of Trump’s tumul­tuous first days in office comes from inter­views with near­ly a dozen senior White House offi­cials and oth­er Trump advis­ers and con­fi­dants, some of whom spoke on the con­di­tion of anonymi­ty to describe pri­vate con­ver­sa­tions and moments.

Near­ly a dozen of Trump’s clos­est con­fi­dantes helped plant an embar­rass­ing news sto­ry about how their boss can’t han­dle embar­rass­ing news sto­ries. Which is to say: A pres­i­dent who prizes loy­al­ty in his sub­or­di­nates has already been betrayed by a huge swath of his inner cir­cle.

It isn’t hard to under­stand why Trump’s aides would want to dis­tance them­selves from the mogul’s deci­sion to begin his pres­i­den­cy by shout­ing self-aggran­diz­ing delu­sions at CIA employ­ees, con­gres­sion­al lead­ers, and the Fourth Estate. But we aren’t in the late days of a los­ing cam­paign, when it’s nor­mal for advis­ers to start leak­ing dirt on the boss to save their rep­u­ta­tions. We’re less than four full days into the Trump pres­i­den­cy, with (bar­ring death, impeach­ment, res­ig­na­tion, or coup) at least 1,461 to go.

“Near­ly a dozen of Trump’s clos­est con­fi­dantes helped plant an embar­rass­ing news sto­ry about how their boss can’t han­dle embar­rass­ing news sto­ries. Which is to say: A pres­i­dent who prizes loy­al­ty in his sub­or­di­nates has already been betrayed by a huge swath of his inner cir­cle.”

When the going gets tough, Trump goes insane. And now this real­i­ty is get­ting leaked from the admin­is­tra­tion head­ed by a man with a loy­al­ty fetishist (there’s pre­sum­ably an aban­don­ment com­plex lurk­er there some­where). That’s got to be dri­ving Trump extra nuts on top of his pre-exist­ing nut­ti­ness. And this leak-fest about the pres­i­den­t’s increas­ing­ly dis­turbed psy­cho­log­i­cal pro­file is just days into the new admin­is­tra­tion and there’s no sign it’s going to stop:

Talk­ing Points Memo
Edi­tor’s Blog

No White House Leaks Like This ... Until Now

By Josh Mar­shall
Pub­lished Jan­u­ary 23, 2017, 10:49 PM EDT

We now have a sto­ry from The Wash­ing­ton Post (“The first days inside Trump’s White House: Fury, tumult and a reboot”) to match yes­ter­day’s from The Times (“Rocky First Week­end for Trump Trou­bles Even His Top Aides”). They are each a clas­sic type for a major news­pa­per. Throw your biggest repor­to­r­i­al names at the sto­ry, talk to every one and put togeth­er an over-arch­ing from-the-inside nar­ra­tive. They are each fas­ci­nat­ing, occa­sion­al­ly com­ic and in some ways hor­ri­fy­ing reads. But there is an under­ly­ing, not-made-explic­it mes­sage to both which is per­haps the most impor­tant. We are three days into the admin­is­tra­tion and the Trump White House leaks not so much like a sieve as a buck­et with no bot­tom.

The Trump White House not only leaks like crazy. It casu­al­ly leaks the most inti­mate and humil­i­at­ing details about the Pres­i­dent — hurt feel­ings, ego injury, child­like behav­ior, self-destruc­tive rages over tweets, media fail­ure to cred­it his own grandios­i­ty. We have sim­ply nev­er seen this lev­el of leak­ing, with this lit­tle respect for the Pres­i­den­t’s dig­ni­ty or rep­u­ta­tion, this ear­ly.

A few exam­ples. From the Times ...

Mr. Trump grew increas­ing­ly angry on Inau­gu­ra­tion Day after read­ing a series of Twit­ter mes­sages point­ing out that the size of his inau­gur­al crowd did not rival that of Mr. Obama’s in 2009. But he spent his Fri­day night in a whirl­wind of cel­e­bra­tion and affir­ma­tion. When he awoke on Sat­ur­day morn­ing, after his first night in the Exec­u­tive Man­sion, the glow was gone, sev­er­al peo­ple close to him said, and the new pres­i­dent was filled anew with a sense of injury.

From The Post ...

Trump has been resent­ful, even furi­ous, at what he views as the media’s fail­ure to reflect the mag­ni­tude of his achieve­ments, and he feels demor­al­ized that the public’s per­cep­tion of his pres­i­den­cy so far does not nec­es­sar­i­ly align with his own sense of accom­plish­ment.

From Politi­co ...

One per­son who fre­quent­ly talks to Trump said aides have to push back pri­vate­ly against his worst impuls­es in the White House, like the news con­fer­ence idea, and have to con­trol infor­ma­tion that may infu­ri­ate him. He gets bored and likes to watch TV, this per­son said, so it is impor­tant to min­i­mize that.

There is, to put it mild­ly, a rather clear­ly recur­ring theme: a torqued up man-child, alter­na­tive­ly rage­ful and frag­ile, both grandiose and pro­found­ly inse­cure. To a degree it is dif­fi­cult to main­tain per­spec­tive since the con­trast between the depart­ed and incom­ing Pres­i­dents could sim­ply not be any greater — either in the com­po­sure and steadi­ness of the man in ques­tion or in his asso­ciates’ will­ing­ness to share his secrets with the press. Would it even be pos­si­ble to mount a leak inves­ti­ga­tion when every­one seems to be leak­ing?

...

“The Trump White House not only leaks like crazy. It casu­al­ly leaks the most inti­mate and humil­i­at­ing details about the Pres­i­dent — hurt feel­ings, ego injury, child­like behav­ior, self-destruc­tive rages over tweets, media fail­ure to cred­it his own grandios­i­ty. We have sim­ply nev­er seen this lev­el of leak­ing, with this lit­tle respect for the Pres­i­den­t’s dig­ni­ty or rep­u­ta­tion, this ear­ly.”

Keep in mind that while Trump him­self isn’t doing the leak­ing here, he’s still the ulti­mate source of the leaks because leaks are a con­se­quence of a men­tal­ly unhinged leader...at least before they go into Joseph Stal­in-mode and purge their inner cir­cle of any­one who might pos­si­bly think of leak­ing. The ‘platelets’ in the Trump admin­is­tra­tion that could stop the bleed­ing reside in Trump’s ego. So if we’re going to avoid a bout of pres­i­den­tial metaphor­i­cal hemo­phil­ia, he might need a doc­tor. For his mind.

For­tu­nate­ly, as pres­i­dent he’ll have the best men­tal health care pro­fes­sion­als in the world at his dis­pos­al. So hope­ful­ly he’ll get the help he needs because if he does­n’t get the help and con­tin­ues hav­ing man-child melt­downs every oth­er day, Trump’s men­tal health cri­sis prob­a­bly isn’t going to be lim­it­ed to Trump. Imag­ine being a vot­er who sup­port­ed Trump out of des­per­a­tion that he would be able to ‘fix every­thing’ and Trump ends up being a real life lunatic that just makes life worse for almost every­one. That’s going to be pret­ty stress­ful, espe­cial­ly for work­ing class vot­ers who real­ly can’t afford to see their per­son­al sit­u­a­tion get much worse. And espe­cial­ly after the GOP gets done gut­ting Oba­macare and replac­ing it with some sort of joke sys­tem with­out the guar­an­tees for men­tal health cov­er­age that the nation is going to need in spades:

The Hill

Repeal­ing Oba­maCare will threat­en our men­tal health

By Dr. Jacob Izen­berg, opin­ion con­trib­u­tor — 01/23/17 07:40 PM EST

When For­mer Pres­i­dent Barack Oba­ma signed the Afford­able Care Act (ACA) in 2010, my first and most over­whelm­ing emo­tion was relief.

Not because I or any of my fam­i­ly mem­bers need­ed the law — we’re among the for­tu­nate who have nev­er had to go with­out decent health insur­ance. Rather, my relief was that of a future physi­cian who could stop fear­ing that giv­ing a crit­i­cal diag­no­sis might sen­tence a patient to a life­time of sky­rock­et­ing insur­ance pre­mi­ums or dropped cov­er­age.

At a more basic lev­el, from the ACA sprang the hope of being able to prac­tice med­i­cine with­out hav­ing to ever ask a patient the ques­tion, “can you pay for this?”

That was in my first year of med­ical school. By the time I start­ed my res­i­den­cy as a psy­chi­a­trist in 2014, most of the ACA’s key pro­vi­sions had gone into effect. It was only then that I could tru­ly take the mea­sure of the law’s impact.

For the more than 40 mil­lion Amer­i­cans suf­fer­ing from men­tal ill­ness and rough­ly 20 mil­lion suf­fer­ing from a sub­stance use dis­or­der in any giv­en year, the pre-Oba­maCare era was a night­mare. Insur­ance com­pa­nies could set arbi­trary lim­its on annu­al care, exclude behav­ioral health ben­e­fits, or deny cov­er­age alto­geth­er.

Those diag­nosed at a young age — com­mon in many psy­chi­atric dis­or­ders — could expect to spend the rest of their lives fear­ing they might be dropped from their plan due to a pre-exist­ing con­di­tion.

More­over, because the most seri­ous men­tal ill­ness­es can make reg­u­lar employ­ment dif­fi­cult or impos­si­ble, many patients were unable to obtain reli­able insur­ance through employ­ment. Turn­ing by neces­si­ty to pub­lic pro­grams like Med­ic­aid, they often encoun­tered strict lim­its on eli­gi­bil­i­ty and lim­it­ed access to providers.

The ACA has dra­mat­i­cal­ly improved the for­tunes of those with men­tal ill­ness, address­ing each of these con­cerns while promis­ing to bet­ter inte­grate behav­ioral health­care into the broad­er health sys­tem.

For those who rely on pri­vate insur­ance, the law offers secu­ri­ty to peo­ple who nev­er pre­vi­ous­ly knew any. For the most seri­ous­ly men­tal­ly ill patients, an expand­ed Med­ic­aid has become a cor­ner­stone, offer­ing access to qual­i­ty com­mu­ni­ty-based ser­vices that help keep them in the com­mu­ni­ty, and out of hos­pi­tals or jails. Now, just as these gains are solid­i­fy­ing, con­gress is threat­en­ing to undo them by repeal­ing the ACA.

Repub­li­can lead­ers insist they will replace the law, sug­gest­ing they can safe­guard its most favored fea­tures while jet­ti­son­ing the rest. But, their var­i­ous pro­pos­als — to the extent they have even been for­mu­lat­ed — fall far short. They have, for exam­ple, promised those with pre-exist­ing con­di­tions that they will remain cov­ered. Yet, no one has explained how to accom­plish this feat with­out fatal­ly under­min­ing insur­ance mar­kets by elim­i­nat­ing the insur­ance man­date and pre­mi­um sub­si­dies.

From the psychiatrist’s per­spec­tive, there’s a sad irony in the impend­ing demise of the ACA. Should the law be repealed, it will come at a time when deaths from over­dose and sui­cide, both trag­ic mark­ers of pro­found men­tal suf­fer­ing, are spik­ing through­out many parts of the coun­try.

It’s not unfair to describe such deaths as part of an epi­dem­ic of men­tal ill­ness and addic­tion, one that has per­haps affect­ed the white work­ing class more than any oth­er sin­gle group, par­tic­u­lar­ly in America’s most eco­nom­i­cal­ly hard-hit com­mu­ni­ties.

The irony is this: many of these com­mu­ni­ties are large­ly made up of the very vot­ers who deliv­ered the pres­i­den­cy to Don­ald Trump.

These vot­ers are under­stand­ably frus­trat­ed by ObamaCare’s mis­steps, com­plex­i­ties, and costs, includ­ing ris­ing insur­ance pre­mi­ums for some. Despite the law’s short­com­ings, the repeal of the ACA will abol­ish pre­cise­ly the safe­guards of which so many are urgent­ly in need at this moment: The right to qual­i­ty health­care, with­out regard to abil­i­ty to pay, even when you have a chron­ic con­di­tion, even when that con­di­tion is a men­tal ill­ness.

On the eve of ObamaCare’s repeal, the men­tal­ly ill across the coun­try, regard­less of race, gen­der, or eco­nom­ic sta­tus, are vul­ner­a­ble.

Along­side so many oth­ers peo­ple lack­ing steady work, or who have ever received a sig­nif­i­cant med­ical diag­no­sis of any kind, or who are fac­ing major med­ical expens­es like chemother­a­py or surgery those suf­fer­ing from men­tal ill­ness may soon find that, once again, health­care in Amer­i­ca is a priv­i­lege, not a right.

...

“From the psychiatrist’s per­spec­tive, there’s a sad irony in the impend­ing demise of the ACA. Should the law be repealed, it will come at a time when deaths from over­dose and sui­cide, both trag­ic mark­ers of pro­found men­tal suf­fer­ing, are spik­ing through­out many parts of the coun­try.”

Yep, in the mid­dle of a men­tal health epi­dem­ic the US elects an overt­ly men­tal­ly ill man to lead the nation and one of the first things he’s like­ly to do is imple­ment a health care ‘reform’ pack­age that’s prob­a­bly going to make it a lot hard­er to get men­tal health treat­ment. It’s pret­ty insane sit­u­a­tion and unless Trump gets the help he needs it’s prob­a­bly not going to end well.

And it’s just get­ting start­ed.

Oh look. Trump­care died in the Sen­ate. Appar­ent­ly it was too Koch-friend­ly and not Koch-friend­ly enough. Oh well. It’ll be back. Trump­care has died and returned already and will like­ly do so many more times. You can’t cure human greed. Ok, you can, but it’s a pret­ty dras­tic cure. Trump­care is almost cer­tain­ly going to be back.

Maybe under a new name. Or a future GOP pres­i­dent *gasp*. The dream of Trump­care will be back. Over and over if need be.

How do we know? All you have to do is look at the GOP’s end­less quest to real­ize Paul Ryan’s dream of pri­va­tiz­ing Medicare and replac­ing it with a “pre­mi­um sup­port” vouch­er sys­tem. It might be a supreme­ly unpop­u­lar dream. And it might end up send­ing many seniors into pover­ty and an ear­ly grave. But voucher­iz­ing Medicare is still the dream that nev­er dies. That’s how the GOP dreams. It dreams big. Per­haps about big tax cuts and big social dis­as­ters. But the GOP dreams big. And you don’t let big dreams die eas­i­ly:

Talk­ing Points Memo
DC

After Oba­macare Repeal Fail, GOP Eyes New Health Care Pro­gram To Gut

By Tier­ney Sneed
Pub­lished July 18, 2017 10:39 am

The les­son Repub­li­cans have tak­en from watch­ing their efforts to gut Med­ic­aid face-plant is that their next act should be an attempt to gut an even more pop­u­lar gov­ern­ment health care pro­gram: Medicare.

On Tues­day morn­ing, hours after Sen­ate Major­i­ty Leader Mitch McConnell (R‑KY) had pulled the plug on an Oba­macare repeal bill that imposed a mas­sive over­haul on Med­ic­aid, the House Bud­get Com­mit­tee unveiled a 10-year bud­get blue­print that would seek to trans­form and pri­va­tize Medicare.

The Bud­get Com­mit­tee doc­u­ment had been long in the works, and yet the tim­ing was strik­ing. It sig­naled that Repub­li­cans may not be ready to aban­don their slash-and-burn approach to social safe­ty net pro­grams, despite that approach pos­ing a major obsta­cle to their efforts to dis­man­tle the Afford­able Care Act.

Though doc­u­ments from the com­mit­tee are treat­ed as rough pro­pos­als and not set-in-stone leg­is­la­tion, Tuesday’s blue­print high­light­ed the goals and pri­or­i­ties of the Repub­li­can Par­ty at a time when the GOP has full con­trol of the fed­er­al gov­ern­ment.

The blue­print includ­ed a pro­pos­al to turn Medicare into what Repub­li­cans call a “pre­mi­um sup­port” sys­tem, a long-held dream of House Speak­er Paul Ryan (R‑WI). Under pre­mi­um sup­port, enrollees would have the option to receive vouch­ers to pur­chase pri­vate insur­ance instead of using the gov­ern­ment health care pro­gram.

There is some debate among experts as to whether this lat­est mod­el of a pre­mi­um sup­port sys­tem would lead to a phase-out of Medicare entire­ly, or just its pri­va­ti­za­tion. Either way, it’s a dras­tic scal­ing back of the pro­gram after Pres­i­dent Don­ald Trump ran explic­it­ly on pre­serv­ing Medicare as is.

The bud­get blue­print also assumes pas­sage of Oba­macare replace­ment leg­is­la­tion that passed in the House but is pre­sumed dead in the Sen­ate, after enough Repub­li­can defec­tions Mon­day night prompt­ed McConnell to announce plans for a “repeal only” vote. There were fierce debates about how the leg­is­la­tion should han­dle the indi­vid­ual insur­ance mar­kets. But both the House and the Sen­ate bills embraced major cuts to Med­ic­aid in the form of cap­ping fed­er­al fund­ing to the pro­gram on a per-enrollee basis—caps that grow more slow­ly over time than Med­ic­aid spend­ing, thus com­pound­ing those cuts in the long run.

...

———-

“After Oba­macare Repeal Fail, GOP Eyes New Health Care Pro­gram To Gut” by Tier­ney Sneed; Talk­ing Points Memo; 07/18/2017

“The blue­print includ­ed a pro­pos­al to turn Medicare into what Repub­li­cans call a “pre­mi­um sup­port” sys­tem, a long-held dream of House Speak­er Paul Ryan (R‑WI). Under pre­mi­um sup­port, enrollees would have the option to receive vouch­ers to pur­chase pri­vate insur­ance instead of using the gov­ern­ment health care pro­gram.”

It Lives.

What kind of polit­i­cal mini-earth­quake did the US expe­ri­ence last week? It’s the big ques­tion roil­ing DC fol­low­ing the stun­ning rebuke by Kansas vot­ers of the anti-choice agen­da in a vote where Kansas vot­ers reject­ed an attempt to over­turn the state’s con­sti­tu­tion­al pro­tec­tion of abor­tion rights by a 60–40 mar­gin. It was seen as the first big test of the post-Roe polit­i­cal envi­ron­ment. And if the results of Kansas are any indi­ca­tion of the kind of ‘brand­ing issues’ the GOP can expect in a post-Roe Amer­i­ca it would appear that the Repub­li­can Par­ty is in des­per­ate need of a dis­trac­tion. Some­thing to keep the pub­lic enraged at Democ­rats over infla­tion but not actu­al­ly think­ing about the con­se­quences of putting the GOP back in pow­er. It’s that need to talk about any­thing but the GOP’s actu­al agen­da that brings us to the fol­low­ing sto­ries about the GOP’s agen­da. An agen­da that can­not be revealed. Yes, as we’re going to see, the Repub­li­can Par­ty has yet to aban­don the ‘no plat­form’ plat­form it adopt­ed dur­ing Trump’s term. Sen­ate Minor­i­ty Leader Mitch McConnell is stick­ing with it. As McConnell him­self describes, the pub­lic does­n’t get to see the plan until after the par­ty has won back pow­er in the Sen­ate.

The prob­lem with McConnel­l’s plan is the rest of his par­ty isn’t stick­ing with it. They keep reveal­ing the GOP’s agen­da. And if you thought over­turn­ing Roe was a polit­i­cal alba­tross for the GOP, just wait until you hear about its big plans. Plans like Wis­con­sin Sen­a­tor Ron John­son’s plan to make all fed­er­al spend­ing dis­cre­tionary. Includ­ing Social Secu­ri­ty and Medicare. Yes, under John­son’s plan, Social Secu­ri­ty and Medicare would no long be enti­tle­ments the fed­er­al gov­ern­ment is legal­ly oblig­at­ed to meet. Instead, the pro­grams would be up for annu­al expen­di­tures and sub­ject to what­ev­er cuts the con­gress deems nec­es­sary that year.

Don’t for­get that bud­get show­downs and GOP threats of allow­ing the fed­er­al gov­ern­ment default are now a reg­u­lar fea­ture of US con­gres­sion­al bud­get-mak­ing. So Social Secu­ri­ty and Medicare would now be part of that annu­al fis­cal hostage-tak­ing tra­di­tion under John­son’s plan. It’s the per­fect recipe for black­mail­ing the Democ­rats into agree­ing to cuts to these pro­gram: either gut the pro­grams or there’s going to be a fed­er­al default. That’s the plan.

And while that cer­tain­ly sounds like the kind of plan we should expect from the mod­ern day Repub­li­can Par­ty, it’s also obvi­ous­ly a polit­i­cal­ly poi­son­ing plan in a post-Roe envi­ron­ment where vot­ers have just been taught a pow­er­ful les­son about the con­se­quences of Repub­li­can rule. As such, it should be lit­tle sur­prise to learn that Mitch McConnell has already shot down John­son’s pro­pos­al. Of course, McConnell did­n’t offer an alter­na­tive pro­pos­al. That’s still a mys­tery by design.

And as we’re also going to see, part of what makes John­son’s pro­pos­al the kind of thing we should take seri­ous­ly is that it sounds a lot like the last plan Mitch McConnell had to pub­licly rebuke: Flori­da Sen­a­tor Rick Scot­t’s pro­pos­al back in March to put a five year sun­set on all fed­er­al spend­ing, includ­ing Social Secu­ri­ty and Medicare. The US basi­cal­ly would­n’t be allowed to make plans longer than 5 years at a time.

Part of what made Scot­t’s plan so polit­i­cal­ly per­ilous is the fact that he’s a mem­ber of the GOP Sen­ate lead­er­ship team. McConnell did­n’t take long to pub­licly shoot down the plan. And yet Scott con­tin­ued to defend the plan while point­ing out that the par­ty has no pub­lic plans and should have one. Yes, Scot­t’s awful idea was the only big pol­i­cy idea we were hear­ing from Repub­li­cans in office and Scott him­self point­ed it out. But McConnell was nonethe­less adamant that vot­ers won’t get to see any GOP plans until they par­ty has won back pow­er.

So while polit­i­cal sci­en­tists, and a lot of GOP­ers them­selves, are no doubt ask­ing them­selves what the GOP’s big pol­i­cy plans should be fol­low­ing the rejec­tion by Kansas vot­ers, we don’t have to ask. Mitch McConnell, Rick Scott, and Ron John­son have already showed up the plan. A plan so polit­i­cal­ly tox­ic that it requires a sep­a­rate plan to hide it. Hide it in plain sight in this case:

The Wash­ing­ton Post

Sen. John­son sug­gests end­ing Medicare, Social Secu­ri­ty as manda­to­ry spend­ing pro­grams

By Amy B Wang
Updat­ed August 3, 2022 at 1:04 p.m. EDT|Published August 3, 2022 at 11:08 a.m. EDT

Sen. Ron John­son (R‑Wis.) has sug­gest­ed that Social Secu­ri­ty and Medicare be elim­i­nat­ed as fed­er­al enti­tle­ment pro­grams, and that they should instead become pro­grams approved by Con­gress on an annu­al basis as dis­cre­tionary spend­ing.

Those who work in the Unit­ed States pay Social Secu­ri­ty and Medicare tax­es that go into fed­er­al trust funds. Upon retire­ment, based on a person’s life­time earn­ings and oth­er fac­tors, a retiree is eli­gi­ble to receive month­ly Social Secu­ri­ty pay­ments. Sim­i­lar­ly, Medicare is the fed­er­al health insur­ance pro­gram that kicks in for peo­ple 65 and old­er, or for oth­ers who have dis­abil­i­ties.

In an inter­view that aired Tues­day on “The Reg­u­lar Joe Show” pod­cast, John­son, who is seek­ing a third term in the Sen­ate, lament­ed that the Social Secu­ri­ty and Medicare pro­grams auto­mat­i­cal­ly grant ben­e­fits to those who meet the qual­i­fi­ca­tions — that is, to those who had been pay­ing into the sys­tem over their work­ing life.

“If you qual­i­fy for the enti­tle­ment, you just get it no mat­ter what the cost,” John­son said. “And our prob­lem in this coun­try is that more than 70 per­cent of our fed­er­al bud­get, of our fed­er­al spend­ing, is all manda­to­ry spend­ing. It’s on auto­mat­ic pilot. It nev­er — you just don’t do prop­er over­sight. You don’t get in there and fix the pro­grams going bank­rupt. It’s just on auto­mat­ic pilot.”

NEW: On the The Reg­u­lar Joe Show, Sen. Ron. John­son (R‑WI) argues for elim­i­nat­ing enti­tle­ments: “Social Secu­ri­ty and Medicare, if you qual­i­fy, you just get it no mat­ter what the cost... We ought to turn every­thing into dis­cre­tionary spend­ing so it’s all eval­u­at­ed.” pic.twitter.com/bE1KUb6uJ5— Heart­land Sig­nal (@HeartlandSignal) August 2, 2022

John­son sug­gest­ed that Social Secu­ri­ty and Medicare be trans­formed into pro­grams whose bud­gets are appro­pri­at­ed by Con­gress on an annu­al basis. He point­ed out that bud­gets for the Defense and Vet­er­ans Affairs depart­ments are approved as dis­cre­tionary spend­ing.

“What we ought to be doing is we ought to turn every­thing into dis­cre­tionary spend­ing so it’s all eval­u­at­ed so that we can fix prob­lems or fix pro­grams that are bro­ken, that are going to be going bank­rupt,” John­son said. “As long as things are on auto­mat­ic pilot, we just con­tin­ue to pile up debt.”

Johnson’s com­ments prompt­ed crit­i­cism from the White House and from Sen­ate Major­i­ty Leader Charles E. Schumer (D‑N.Y.), who said Democ­rats would fight any attempt by Repub­li­cans to “pull the rug out from under our seniors.”

“The junior sen­a­tor from Wis­con­sin wants to put Medicare and Social Secu­ri­ty on the chop­ping block,” Schumer told reporters Wednes­day. “He has argued that the ben­e­fits which mil­lions of Amer­i­cans rely on every day shouldn’t be guar­an­teed, but should be sub­ject to par­ti­san infight­ing here in Wash­ing­ton. He would like to revoke the guar­an­tee of Medicare and Social Secu­ri­ty and make them dis­cre­tionary. Well, you know what hap­pens when we make things dis­cre­tionary around here? All too often they get cut, or even elim­i­nat­ed. We don’t want to do that.”

A rep­re­sen­ta­tive for Johnson’s office pushed back on the idea that John­son want­ed to elim­i­nate Medicare or Social Secu­ri­ty.

“The Senator’s point was that with­out fis­cal dis­ci­pline and over­sight typ­i­cal­ly found with dis­cre­tionary spend­ing, Con­gress has allowed the guar­an­teed ben­e­fits for pro­grams like Social Secu­ri­ty and Medicare to be threat­ened,” John­son spokes­woman Alexa Hen­ning said in an email.

“This must be addressed by Con­gress tak­ing its respon­si­bil­i­ties seri­ous­ly to ensure that seniors don’t need to ques­tion whether the pro­grams they depend on remain sol­vent,” she added. “As he said, we need a process to save these pro­grams and no one is doing any­thing to save them long term. We just con­tin­ue pil­ing up debt, mort­gag­ing our children’s future, and putting these pro­grams at risk.”

Asked Wednes­day whether Sen­ate Minor­i­ty Leader Mitch McConnell (R‑Ky.) would sup­port such a plan, a rep­re­sen­ta­tive for him point­ed to his pre­vi­ous rejec­tion of a pro­pos­al by Sen. Rick Scott (R‑Fla.) that would have sim­i­lar­ly upend­ed Social Secu­ri­ty and Medicare. In March, John­son said he sup­port­ed “most” of Scott’s plan and called it “a pos­i­tive thing.”

“If we’re for­tu­nate enough to have the major­i­ty next year, I’ll be the major­i­ty leader. I’ll decide in con­sul­ta­tion with my mem­bers what to put on the floor,” McConnell told reporters in March. “Let me tell you what would not be a part of our agen­da: We will not have as part of our agen­da a bill that rais­es tax­es on half the Amer­i­can peo­ple and sun­sets Social Secu­ri­ty and Medicare with­in five years.”

Ear­li­er this year, John­son announced that he would seek reelec­tion in Novem­ber, despite a pre­vi­ous pledge to retire after two terms. He is wide­ly expect­ed to win his pri­ma­ry elec­tion next Tues­day.

...

This was not the first time John­son has made news for a pro­pos­al that prompt­ed even oth­er Repub­li­cans to dis­tance them­selves. In March, John­son said he want­ed to see the GOP repeal the Afford­able Care Act if his par­ty won the White House and the House and Sen­ate majori­ties in 2024, some­thing Repub­li­cans failed to do the last time they had majori­ties in Wash­ing­ton.

———–

“Sen. John­son sug­gests end­ing Medicare, Social Secu­ri­ty as manda­to­ry spend­ing pro­grams” By Amy B Wang; The Wash­ing­ton Post; 08/03/2022

“In an inter­view that aired Tues­day on “The Reg­u­lar Joe Show” pod­cast, John­son, who is seek­ing a third term in the Sen­ate, lament­ed that the Social Secu­ri­ty and Medicare pro­grams auto­mat­i­cal­ly grant ben­e­fits to those who meet the qual­i­fi­ca­tions — that is, to those who had been pay­ing into the sys­tem over their work­ing life.”

It’s a bad thing that Social Secu­ri­ty and Medicare just auto­mat­i­cal­ly grants ben­e­fits to those who qual­i­fy and that needs to change, accord­ing to Wis­con­sin Repub­li­can Sen­a­tor Ron John­son. Under his vision of these pro­grams, that deci­sion of whether or not the fed­er­al gov­ern­ment can afford these ben­e­fits — or instead need to cut them — should be part of the reg­u­lar polit­i­cal wran­gling that hap­pens with all dis­cre­tionary spend­ing, where the pro­grams are sub­ject to review and poten­tial gut­ting on an annu­al basis. In oth­er words, these won’t be enti­tle­ments. You will be enti­tled to noth­ing more than the scraps con­gress decides to throw you on a giv­en year.

Also keep in mind that oth­er major fea­ture of shift­ing enti­tle­ments to dis­cre­tionary spend­ing: every sin­gle time there’s an annu­al bud­get ‘shut­down show­down’, where the GOP threat­ens to trig­ger a fed­er­al default unless the Democ­rats agree to their demands, it will be an oppor­tu­ni­ty to force ‘bipar­ti­san’ to enti­tle­ments. The US has long been used to annu­al polit­i­cal hostage-tak­ing as part of the reg­u­lar bud­getary process­es. It will just be a MUCH LARGER hostage-tak­ing sit­u­a­tion. Well, at least until they suc­cess­ful­ly gut these enti­tle­ments down to a nub and there’s not more cut­ting to do:

...
“If you qual­i­fy for the enti­tle­ment, you just get it no mat­ter what the cost,” John­son said. “And our prob­lem in this coun­try is that more than 70 per­cent of our fed­er­al bud­get, of our fed­er­al spend­ing, is all manda­to­ry spend­ing. It’s on auto­mat­ic pilot. It nev­er — you just don’t do prop­er over­sight. You don’t get in there and fix the pro­grams going bank­rupt. It’s just on auto­mat­ic pilot.”

...

John­son sug­gest­ed that Social Secu­ri­ty and Medicare be trans­formed into pro­grams whose bud­gets are appro­pri­at­ed by Con­gress on an annu­al basis. He point­ed out that bud­gets for the Defense and Vet­er­ans Affairs depart­ments are approved as dis­cre­tionary spend­ing.

“What we ought to be doing is we ought to turn every­thing into dis­cre­tionary spend­ing so it’s all eval­u­at­ed so that we can fix prob­lems or fix pro­grams that are bro­ken, that are going to be going bank­rupt,” John­son said. “As long as things are on auto­mat­ic pilot, we just con­tin­ue to pile up debt.”

...

And as the arti­cle reminds us, this was­n’t the first time this year that promi­nent GOP Sen­a­tor pro­mot­ed a plan that — while quin­tes­sen­tial­ly Repub­li­can in its design — is also so polit­i­cal­ly tox­ic that Minor­i­ty Leader Mitch McConnell felt the need to pub­licly rebuke it. McConnell had to do the same pub­lic dam­age con­trol back in March after Flori­da Sen­a­tor Rick Scott pro­mot­ed an idea that’s arguably polit­i­cal­ly even worse than Ron John­son’s: an 11-point plan that would raise income tax­es on the poor­est Amer­i­can’s who make too lit­tle to pay under the cur­rent tax code and also sun­set Social Secu­ri­ty and Medicare with­in five year. It’s like the worst plan you could imag­ine polit­i­cal­ly-speak­ing. And yet Rick Scott, a mem­ber of the Repub­li­can Sen­ate lead­er­ship, actu­al­ly put this plan for­ward. Why? Because that’s the Repub­li­can agen­da. It’s that sim­ple. Mitch McConnell pub­licly opposed Scot­t’s plan for the same rea­son he pub­licly opposed John­son’s plan: they’re polit­i­cal­ly sui­ci­dal. And yet these polit­i­cal sui­ci­dal plans are very much at the core of the GOP’s agen­da. That’s why McConnell has to keep play­ing whack-a-mole with polit­i­cal­ly awful ideas:

...
Asked Wednes­day whether Sen­ate Minor­i­ty Leader Mitch McConnell (R‑Ky.) would sup­port such a plan, a rep­re­sen­ta­tive for him point­ed to his pre­vi­ous rejec­tion of a pro­pos­al by Sen. Rick Scott (R‑Fla.) that would have sim­i­lar­ly upend­ed Social Secu­ri­ty and Medicare. In March, John­son said he sup­port­ed “most” of Scott’s plan and called it “a pos­i­tive thing.”

“If we’re for­tu­nate enough to have the major­i­ty next year, I’ll be the major­i­ty leader. I’ll decide in con­sul­ta­tion with my mem­bers what to put on the floor,” McConnell told reporters in March. “Let me tell you what would not be a part of our agen­da: We will not have as part of our agen­da a bill that rais­es tax­es on half the Amer­i­can peo­ple and sun­sets Social Secu­ri­ty and Medicare with­in five years.”
...

Yes, John­son’s plan was so sim­i­lar to Rick Scot­t’s plan back in March that McConnel­l’s spokesper­son could sim­ply refer back to McConnel­l’s rejec­tion of that plan. A plan to replace the US’s enti­tle­ments sys­tem to an end­less string of ‘5‑year plans’, because longer-term plan­ning would­n’t be allowed:

Politi­co

McConnell clash­es with Rick Scott over Repub­li­can agen­da

Mitch McConnell and Sen­ate Repub­li­can lead­ers are warn­ing Rick Scott that his agen­da for the GOP could expose the par­ty to unnec­es­sary attacks this fall.

By Burgess Everett and Mar­i­anne LeVine
03/01/2022 01:53 PM EST
Updat­ed: 03/01/2022 03:16 PM EST

Mitch McConnell and Sen­ate Repub­li­can lead­ers are warn­ing Rick Scott that his agen­da for the GOP could expose the par­ty to unnec­es­sary attacks this fall, a sig­nif­i­cant intra­party rebuke of the Florid­i­an.

The Sen­ate minor­i­ty leader, who has declined thus far to release a the agen­da, advised Scott at a GOP lead­er­ship meet­ing on Mon­day after­noon that his 11-point pro­pos­al gave Democ­rats ammu­ni­tion for mil­lions of dol­lars of ads in the midterms, accord­ing to mul­ti­ple peo­ple briefed on the exchange.

Though he chairs Sen­ate Repub­li­cans’ cam­paign arm, Scott defend­ed him­self by say­ing he released the agen­da in his role as a rank-and-file sen­a­tor, not as a state­ment of par­ty plans. The meet­ing last­ed near­ly an hour, and Scott’s recess-week agen­da intro­duc­tion dom­i­nat­ed the dis­cus­sion.

The exchange between McConnell and his top cam­paign hand high­lights a grow­ing divide in the par­ty as the GOP fights to take the House and Sen­ate, despite their bright elec­toral prospects. While McConnell prefers to keep the heat on Democ­rats and make the elec­tion a ref­er­en­dum on Pres­i­dent Joe Biden, some in the par­ty — not just Scott — believe Repub­li­cans need a more affir­ma­tive agen­da.

The schism played out on into Tues­day at a lead­er­ship press con­fer­ence. Scott exit­ed the event abrupt­ly just before McConnell cas­ti­gat­ed two of his pro­pos­als.

“Let me tell you what will not be a part of our agen­da: We will not have as part of our agen­da a bill that rais­es tax­es on half the Amer­i­can peo­ple and sun­sets Social Secu­ri­ty and Medicare after five years. That will not be part of the Repub­li­can Sen­ate major­i­ty agen­da,” McConnell said.

And McConnell made clear he’s plan­ning to be ful­ly in charge in 2023: “If we’re for­tu­nate enough to have the major­i­ty next year, I’ll be the major­i­ty leader. I’ll decide, in con­sul­ta­tion with my mem­bers, what to put on the floor.” He didn’t offer specifics of what his agen­da would be beyond top­ics like infla­tion, bor­der secu­ri­ty, crime and ener­gy.

Scott has launched an ad to pro­mote his agen­da and has been unre­pen­tant about roil­ing his par­ty with poten­tial­ly polar­iz­ing pro­pos­als, such as sun­set­ting all fed­er­al laws after five years and advis­ing that “all Amer­i­cans should pay some income tax to have skin in the game.” Scott declined to address the Mon­day meet­ing with McConnell, and said in a brief inter­view that he’s “not ever going to talk about pri­vate con­ver­sa­tions, but I believe it’s impor­tant to tell peo­ple what we’re going to do.”

“Repub­li­cans, and real­ly all Amer­i­cans out­side of Wash­ing­ton, are demand­ing that we have a plan to turn our coun­try around,” said Chris Hart­line, a spokesper­son for Scott. “Sen. Scott is not afraid to start this con­ver­sa­tion and will con­tin­ue talk­ing about his plan to res­cue Amer­i­ca.”

...

Some have spec­u­lat­ed that Scott might be prepar­ing to chal­lenge McConnell or run for pres­i­dent, both of which he has denied. And though Scott launched his agen­da in his per­son­al capac­i­ty, Repub­li­cans said the fact that Scott is the chair of the Nation­al Repub­li­can Sen­a­to­r­i­al Com­mit­tee has made every­thing a lit­tle messier.

That’s what “makes it a lit­tle con­fus­ing,” said Sen. John Cornyn (R‑Texas), a for­mer two-time NRSC chair.

“This is not an approach embraced by the entire Repub­li­can con­fer­ence,” Cornyn added of Scott’s agen­da. “We’re going to keep our focus on infla­tion, crime, the bor­der and Afghanistan. And some of these oth­er things are things to think about … after the elec­tion is over.”

McConnell wants to avoid giv­ing Democ­rats things to crit­i­cize over the next eight months, hop­ing to keep his par­ty on offense. He believes that focus­ing on Biden’s low approval rat­ings and run­ning as a check on the Demo­c­ra­t­ic Par­ty is the most effec­tive midterm strat­e­gy. He’s also reluc­tant to embrace spe­cif­ic pol­i­cy mea­sures after the Sen­ate GOP failed to repeal Oba­macare after a years-long cam­paign against the law.

Scott has indis­putably dis­rupt­ed that strat­e­gy, as Democ­rats tee off on aspects of his plan. Sen­ate Major­i­ty Leader Chuck Schumer said on Tues­day that Scott had “pro­posed every­thing from rais­ing tax­es on low-income Amer­i­cans to nam­ing a use­less and inef­fec­tive bor­der wall after Don­ald Trump.”

...

And it’s pos­si­ble McConnell and oth­er Sen­ate lead­ers do even­tu­al­ly put togeth­er a broad out­line of their goals for the 2022 elec­tion. But at the moment, that’s not the party’s focus.

“We’re wis­er to have each sen­a­tor pro­mote their own view on the issues they care about,” said Sen. Mitt Rom­ney (R‑Utah).

Though Scott’s plat­form has roiled some cor­ners of the GOP, it has some sup­port in the par­ty too. Sen. Tom­my Tuberville (R‑Ala.) said he’s “on board” with Scott’s blue­print and said Repub­li­cans need to be think­ing about “a uni­ver­sal plan that we need to sell to the Amer­i­can peo­ple.”

Scott’s plan is a mix­ture of fis­cal con­ser­vatism and the more con­fronta­tion­al style of pol­i­tics ush­ered in by for­mer Pres­i­dent Don­ald Trump. Scott wants to treat social­ism “as a for­eign com­bat­ant which aims to destroy our pros­per­i­ty and free­dom” and says the par­ty should “pro­hib­it debt ceil­ing increas­es absent a dec­la­ra­tion of war.”

He also wants to name the south­ern bor­der wall after Trump, draw­ing a gen­tle reproach from some of his col­leagues.

“Com­plet­ing the bor­der wall and the broad­er issue with bor­der secu­ri­ty is on the top of mind for the Amer­i­can peo­ple,” said Sen. Thom Tillis (R‑N.C.). “What we name it after to me is less rel­e­vant than fix­ing 2 mil­lion peo­ple com­ing across the bor­der.”

Because of how the Sen­ate map is shap­ing up, Scott’s blue­print will only affect a hand­ful of Repub­li­cans run­ning for reelec­tion. Just three GOP sen­a­tors are run­ning in states con­sid­ered at all com­pet­i­tive: Grass­ley, Sen. Ron John­son (R‑Wis.) and Mar­co Rubio (R‑Fla.).

...

———-

“McConnell clash­es with Rick Scott over Repub­li­can agen­da” by Burgess Everett and Mar­i­anne LeVine; Politi­co; 03/01/2022

“Scott has launched an ad to pro­mote his agen­da and has been unre­pen­tant about roil­ing his par­ty with poten­tial­ly polar­iz­ing pro­pos­als, such as sun­set­ting all fed­er­al laws after five years and advis­ing that “all Amer­i­cans should pay some income tax to have skin in the game.” Scott declined to address the Mon­day meet­ing with McConnell, and said in a brief inter­view that he’s “not ever going to talk about pri­vate con­ver­sa­tions, but I believe it’s impor­tant to tell peo­ple what we’re going to do.””

A plan to sun­set not just Social Secu­ri­ty and Medicare in five year. ALL fed­er­al law would be sun­set­ted in five years under Rick Scot­t’s plan. You basi­cal­ly could­n’t rely on the US fed­er­al gov­ern­ment for any­thing. All it would take is one major tem­po­rary finan­cial cri­sis to cre­ate the pre­text for the per­ma­nent gut­ting of almost all fed­er­al spend­ing. Sure, you could in the­o­ry restart Social Secu­ri­ty and Medicare after killing the pro­grams, but we know how real­is­tic that is. Which entire­ly unre­al­is­tic. This is just the lat­est plan to cre­ate a pre­text for the slash­ing of almost all fed­er­al spend­ing. Social Secu­ri­ty and Medicare are just the two biggest tar­gets:

...
The exchange between McConnell and his top cam­paign hand high­lights a grow­ing divide in the par­ty as the GOP fights to take the House and Sen­ate, despite their bright elec­toral prospects. While McConnell prefers to keep the heat on Democ­rats and make the elec­tion a ref­er­en­dum on Pres­i­dent Joe Biden, some in the par­ty — not just Scott — believe Repub­li­cans need a more affir­ma­tive agen­da.

The schism played out on into Tues­day at a lead­er­ship press con­fer­ence. Scott exit­ed the event abrupt­ly just before McConnell cas­ti­gat­ed two of his pro­pos­als.

“Let me tell you what will not be a part of our agen­da: We will not have as part of our agen­da a bill that rais­es tax­es on half the Amer­i­can peo­ple and sun­sets Social Secu­ri­ty and Medicare after five years. That will not be part of the Repub­li­can Sen­ate major­i­ty agen­da,” McConnell said.

And McConnell made clear he’s plan­ning to be ful­ly in charge in 2023: “If we’re for­tu­nate enough to have the major­i­ty next year, I’ll be the major­i­ty leader. I’ll decide, in con­sul­ta­tion with my mem­bers, what to put on the floor.” He didn’t offer specifics of what his agen­da would be beyond top­ics like infla­tion, bor­der secu­ri­ty, crime and ener­gy.

...

“Repub­li­cans, and real­ly all Amer­i­cans out­side of Wash­ing­ton, are demand­ing that we have a plan to turn our coun­try around,” said Chris Hart­line, a spokesper­son for Scott. “Sen. Scott is not afraid to start this con­ver­sa­tion and will con­tin­ue talk­ing about his plan to res­cue Amer­i­ca.”

...

McConnell wants to avoid giv­ing Democ­rats things to crit­i­cize over the next eight months, hop­ing to keep his par­ty on offense. He believes that focus­ing on Biden’s low approval rat­ings and run­ning as a check on the Demo­c­ra­t­ic Par­ty is the most effec­tive midterm strat­e­gy. He’s also reluc­tant to embrace spe­cif­ic pol­i­cy mea­sures after the Sen­ate GOP failed to repeal Oba­macare after a years-long cam­paign against the law.

...

Because of how the Sen­ate map is shap­ing up, Scott’s blue­print will only affect a hand­ful of Repub­li­cans run­ning for reelec­tion. Just three GOP sen­a­tors are run­ning in states con­sid­ered at all com­pet­i­tive: Grass­ley, Sen. Ron John­son (R‑Wis.) and Mar­co Rubio (R‑Fla.).
...

And note how Scott defend­ed his 11-point plan by assert­ing that we was mere­ly putting it for­ward in his role as a rank-and-file sen­a­tor and not in his role as a mem­ber of the par­ty’s lead­er­ship team. As we’re going to see in the fol­low­ing arti­cle, that does­n’t actu­al­ly appear to be the case and Scott released a ver­sion of his plan that was intend­ed to rep­re­sent the entire par­ty’s agen­da. It’s a reflec­tion of the awful­ness of the pol­i­tics of this plan. And yet Scott did it. Why? Because that’s the par­ty’s actu­al plan. Mitch McConnell just has enough polit­i­cal sense not to release it to the pub­lic before they’re ready to put it into law. And yet as Scott points out in his defense of his plan, the Repub­li­can par­ty does­n’t actu­al­ly have a pub­lic agen­da in 2022. Yes, the GOP’s aban­don­ment of pub­lic plat­forms was­n’t just a Trump phe­nom­e­na. Of course, as we’re also going to see in the fol­low­ing arti­cle, not hav­ing a plan is very much part of Mitch McConnel­l’s plan for 2022. Which is fur­ther indi­ca­tion that Scot­t’s plan is indeed the GOP’s plan:

...
Though he chairs Sen­ate Repub­li­cans’ cam­paign arm, Scott defend­ed him­self by say­ing he released the agen­da in his role as a rank-and-file sen­a­tor, not as a state­ment of par­ty plans. The meet­ing last­ed near­ly an hour, and Scott’s recess-week agen­da intro­duc­tion dom­i­nat­ed the dis­cus­sion.

...

Though Scott’s plat­form has roiled some cor­ners of the GOP, it has some sup­port in the par­ty too. Sen. Tom­my Tuberville (R‑Ala.) said he’s “on board” with Scott’s blue­print and said Repub­li­cans need to be think­ing about “a uni­ver­sal plan that we need to sell to the Amer­i­can peo­ple.”

Scott’s plan is a mix­ture of fis­cal con­ser­vatism and the more con­fronta­tion­al style of pol­i­tics ush­ered in by for­mer Pres­i­dent Don­ald Trump. Scott wants to treat social­ism “as a for­eign com­bat­ant which aims to destroy our pros­per­i­ty and free­dom” and says the par­ty should “pro­hib­it debt ceil­ing increas­es absent a dec­la­ra­tion of war.”
...

And as the fol­low­ing arti­cle notes, while Scott now claims that he put for­ward this pro­pos­al mere­ly in his role as a rank-and-file sen­a­tor, he actu­al­ly released a ver­sion of the plan that was pur­port­ing to rep­re­sent the Repub­li­can Par­ty. So we have Scot­t’s plan vs McConnel­l’s no plan. Or at least McConnel­l’s alleged lack of plans. He obvi­ous­ly has plans. Which he obvi­ous­ly knows are so tox­ic they can’t be shared. Pre­sum­ably because they’re basi­cal­ly the same plans Scott and John­son keep spilling:

The Wash­ing­ton Post

McConnell rejects GOP Sen. Rick Scott’s tax plan and agen­da, insists he will remain Repub­li­can leader

By Amy B Wang, Josh Dawsey and Mar­i­ana Alfaro
Updat­ed March 1, 2022 at 5:06 p.m. EST|Published March 1, 2022 at 4:21 p.m. EST

Sen­ate Minor­i­ty Leader Mitch McConnell (R‑Ky.) on Tues­day pub­licly reject­ed a pro­pos­al by Sen. Rick Scott (R‑Fla.), who last month released a “11-point plan to res­cue Amer­i­ca” that has drawn crit­i­cism from sev­er­al promi­nent Repub­li­cans. McConnell insist­ed that if Repub­li­cans win the major­i­ty in Novem­ber, he will decide the party’s course, stak­ing out a defi­ant stance against for­mer pres­i­dent Don­ald Trump’s efforts to oust him as the GOP leader.

At a Sen­ate GOP lead­er­ship news con­fer­ence Tues­day after­noon, McConnell seemed to take issue not only with Scott’s plan — which includ­ed a pro­pos­al for all Amer­i­cans to pay some form of income tax — but also with the fact that Scott, a mem­ber of the lead­er­ship team, had released one pur­port­ing to rep­re­sent the Repub­li­can Par­ty.

...

McConnell has been adamant that the Sen­ate GOP will not release a plat­form ahead of the midterm elec­tion, say­ing the par­ty only needs to reveal its plans for run­ning Con­gress “when we take it back” — a posi­tion some oth­er Repub­li­cans, includ­ing House Minor­i­ty Leader Kevin McCarthy (R‑Calif.), have dis­agreed with.

Scott’s 11-point pro­pos­al includes many oth­er long-stand­ing con­ser­v­a­tive projects, such as elim­i­nat­ing the Edu­ca­tion Depart­ment, build­ing Trump’s bor­der wall and declar­ing that there are only two gen­ders.

At Tuesday’s news con­fer­ence, after each mem­ber of the Repub­li­can lead­er­ship had deliv­ered remarks, reporters asked McConnell about Scott’s plan.

“Sen. Scott is behind me, and he can address the issue of his par­tic­u­lar mea­sure,” he said, though at that moment, Scott, the chair­man of the Nation­al Repub­li­can Sen­a­to­r­i­al Com­mit­tee, was walk­ing away.

McConnell was told in advance of the Scott plan but did not sup­port it, accord­ing to a McConnell advis­er who spoke on the con­di­tion of anonymi­ty to dis­cuss pri­vate delib­er­a­tions. Dur­ing a meet­ing Mon­day night ahead of Tuesday’s news con­fer­ence, McConnell was sharply crit­i­cal of the idea dur­ing a pri­vate lead­er­ship meet­ing.Politi­co first report­ed on the Mon­day clash.

“The entire lead­er­ship team teed off on Rick Scott for the entire­ty of the meet­ing,” said a per­son famil­iar with the meet­ing who spoke on the con­di­tion of anonymi­ty to dis­cuss what was said. The per­son feared that Repub­li­can sen­a­tors such as Charles E. Grass­ley (Iowa) and Mar­co Rubio (Fla.) would face Demo­c­ra­t­ic attacks over the plan as they run for reelec­tion this year.

“It’s the polit­i­cal com­pe­ten­cy or the lack there­of,” the per­son said.

In a state­ment Tues­day, Scott did not back down, insist­ing that the GOP should have a plan and that he would con­tin­ue talk­ing about his.

“I agree with Sen­a­tor McConnell that this elec­tion will pri­mar­i­ly be about Joe Biden and the Democ­rats’ fail­ures, but have been clear that I also believe Repub­li­cans should talk about a plan for turn­ing this coun­try around,” Scott said. “I’m a busi­ness guy and I’ve always believed in mak­ing plans in order to get things done. Repub­li­cans, and real­ly all Amer­i­cans out­side of Wash­ing­ton, are demand­ing it.”

McConnell decid­ed over the week­end to say some­thing pub­licly about Scott’s pro­pos­al because he watched ads and news releas­es that his mem­bers were for­ward­ing to him, with their oppo­nents attack­ing them over the plan. McConnell wor­ried the ads would pro­lif­er­ate if he did not say some­thing denounc­ing the plan, the advis­er said.

The argu­ment from McConnell is that Democ­rats are under­wa­ter across the board, and “why would we give our oppo­nents some­thing to attack us with?” the per­son said. “Why would you want to ele­vate your­self to be a lia­bil­i­ty for Sen­ate Repub­li­can can­di­dates?”

As head of the Nation­al Repub­li­can Sen­a­to­r­i­al Com­mit­tee, the group that works to elect Repub­li­cans to the Sen­ate, Scott has had to walk a tightrope, embrac­ing Trump while avoid­ing or wav­ing off Trump’s most out­landish claims and feuds. Scott has also met with Trump sev­er­al times recent­ly, includ­ing last month at the for­mer president’s Mar-a-Lago estate. The NRSC held a high-dol­lar event at the club, but most of the sen­a­tors, stay­ing at the near­by Break­ers, did not attend.

Over the last year, Trump has inten­si­fied his attacks of McConnell, call­ing him out of touch with the Repub­li­can base and a “bro­ken old crow,” among oth­er pejo­ra­tives. But Trump’s efforts to pluck away sen­a­tors from vot­ing for McConnell have not real­ly amount­ed to much, mul­ti­ple advis­ers said, as most sen­a­tors are non­com­mit­tal or pos­i­tive about the minor­i­ty leader. McConnell remains the longest-serv­ing Sen­ate Repub­li­can leader in U.S. his­to­ry, unan­i­mous­ly elect­ed by the par­ty eight times since 2006.

Scott has denied that he is plan­ning to chal­lenge McConnell for head of the GOP. In Novem­ber, Scott defied Trump to state he would back McConnell’s reelec­tion as the Repub­li­can leader, as well as the reelec­tion of Sen. Lisa Murkows­ki (R‑Alaska), whom Trump is also try­ing to unseat.

...

———–

“McConnell rejects GOP Sen. Rick Scott’s tax plan and agen­da, insists he will remain Repub­li­can leader” By Amy B Wang, Josh Dawsey and Mar­i­ana Alfaro; The Wash­ing­ton Post; 03/01/2022

“McConnell has been adamant that the Sen­ate GOP will not release a plat­form ahead of the midterm elec­tion, say­ing the par­ty only needs to reveal its plans for run­ning Con­gress “when we take it back” — a posi­tion some oth­er Repub­li­cans, includ­ing House Minor­i­ty Leader Kevin McCarthy (R‑Calif.), have dis­agreed with.”

Yes, Mitch McConnell was­n’t just adamant­ly opposed to Rick Scot­t’s plans to raise income tax­es on the poor­est Amer­i­cans and sun­set Social Secu­ri­ty and Medicare with­in five years. He’s adamant­ly opposed to any plans. At least any plans being released to the pub­lic. That’s part of why McConnell was quick to pub­licly rebuke Scot­t’s plan. That and the fact that Scott actu­al­ly released a ver­sion of the plan pur­port­ing to rep­re­sent the Repub­li­can Par­ty. The more details we learn about this intra-par­ty lead­er­ship ker­fuf­fle, the more it appears that Scott was let­ting the cat out of the bag too soon. That’s part of the con­text of McConnel­l’s com­plete rebuke of Scot­t’s plan: a com­plete rebuke was the only way to get that cat back in the bag. Which is also why we can’t take McConnel­l’s denials seri­ous­ly:

...
At a Sen­ate GOP lead­er­ship news con­fer­ence Tues­day after­noon, McConnell seemed to take issue not only with Scott’s plan — which includ­ed a pro­pos­al for all Amer­i­cans to pay some form of income tax — but also with the fact that Scott, a mem­ber of the lead­er­ship team, had released one pur­port­ing to rep­re­sent the Repub­li­can Par­ty.

...

McConnell was told in advance of the Scott plan but did not sup­port it, accord­ing to a McConnell advis­er who spoke on the con­di­tion of anonymi­ty to dis­cuss pri­vate delib­er­a­tions. Dur­ing a meet­ing Mon­day night ahead of Tuesday’s news con­fer­ence, McConnell was sharply crit­i­cal of the idea dur­ing a pri­vate lead­er­ship meet­ing.Politi­co first report­ed on the Mon­day clash.

“The entire lead­er­ship team teed off on Rick Scott for the entire­ty of the meet­ing,” said a per­son famil­iar with the meet­ing who spoke on the con­di­tion of anonymi­ty to dis­cuss what was said. The per­son feared that Repub­li­can sen­a­tors such as Charles E. Grass­ley (Iowa) and Mar­co Rubio (Fla.) would face Demo­c­ra­t­ic attacks over the plan as they run for reelec­tion this year.

“It’s the polit­i­cal com­pe­ten­cy or the lack there­of,” the per­son said.

In a state­ment Tues­day, Scott did not back down, insist­ing that the GOP should have a plan and that he would con­tin­ue talk­ing about his.

...

McConnell decid­ed over the week­end to say some­thing pub­licly about Scott’s pro­pos­al because he watched ads and news releas­es that his mem­bers were for­ward­ing to him, with their oppo­nents attack­ing them over the plan. McConnell wor­ried the ads would pro­lif­er­ate if he did not say some­thing denounc­ing the plan, the advis­er said.

The argu­ment from McConnell is that Democ­rats are under­wa­ter across the board, and “why would we give our oppo­nents some­thing to attack us with?” the per­son said. “Why would you want to ele­vate your­self to be a lia­bil­i­ty for Sen­ate Repub­li­can can­di­dates?”
...

And that’s all par­ty of the con­text of Ron John­son’s omi­nous pro­pos­al to make all fed­er­al spend­ing dis­cre­tionary. It’s basi­cal­ly a retool­ing of Rick Scot­t’s plan from ear­li­er this year.

So giv­en that the GOP’s secret plan for ‘drown­ing the gov­ern­ment in the bath­tub’ appears to revolv­ing around the bud­get gim­mick of turn­ing every­thing into dis­cre­tionary spend­ing that requires con­tin­u­ous re-approval by con­gress, here’s a recent reminder of the kind of ‘over­sight’ we can expect from Repub­li­cans once every­thing is sub­ject to pen­ny-wise-pound-fool­ish pen­ny-pinch­ing. It was a reminder that US vet­er­ans suf­fer­ing from the health con­se­quences of their expo­sure to ‘burn pits’ aren’t going to for­get any time soon. At least until they die from their health issues:

ABC News

Repub­li­cans reject spend­ing bill for vet­er­ans exposed to ‘burn pits,’ tox­ins

Near­ly 30 Repub­li­cans changed their yes votes since last month.

By Alli­son Pecorin and Isabel­la Mur­ray
July 29, 2022, 3:57 PM

Mil­i­tary vet­er­ans and advo­cates are push­ing back after Repub­li­can sen­a­tors this week blocked pas­sage of a wide­ly sup­port­ed bipar­ti­san bill that would have pro­vid­ed mil­lions of vet­er­ans with expe­dit­ed health care and dis­abil­i­ty pay­ments relat­ed to ill­ness­es caused by tox­ic expo­sure from burn pits dur­ing their ser­vice.

Come­di­an and activist Jon Stew­art on Thurs­day dur­ing a press con­fer­ence in front of the Capi­tol had some choice words for the Repub­li­cans who ral­lied togeth­er to block Wednes­day evening’s Sen­ate pro­ce­dur­al vote on the bill, a stun­ning reverse of pre­vi­ous sup­port for the mea­sure that Democ­rats say could be instru­men­tal in sav­ing the lives of sick vet­er­ans.

“Amer­i­ca’s heroes who fought in our wars out­side sweat­ing their assess off with oxy­gen, bat­tling all kinds of ail­ments while these motherf**kers sit in the air con­di­tion­ing walled off from any of it,” Stew­art said on Thurs­day. “They don’t have to hear it, they don’t have to see it. They don’t have to under­stand that these are human beings.”

Just last month, a near­ly iden­ti­cal bill passed in the Sen­ate with over­whelm­ing bipar­ti­san sup­port, clear­ing by a mar­gin of 84–14. The pro­posed leg­is­la­tion trav­eled to the House cham­ber, where rep­re­sen­ta­tives made a small tech­ni­cal tweak to remove an obscure tax pro­vi­sion that raised a con­sti­tu­tion­al con­cern, and passed again with bipar­ti­san sup­port in a 342–88 vote, send­ing it back to the Sen­ate.

Twen­ty-six Repub­li­cans changed their votes since last month on Wednes­day night when the bill made its way back to the Sen­ate, blocked by a con­tin­gency of Repub­li­cans led by Sen. Pat Toomey, R‑Pa., by a vote mar­gin of 55–42. Six­ty votes were need­ed to move for­ward with the bill. After the vote, GOP sen­a­tors includ­ing Texas’ Ted Cruz cel­e­brat­ed togeth­er, fist-bump­ing on the floor.

Sen­ate Repub­li­cans now say they want to be able to mod­i­fy the bill, to fix a “bud­get gim­mick’ ” they say could be exploit­ed by Democ­rats.

They say their sud­den objec­tion to the bill has noth­ing to do with the $280B in new spend­ing for vet­er­ans’ health and are ral­ly­ing behind Toomey’s efforts to close the per­ceived bud­get loop­hole.

“My con­cern about this bill has noth­ing to do with the pur­pose of the bill,” Toomey said on the Sen­ate floor ahead of the vote.

Toomey insist­ed upon objec­tions to what he claims is an effort by Democ­rats to free up $400 bil­lion in exist­ing funds already being used for vet­er­ans by shuf­fling the mon­ey inside the bud­get to use for unre­lat­ed pur­pos­es.

Stew­art dur­ing Thursday’s press con­fer­ence called Toomey a “f***ing cow­ard.”

“Mitch McConnell yes­ter­day flipped. I’m used to the lies. I’m used to the hypocrisy. Sen. Pat Toomey won’t take a meet­ing with the vet­er­ans groups, sends out his chief of staff. I’m used to the cow­ardice. I’ve been here a long time. The Sen­ate is where account­abil­i­ty goes to die,” Stew­art said.

McConnell backed Toomey in a state­ment Wednes­day.

“As writ­ten, the leg­is­la­tion would not just help America’s vet­er­ans as designed. It could also allow Democ­rats to effec­tive­ly spend the same mon­ey twice and enable hun­dreds of bil­lions in new, unre­lat­ed spend­ing on the dis­cre­tionary side of the fed­er­al bud­get,” McConnell said

...

———–

“Repub­li­cans reject spend­ing bill for vet­er­ans exposed to ‘burn pits,’ tox­ins” by Alli­son Pecorin and Isabel­la Mur­ray; ABC News; 07/29/2022

“Come­di­an and activist Jon Stew­art on Thurs­day dur­ing a press con­fer­ence in front of the Capi­tol had some choice words for the Repub­li­cans who ral­lied togeth­er to block Wednes­day evening’s Sen­ate pro­ce­dur­al vote on the bill, a stun­ning reverse of pre­vi­ous sup­port for the mea­sure that Democ­rats say could be instru­men­tal in sav­ing the lives of sick vet­er­ans.”

It was quite the stun­ning rever­sal: after pre­vi­ous­ly approv­ing the fed­er­al funds for vet­er­an vic­tims of ‘burn pits’, a large num­ber of Repub­li­can sen­a­tors sud­den­ly dropped their sup­port. Why? Well, their osten­si­ble rea­son was some sort of bud­get loop­hole they sud­den­ly found that they demand­ed be fixed. But, of course, that’s not the real rea­son. They just did­n’t want to hand Democ­rats a ‘win’. It’s a pre­view for what the US pub­lic can expect for all fed­er­al spend­ing after the GOP suc­ceeds in mak­ing every­thing dis­cre­tionary spend­ing. The fact that it was sick vet­er­ans get­ting this kind of treat­ment just under­scores how no one will be safe. At least no one who isn’t a GOP mega-donor:

...
Just last month, a near­ly iden­ti­cal bill passed in the Sen­ate with over­whelm­ing bipar­ti­san sup­port, clear­ing by a mar­gin of 84–14. The pro­posed leg­is­la­tion trav­eled to the House cham­ber, where rep­re­sen­ta­tives made a small tech­ni­cal tweak to remove an obscure tax pro­vi­sion that raised a con­sti­tu­tion­al con­cern, and passed again with bipar­ti­san sup­port in a 342–88 vote, send­ing it back to the Sen­ate.

Twen­ty-six Repub­li­cans changed their votes since last month on Wednes­day night when the bill made its way back to the Sen­ate, blocked by a con­tin­gency of Repub­li­cans led by Sen. Pat Toomey, R‑Pa., by a vote mar­gin of 55–42. Six­ty votes were need­ed to move for­ward with the bill. After the vote, GOP sen­a­tors includ­ing Texas’ Ted Cruz cel­e­brat­ed togeth­er, fist-bump­ing on the floor.

Sen­ate Repub­li­cans now say they want to be able to mod­i­fy the bill, to fix a “bud­get gim­mick’ ” they say could be exploit­ed by Democ­rats.

They say their sud­den objec­tion to the bill has noth­ing to do with the $280B in new spend­ing for vet­er­ans’ health and are ral­ly­ing behind Toomey’s efforts to close the per­ceived bud­get loop­hole.

“My con­cern about this bill has noth­ing to do with the pur­pose of the bill,” Toomey said on the Sen­ate floor ahead of the vote.

...

McConnell backed Toomey in a state­ment Wednes­day.
...

As we can see, Mitch McConnell was all on board with these kinds of bud­get gim­micks when that gim­mick­ry result­ed in the block­ing of funds for sick vet­er­ans. It was a pre­view for what we can expect from a Repub­li­can-con­trolled con­gress that treats every­thing like dis­cre­tionary spend­ing. So if it seems some­what unchar­ac­ter­is­tic of Mitch McConnell to pub­licly rebuke plans that sound exact­ly like what the GOP is actu­al­ly plan­ning, it’s impor­tant to keep in mind that hid­ing these plans from the pub­lic until its too late for them to do any­thing about it is the plan. Curi­ous­ly, McConnell isn’t hid­ing it. He’s hid­ing a lot of oth­er stuff but he’s not hid­ing the fact that his plan is to hide his plans. It’s a some­what para­dox­i­cal pub­lic posi­tion for a leader of the par­ty to take. No won­der McConnell is so para­noid about the Scott/Johnson plans to make every­thing into dis­cre­tionary spend­ing. It was under­cut­ting the big plan to not reveal any of the par­ty’s very big plans.