Shifting Dollars From Poor To Give To the Rich Is a Key Part of the Senate Health Bill

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

Senate Majority Leader Mitch McConnell at his office on Thursday, when the Republican health plan was made public. CreditDoug Mills/The New York Times

The Affordable Care Act gave health insurance to millions of Americans by shifting resources from the wealthy to the poor and by moving oversight from states to the federal government. The Senate bill introduced Thursday pushes back forcefully on both dimensions.

The bill is aligned with long-held Republican values, advancing states’ rights and paring back growing entitlement programs, while freeing individuals from requirements that they have insurance and emphasizing personal responsibility. Obamacare raised taxes on high earners and the health care industry, and essentially redistributed that income — in the form of health insurance or insurance subsidies — to many of the groups that have fared poorly over the last few decades.

The draft Senate bill, called the Better Care Reconciliation Act, would jettison those taxes while reducing federal funding for the care of low-income Americans. The bill’s largest benefits go to the wealthiest Americans, who have the most comfortable health care arrangements, and its biggest losses fall to poorer Americans who rely on government support. The bill preserves many of the structures of Obamacare, but rejects several of its central goals.

Mitch McConnell, the Senate majority leader, in the Capitol on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

Like a House version of the legislation, the bill would fundamentally change the structure of Medicaid, which provides health insurance to 74 million disabled or poor Americans, including nearly 40 percent of all children. Instead of open-ended payments, the federal government would give states a maximum payment for nearly every individual enrolled in the program. The Senate version of the bill would increase that allotment every year by a formula that is expected to grow substantially more slowly than the average increase in medical costs.

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Avik Roy, the president of the Foundation for Research on Equal Opportunity, and a conservative health care analyst, cheered the bill on Twitter, saying, “If it passes, it’ll be the greatest policy achievement by a G.O.P. Congress in my lifetime.” The bill, he explained in an email, provides a mechanism for poor Americans to move from Medicaid coverage into the private market, a goal he has long championed as a way of equalizing insurance coverage across income groups.

High-income earners would get substantial tax cuts on payroll and investment income. Subsidies for those low-income Americans who buy their own insurance would decline compared with current law. Low-income Americans who currently buy their own insurance would also lose federal help in paying their deductibles and co-payments.

The bill does offer insurance subsidies to poor Americans who live in states that don’t offer them Medicaid coverage, a group without good insurance options under Obamacare. But the high-deductible plans that would become the norm might continue to leave care out of their financial reach even if they do buy insurance.

The battle over resources played into the public debate. Mitch McConnell, the Senate majority leader, said the bill was needed to “bring help to the families who have been struggling with Obamacare.” In a Facebook post, President Barack Obama, without mentioning the taxes that made his program possible, condemned the Senate bill as “a massive transfer of wealth from middle-class and poor families to the richest people in America.”

In another expression of Republican principles, the bill would make it much easier for states to set their own rules for insurance regulation, a return to the norm before Obamacare.

Under the bill, states would be able to apply for waivers that would let them eliminate consumer protection regulations, like rules that require all health plans to cover a basic package of benefits or that prevent insurance plans from limiting how much care they will cover in a given year.

Where Senators Stand on the Health Care Bill

Senate Republican leaders unveiled their health care bill on Thursday.

States could get rid of the online marketplaces that help consumers compare similar health plans, and make a variety of other changes to the health insurance system. The standards for approval are quite permissive. Not every state would choose to eliminate such rules, of course. But several might.

“You can eliminate all those financial protections,” said Nicholas Bagley, a law professor at the University of Michigan. “That would be huge.”

Americans with pre-existing conditions would continue to enjoy protection from discrimination: In contrast with the House health bill, insurers would not be allowed to charge higher prices to customers with a history of illness, even in states that wish to loosen insurance regulations.

But patients with serious illnesses may still face skimpier, less useful coverage. States may waive benefit requirements and allow insurers to charge customers more. Someone seriously ill who buys a plan that does not cover prescription drugs, for example, may not find it very valuable.

A protester being removed from outside the office of Mitch McConnell on Thursday.CreditSaul Loeb/Agence France-Presse — Getty Images

There are features that would tend to drive down the sticker price of insurance, a crucial concern of many Republican lawmakers, who have criticized high prices under Obamacare. Plans that cover fewer benefits and come with higher deductibles would cost less than more comprehensive coverage.

But because federal subsidies would also decline, only a fraction of people buying their own insurance would enjoy the benefits of lower prices. Many middle-income Americans would be expected to pay a larger share of their income to purchase health insurance that covers a smaller share of their care.

The bill also includes substantial funds to help protect insurers from losses caused by unusually expensive patients, a measure designed to lure into the market those insurance carriers that have grown skittish by losses in the early years of Obamacare. But it removes a policy dear to the insurance industry — if no one else. Without an individual mandate with penalties for Americans who remain uninsured, healthier customers may choose to opt out of the market until they need medical care, increasing costs for those who stay in.

The reforms are unlikely to drive down out-of-pocket spending, another perennial complaint of the bill’s authors, and a central critique by President Trump of the current system. He often likes to say that Obamacare plans come with deductibles so high that they are unusable. Subsidies under the bill would help middle-income consumers buy insurance that pays 58 percent of the average patient’s medical costs, down from 70 percent under Obamacare; it would also remove a different type of subsidy designed to lower deductibles further for Americans earning less than around $30,000 a year.

Out-of-pocket spending is the top concern of most voters. The insurance they would buy under the bill might seem cheap at first, but it wouldn’t be if they ended up paying more in deductibles.

Mr. McConnell was constrained by political considerations and the peculiar rules of the legislative mechanism that he chose to avoid a Democratic filibuster. Despite those limits, he managed to produce a bill that reflects some bedrock conservative values. But the bill also shows some jagged seams. It may not fix many of Obamacare’s problems — high premiums, high deductibles, declining competition — that he has railed against in promoting the new bill’s passage.

Senate Health Care Bill Includes Deep Cuts to Medicaid

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

The Senate majority leader, Mitch McConnell of Kentucky, is the chief author of the Senate’s health care bill.CreditDoug Mills/The New York Times

WASHINGTON — Senate Republicans, who have promised a repeal of the Affordable Care Act for seven years, took a major step on Thursday toward that goal, unveiling a bill to cut Medicaid deeply and end the health law’s mandate that most Americans have health insurance.

The 142-page bill would create a new system of federal tax credits to help people buy health insurance, while offering states the ability to drop many of the benefits required by the Affordable Care Act, like maternity care, emergency services and mental health treatment.

The Senate bill — once promised as a top-to-bottom revamp of the health bill passed by the House last month — instead maintains its structure, with modest adjustments. The Senate version is, in some respects, more moderate than the House bill, offering more financial assistance to some lower-income people to help them defray the rapidly rising cost of private health insurance.

But the Senate measure, like the House bill, would phase out the extra money that the federal government has provided to states as an incentive to expand eligibility for Medicaid. And like the House measure, it would put the entire Medicaid program on a budget, ending the open-ended entitlement that now exists.

 

Video

How the G.O.P. Health Bill Would Change Medicaid

The reporter Margot Sanger-Katz examines how the Republican health plan aims to roll back a program that insures nearly one in five Americans.

By MARGOT SANGER-KATZ, ROBIN STEIN and SARAH STEIN KERR on Publish DateJune 22, 2017. Photo by Doug Mills/The New York Times. Watch in Times Video »

It would also repeal virtually all the tax increases imposed by the Affordable Care Act to pay for itself, in effect handing a broad tax cut to the affluent, paid for by billions of dollars sliced from Medicaid, a health care program that serves one in five Americans, not only the poor but almost two-thirds of those in nursing homes. The bill, drafted in secret, is likely to come to the Senate floor next week, and could come to a vote after 20 hours of debate.

If it passes, President Trump and the Republican Congress would be on the edge of a major overhaul of the American health care system — onesixth of the nation’s economy.

The premise of the bill, repeated almost daily in some form or other by its chief author, the Senate majority leader, Mitch McConnell of Kentucky, is that “Obamacare is collapsing around us, and the American people are desperately searching for relief.”

Mr. Trump shares that view, and the Senate bill, if adopted, would move the president a great distance closer to being able to boast about final passage of a marquee piece of legislation, a feat he has so far been unable to accomplish.

Where Senators Stand on the Health Care Bill

Senate Republican leaders unveiled their health care bill on Thursday.

Democrats and some insurers blame the Republicans and Mr. Trump for sabotaging the law, in part by threatening to withhold subsidies used to help pay for deductibles and co-payments for millions of poor people covered by the law.

In the Senate, Democrats are determined to defend a law that has provided coverage to 20 million people and is a pillar of former President Barack Obama’s legacy. The debate over the repeal bill is shaping up as a titanic political clash, which could have major implications for both parties, affecting their electoral prospects for years to come.

Mr. McConnell faces a great challenge in amassing the votes to win Senate approval of the bill, which Republicans are trying to pass using special budget rules that will allow them to avoid a Democratic filibuster. But with only 52 seats, Mr. McConnell can afford to lose only two Republicans, with Vice President Mike Pence breaking the tie. He may have already lost one — Senator Rand Paul, Republican of Kentucky, has indicated repeatedly that the bill is too liberal for him.

Democrats are unified in opposing the repeal efforts, and they have already assailed Republicans for the work they have done so far, criticizing them for putting the bill together without a single public hearing or bill-drafting session.

GRAPHIC

How Senate Republicans Plan to Dismantle Obamacare

A comparison of the Senate health care with the Affordable Care Act.

OPEN GRAPHIC

In the short term, the possible electoral consequences are more muted in the Senate than in the House, as only two of the Senate Republicans who face re-election next year, Dean Heller of Nevada and Jeff Flake of Arizona, are seen as vulnerable.

But Republican leaders still must contend with internal divisions that will be difficult to overcome. Numerous Republican senators from states that expanded Medicaid are concerned about how a rollback of the program could affect their constituents, and they face pressure from governors back home.

Some senators have concerns based on other issues specific to their states, including the opioid epidemic that has battered states like West Virginia and Ohio. And some of the Senate’s most conservative members could resist a bill that they view as not going far enough in dismantling the Affordable Care Act.

Senators will not have long to sort out their differences. Mr. McConnell wants to hold a vote before lawmakers return home for the Fourth of July recess. If the repeal bill is still looming over the Senate, Republicans are certain to face intense pressure from constituents who wish to see the Affordable Care Act remain in place.

The assessment being made by senators will be shaped in part by an analysis of the bill to be released by the Congressional Budget Office, the official scorekeeper on Capitol Hill.

The budget office found that the bill passed by the House last month would leave 23 million more people without insurance in a decade. Mr. Trump recently told senators that the House bill was “mean,” though weeks earlier he had celebrated its passage.

Abortion Adds Obstacle as Republicans Plan to Unveil Health Bill

(THIS ARTICLE IS COURTESY OF THE NEW YORK TIMES)

Senator Mitch McConnell of Kentucky, the majority leader, hopes to unveil the contents of Republicans’ health bill on Thursday and pass it next week. CreditDoug Mills/The New York Times

WASHINGTON — Abortion flared up Wednesday as the latest hot-button issue to complicate passage of a bill to repeal and replace the Affordable Care Act, which Senate Republican leaders hope to unveil on Thursday and pass next week.

The repeal bill approved last month by the House would bar the use of federal tax credits to help purchase insurance plans that include coverage of abortion. But senators said that provision might have to be jettisoned from their version because of complicated Senate rules that Republicans are using to expedite passage of the bill and avoid a filibuster.

If that provision is dropped, a bill that has already elicited deep misgivings among moderate Republicans — and stiff resistance from Democrats, health care providers and patient advocacy groups — could also generate concern among abortion opponents, as well as conservative lawmakers.

Further complicating the measure’s prospects, insurance companies, which took a leading role in the health care fights of 1993-94 and 2009-10 but have been conspicuously quiet this year, released a blistering letter objecting to Republican plans to remake Medicaid and cut its funding.

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The changes being considered in Congress could “amount to a 25 percent shortfall in covering the actual cost of providing care to our nation’s neediest citizens,” the top executives of 10 insurance companies wrote this week. “These amounts spell deep cuts, not state flexibility, in Medicaid.”

As senators struggle to develop a health care bill, their handiwork appears to be too moderate for some Senate conservatives and too conservative for some Senate moderates. The latest version, without the abortion-coverage prohibition and with steep Medicaid cuts, may prove unacceptable to some in both camps. To pass it, Senate leaders can afford to lose only two Republican votes of the 52 in the chamber.

Republican senators got a glimpse Wednesday of the highlights of the bill, which was drafted in secret by the majority leader, Senator Mitch McConnell of Kentucky, and top aides. White House officials were granted a formal briefing, which risked irking many senators who had yet to see the actual bill.

The House abortion provision has sweeping implications because many health plans subsidized under the Affordable Care Act include coverage for abortion services. The provision has encountered outspoken opposition from officials in states like Oregon, where most health plans on the public insurance exchange cover abortion.

But senators said the provision might have to be dropped for a more prosaic reason: It may not comply with the Senate rules that Republicans are using to speed the health care bill through the Senate.

The bill is scheduled to go to the Senate floor next week under these procedures, which limit debate and preclude a Democratic filibuster.

“It’s one of the problems we have to work with,” Senator Orrin G. Hatch, Republican of Utah and the chairman of the Finance Committee, said of the abortion issue. “We’re not quite sure how that’s going to be resolved.”

Mr. McConnell is determined to get a vote on the bill by the end of next week, before a break for the Fourth of July holiday, but he still does not have enough committed votes to ensure passage.

Senator Rand Paul, Republican of Kentucky, made clear on Wednesday that he was not on board with the Republican bill.

“I’m still hoping we reach impasse, and we actually go back to the idea we originally started with, which is repealing Obamacare,” Mr. Paul said, adding, “I’m not for replacing Obamacare with Obamacare lite.”

Document: Health Insurers Speak Out

The House bill and the Senate version, like the Affordable Care Act, would provide tens of billions of dollars in tax credits to help people pay insurance premiums.

The federal government is expected to spend more than $30 billion this year on tax credits to help lower- and middle-income people pay premiums. The Senate bill would provide more assistance to lower-income people than the House bill, which bases tax credits on a person’s age.

The Senate bill would also repeal most of the taxes imposed by the Affordable Care Act. It would delay the effective date of a tax on high-cost employer-sponsored health coverage, but Republicans plan to offer an amendment next week to eliminate this “Cadillac tax,” which is opposed by labor unions and employers.

Senators Thom Tillis of North Carolina and Susan Collins of Maine, both Republicans, said they understood that the House restrictions on the use of tax credits for insurance covering abortion had encountered parliamentary problems.

“What I heard earlier from the parliamentarian is they didn’t think it would pass” muster under Senate rules, Mr. Tillis said.

Mr. Tillis and Ms. Collins said they understood that Senate Republican leaders were hoping to devise some kind of workaround to address concerns of anti-abortion lawmakers. But it was not clear whether those anti-abortion lawmakers would be satisfied with such a plan, which could involve separate legislation.

Republicans have been promising to repeal the health law ever since it was signed by President Barack Obama in 2010. On Wednesday, in the final hours before the Senate repeal bill was to be unveiled, members of Congress, consumer groups and health care executives engaged in frenetic advocacy in hopes of shaping the bill.

Women’s groups and at least two moderate Republicans, Ms. Collins and Senator Lisa Murkowski of Alaska, continued to object to a provision of Mr. McConnell’s bill that would cut off funds for Planned Parenthood.

In a letter to Mr. McConnell on Wednesday, more than two dozen House members in the conservative Republican Study Committee listed several parts of the House bill they view as crucial, including cutting funds to Planned Parenthood and restricting the use of the tax credits. The bill, they wrote, fulfills “an important conservative commitment to promote life and protect the unborn.”

Leaders of the 10 insurance companies told Mr. McConnell that proposed caps on federal Medicaid spending would cause “an enormous cost shift to the states,” which could force them to raise taxes, reduce benefits, cut payments to health care providers or eliminate coverage for some beneficiaries. Among those signing the letter were top executives of AmeriHealth Caritas, Molina Healthcare, Blue Shield of California and Healthfirst, in New York.

But Senator John Kennedy, Republican of Louisiana, said the Medicaid provisions were one of the bill’s chief attractions for him.

“In my state,” Mr. Kennedy said, “we are now spending 47 percent of our budget on Medicaid. That’s up from 23 percent in 2008. It’s crowding out money for universities and roads and public safety and coastal restoration, and it just keeps climbing.”

Even senators who might support the legislation said they did not want to be rushed.

Asked how he felt about the prospect of voting for a bill a week after its release, Senator John McCain, Republican of Arizona, said, “I feel terrible about it.”

12COMMENTS

Senator Ron Johnson, Republican of Wisconsin, said, “I need the information, I need to hear from constituents, and that’s going to take some time.”

Debate on the Senate bill will be shaped by an analysis from the Congressional Budget Office, which will estimate the impact on federal spending and the number of people without health insurance. Under the House bill, the office said, the number of uninsured would be 23 million higher than under the Affordable Care Act in 2026. And for some older Americans and sick people, it said, premiums and out-of-pocket costs could be significantly higher.

White House to Republicans: Trump reserves the right to throw all of you under the bus

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

The Fix

White House to Republicans: Trump reserves the right to throw all of you under the bus

June 20 at 3:29 PM
Spicer: Trump ‘wants a bill that has heart in it’
White House press secretary Sean Spicer said President Trump wants Congress to pass a health-care bill that “has heart in it,” on June 20 at the White House. (Reuters)

Senate Republicans are confronting a potentially career-altering decision: whether to vote for a health-care bill that polls show is vastly unpopular and could backfire stupendously. And on Tuesday, White House press secretary Sean Spicer had a chance to provide them some reassurance that President Trump wasn’t going to throw them under the bus if things go sideways.

Instead, he basically shrugged his shoulders.

Reports in recent days have quoted Trump, in private settings, as both calling the House GOP’s health-care bill “mean” and saying the Senate bill needed “more heart.” Asked about that second report, from CNBC on Tuesday, Spicer practically confirmed the quote — or at least he didn’t dispute it, as the White House often does.

“The president clearly wants a bill that has heart in it,” Spicer said. “He believes health care is something that is near and dear to so many families and individuals. He made it clear from the beginning that it was one of his priorities.”

If you are a Republican who is thinking about sticking your neck out for this bill, that has to make you think twice.

Last month Trump held a Rose Garden celebration with House Republicans after they passed their version of a health-care bill. Some even thought that festivities were a little over-the-top. But the president clearly wanted to celebrate a first legislative win.

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His actions since then, however, suggest he doesn’t necessarily want his brand attached to this bill and all the sausage-making that goes with it. Recent polls have shown Americans oppose the legislation by a 2-to-1 margin or even a 3-to-1 margin, and the nonpartisan Congressional Budget Office estimates indicate it could reduce the number of insured Americans by 23 million over a decade and raise premiums for older, poorer people. And whatever the perceptions and projections are today, the law of unintended consequences certainly applies when it comes to large-scale legislation. It’s a massively difficult vote to take for any member.

The White House will almost surely come around and say all the right things when the Senate ultimately reveals its bill. And for Trump and Spicer, it’s probably smart to withhold your full endorsement to make sure that bill will reflect the things the White House feels are important. But the fact that Trump is saying these things behind closed doors about a bill he once celebrated has to make Republican senators think twice.

What if the bill they are working on does wind up causing major problems? What if it doesn’t even pass, and most all of them put themselves on the record voting for something that can still be used in a pretty brutal attack ad using those CBO numbers? There is basically nothing to suggest that Trump is going to allow himself to go down with this ship. And unlike your normal politician, he’s not going to feel bound by loyalty, his past statements or that Rose Garden celebration. When Trump feels like disowning something politically, Trump will disown it.

Perhaps the White House could be forgiven for not fighting back strongly enough against reports of Trump’s initial “mean” comment last week. But now it’s happened again; Trump and his White House have basically put the House’s bill at arms-length twice in the span of a week. And on Tuesday it suggested that it reserves the right to bash the bill at a later date if Trump feels like it.

Given the bill will need 50 of 52 Republican senators to vote for it, that’s a pretty terrible message to send right now.

Senate Leader Mitch McConnell Proving He Cares Nothing About The Voters, Only Doners

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

Politics

Senate leaders plan to rush a health-care bill to a vote, and there’s nothing Democrats can do about it

June 19 at 1:11 PM

When the Republican-led Senate Rules Committee briefly flirted with the idea of restricting television interviews in the hallways of the Capitol last week, it became only the most obvious manifestation of how the party’s leaders were handling the development of a bill to overhaul Obamacare: out of the public eye.

While that effort was quickly sidelined after some outcry, the Republican leadership in the Senate was otherwise unfazed in its push to craft a bill that would expose its members to as little negative public attention as possible. No repeat of the town hall meetings that drew angry constituents who yelled at House Republicans and, they clearly hope, no weeks and weeks of swamped office phone lines.

In an article for the Monkey Cage, George Washington University’s Sarah Binder explained the four ways in which the Senate effort was unusually secretive. Sure, members of Congress would always rather pass legislation without dealing with negative criticism, but rarely have they gone so dark on such a big effort.

Here’s what’s in the new CBO report on the Republican health-care bill
The Congressional Budget Office has released its score on the revised American Health Care Act. Here’s what’s in the report. (Daron Taylor/The Washington Post)

The question that arises, though, is what Democrats could actually do about it. Binder told me that the answer was probably a simple one.

Nothing.

“I have a hard time seeing a real avenue for successful obstruction by the Democrats,” Binder said. The situation is unusual enough that making hard and fast predictions is tricky, she said, but “Republicans have been so aggressive on procedure here that I’d expect them to … get this through without any heed of what the Democrats were raising.”

In particular, Binder addressed a proposal outlined in a series of tweets last week by Ezra Levin, a former deputy policy director for House Democrats. Levin suggested that the Democrats could introduce an almost infinite number of amendments that would choke the Senate calendar indefinitely until they got what they wanted.

The plan hinges on the way in which the bill is being moved through the Senate. To avoid the need for Democratic votes — which the Republican majority wouldn’t get — the Obamacare replacement is being advanced using what’s known as the reconciliation process. That process involves a special set of rules that are meant to fast-track debate over the budget, but, given that it also means legislation can avoid a filibuster in the Senate, it has also been used to pass controversial bills. (Several fixes essential to the passage of Obamacare were moved using the reconciliation process, for example.)

Those rules, defined by law, include allowing only 20 hours for debate but it also includes a process called “vote-a-rama,” in which amendments may be proposed and must be voted on before the final passage of the bill. That’s where Levin’s idea comes in: He proposed introducing tens of thousands of amendments that would need to be voted on before the Senate’s bill could be passed. In theory, Levin figured, Democrats could introduce enough amendments to shut down the Senate for a year.

Binder disagrees.

“In reality, that’s not going to happen,” she said. What was more likely, she said, is that someone would make a point of order that the Democrats were being “dilatory” — that is, slowing down the process unnecessarily. The presiding officer — the Republican senator on duty to manage floor debate — would be asked to rule on whether that was the case and would likely agree. Democrats could appeal the decision, but a majority vote would end the process.

The Senate Parliamentarian Warns Republicans That Their Healthcare Bill Can’t Pass

(THIS ARTICLE IS COURTESY OF THE HILL NEWSPAPER)

The Senate parliamentarian has warned Republicans that a key provision in their healthcare reform bill related to abortion is unlikely to be allowed, raising a serious threat to the legislation.

The parliamentarian, Elizabeth MacDonough, has flagged language that would bar people from using new refundable tax credits for private insurance plans that cover abortion, according to Senate sources.

If Republicans are forced to strip the so-called Hyde language from the legislation, which essentially bars federal funds from being used to pay for abortions unless to save the life of a mother or in cases of rape and incest, it may doom the bill.

MacDonough declined to comment for this article.

Unless a workaround can be found, conservative senators and groups that advocate against abortion rights are likely to oppose the legislation.

Republicans control 52 seats in the Senate; they can afford only two defections and still pass the bill, assuming Democrats are united against it. Vice President would break a 50-50 tie.

Normally controversial legislation requires 60 votes to pass the Senate, but Republicans hope to pass the ObamaCare repeal-and-replace bill with a simple majority vote under a special budgetary process known as reconciliation.

The catch is that the legislation must pass a six-part test known as the Byrd Rule, and it’s up to the parliamentarian to advise whether legislative provisions meet its requirements.

The toughest requirement states that a provision cannot produce changes in government outlays or revenues that are merely incidental to the non-budgetary components of the provision.

In other words, a provision passed under reconciliation cannot be primarily oriented toward making policy change instead of impacting the budget. Arguably, attaching Hyde language to the refundable tax credits is designed more to shape abortion policy than affect how much money is spent to subsidize healthcare coverage.

 

The abortion language that conservatives want in the healthcare bill may run afoul of a precedent set in 1995, when then-Senate Parliamentarian Robert Dove ruled that an abortion provision affecting a state block grant program failed to meet reconciliation requirements, according to a source briefed on internal Senate discussions.

One GOP source identified the parliamentarian’s objection to the Hyde language along with Republican infighting over how to cap ObamaCare’s Medicaid expansion as two of the biggest obstacles to passing a bill.

A Republican senator confirmed that negotiators have wrestled with the procedural obstacle facing the anti-abortion language.

“That has come up and there well could be a challenge,” the lawmaker said.

The lawmaker, however, said that the problem is surmountable, arguing “there are ways around it.”

One possibility would be to change the form of assistance to low-income people by changing it from a refundable tax credit to a subsidy filtered through an already existing government program that restricts abortion services, such as the Federal Employee Health Benefits program or Medicaid.

A second Republican senator said discussions on the topic are ongoing.

GOP negotiators picked up the pace of their discussions with the parliamentarian after the Congressional Budget Office released an updated score for the House-passed bill in late May.

President Trump is pushing the Senate to pass its version of the legislation by July 4.

If GOP leaders are forced to strip the Hyde language from the healthcare bill and cannot find an alternative way to seal off insurance tax credits or subsidies from abortion services, they would lose the support of anti-abortion rights groups, a devastating blow.

“We’ve made it clear in a lot of conversations and some letters that any GOP replacement plan has to be consistent with the principles of the Hyde Amendment,” said David Christensen, vice president of government affairs at Family Research Council, a conservative group that promotes Christian values.

“Abortion is not healthcare and the government should not be subsidizing elective abortion,” he added.

Christensen predicted that activists would be up in arms if abortion services aren’t barred under the bill.

“If the Byrd Rule were to be an obstacle to ensuring the GOP replacement plan in the Senate does not subsidize abortion, that’s something that would be a serious problem for us and the pro-life community,” he said.

Republican senators who are thought to be safe votes to support the GOP leadership’s ObamaCare repeal and replace plan may suddenly shift to undecided or opposed.

“Would that be a deal killer? I’d have to think about it. I’m inclined to think it would [be],” said Sen. Jim Inhofe (R-Okla.).

Senate Finance Committee Chairman Orrin Hatch (R-Utah), who has jurisdiction over the tax credits in the healthcare bill, acknowledged it could be tough to pass the bill without the anti-abortion language.

“I think a lot of people do think that’s essential,” he said.

Senate returns more pessimistic than ever on healthcare

(THIS ARTICLE IS COURTESY OF THE HILL NEWSPAPER)

Senate returns more pessimistic than ever on healthcare

Senators went into a recess skeptical over whether they could agree to legislation repealing and replacing ObamaCare.

They will return on Monday more doubtful than ever.

Sen. Richard Burr (R-N.C.), one of Senate Majority Leader Mitch McConnell’s (R-Ky.) most loyal allies, said Thursday that it’s “unlikely” the GOP will get a healthcare deal.

“I don’t see a comprehensive healthcare plan this year,” he told a local news station.

Senate Republicans hoped to have a draft bill this week, but it now looks like there will at best be an outline.

A Senate Republican aide said it’s too early to begin drafting legislation that can come to the floor in the next few weeks.“Parameters are more likely,” said the aide, who explained that McConnell wants to keep the details held closely so the legislation doesn’t get picked apart before lawmakers have a chance to consider it carefully.

“The last thing we want to do is litigate this in the press,” the aide said. “We want to discuss parameters and concepts without releasing a draft.”

“Maybe they can start talking to members about a specific product next week, but I would not be surprised if we don’t,” said another Senate GOP aide.

More unhelpful news came in the form of a Kaiser Family Foundation poll underscoring how unpopular the bill approved by the House is.

It found that three-quarters of Americans surveyed think the House bill does not fulfill President Trump’s promises on healthcare.

A full 82 percent said federal funding for ObamaCare’s expansion of Medicaid should be continued, an issue that deeply divides the Senate GOP. The House bill ends the ObamaCare funds in 2020.

Yet another factor for Republicans is Trump’s approval rating, which has fallen to its lowest point with Republicans since he took office in the latest Reuters/Ipsos tracking poll.

Republicans already had sought to lower expectations.

McConnell conceded last week that, “I don’t know how we get to 50 [votes] at the moment.”

He sounded more optimistic about passing major tax reform legislation, rating its chances as “pretty good.”

Republicans control 52 seats and can afford only two defections from their ranks. Vice President Pence could cast the deciding vote in case of a 50-50 tie.

The Senate GOP hasn’t given up hope on healthcare and faces tremendous pressure from the White House and House Republicans to hold a vote.

Republicans for years have promised to repeal ObamaCare, so failure would be a major blow. They also face pressure to finish their work on healthcare because of the tax reform push.

The GOP is using special budgetary rules to prevent Democrats from filibustering legislation on tax reform and healthcare.

Republicans can’t move to tax reform until the healthcare debate is finished because once they pass a new budget resolution that would allow them to move tax legislation with 51 votes, they will lose the vehicle set up to enable a healthcare bill that would circumvent a Democratic filibuster.

Those on a special 13-member working group have heard very little about the drafting efforts that were supposed to take place over the recess.

Senate Budget Committee Chairman Mike Enzi (R-Wyo.) was to provide the framework in consultation with GOP leaders and Senate Finance Committee Chairman Orrin Hatch (R-Utah).

A major sticking point in the Senate is Medicaid. The House bill would cut nearly $900 billion from the program and cap the federal contribution for expanded enrollment in that program by 2020.

Several Republican governors from Medicaid expansion states, led by Govs. John Kasich (Ohio) and Rick Snyder (Mich.), earlier this year came out against the House bill, warning that it failed to provide adequate resources.

Sen. Rob Portman (R-Ohio) said he wants a more gradual “glide path” for capping the expansion, an idea not popular with conservatives.

Twenty Republican senators, including Portman, represent states that opted to expand Medicaid, and many of them worry that cutting federal funding will cause significant budget problems at home.

But another group of GOP governors, primarily from states that opted out of the Medicaid expansion, want to end federal support for the expansion.

Senators are divided as well over proposals to limit federal assistance for health insurance subsidies, which would hit older, low-income Americans disproportionately.

McConnell hasn’t set a deadline for passing the ObamaCare repeal-and-replace bill, but he has indicated concern about the debate dragging on for months, which could imperil tax reform.

“We can’t take forever,” he told Bloomberg TV last month.

By raising doubts about the possibility of getting a deal that musters 51 votes, the GOP leader is putting pressure on his colleagues to either come together or move on before the August recess.

McConnell has told colleagues that the 13-member working group will put together a bill and that he will bring it to the floor for a vote, but he has stopped short of promising that it will pass — in contrast to Speaker Paul Ryan (R-Wis.), who earlier this year guaranteed that the House bill would pass.

If the Senate bill fails on the floor, McConnell is likely to declare the GOP conference has worked its will and move on.

Even as the House voted to narrowly pass the House’s American Health Care Act last month, there was already strong pessimism among Senate Republicans about the chances of putting together a comprehensive package in the upper chamber.

A senior GOP senator at the time said the chances of getting 51 votes for legislation based on the House healthcare bill were less than 1 in 5.

When House Republicans debated healthcare reform earlier this year, some of their Senate colleagues said privately that they thought it might be better if the legislation died in the lower chamber.

We Have Been Duped: Obama Care Is Not Raising Our Insurance, Republicans Are

(THIS ARTICLE IS COURTESY OF U.S. NEWS AND WORLD REPORT)

You’ve Been Duped

The Affordable Care Act isn’t raising your premiums. Republicans are.

You’ve Been Duped

By J. Mario Molina | Opinion Contributor

May 30, 2017, at 11:20 a.m.

As I watch the debate unfold over repeal of the Affordable Care Act, I keep thinking about the Hans Christian Anderson story “The Emperor’s New Clothes.” In the story, the emperor’s weavers convince him that they have made him clothes of special cloth, invisible to those too stupid to appreciate their beauty. The emperor parades through town stark naked, and his subjects are too afraid to state the obvious until one little boy blurts out that the emperor has no clothes. The emperor looks down and realizes the boy is right.

You might guess that President Donald Trump is the emperor in my metaphor, but you’d be wrong. The emperor is the American public, who has been duped into believing that the Affordable Care Act is failing, even as Republicans work behind the scenes to destroy it.

And who is the little boy in this story? I am. I am the former CEO of a health insurance company, and I have been warning publicly what will happen if Trump continues to effectively sabotage the Affordable Care Act. Earlier this month, I lost my job.

When Trump ran for president, he promised reforms to ensure there would be health insurance for everyone and that it would be a “lot less expensive” than under President Barack Obama’s health care law. We have yet to see the plan he described during his campaign. Instead, earlier this month, House Republicans passed the American Health Care Act – a bill the nonpartisan Congressional Budget Office determined would cause 23 million Americans to lose health insurance coverage.


CARTOON GALLERY
Editorial cartoon on President Donald Trump and health care
Editorial cartoon on Trumpcare
Editorial cartoon on Republicans and health care
Editorial cartoon on Republican Party and health care and Obamacare
Editorial cartoon on Republicans and health care
Editorial cartoon on Paul Ryan and health care and Medicaid
Editorial cartoon on Paul Ryan and health care
Editorial cartoon on Republicans and health care and pre-existing conditions
Editorial cartoon on health care
Editorial cartoon on House Republicans and health care and the Senate
Editorial cartoon on President Donald Trump and House Republicans and Obamacare
Editorial cartoon on House Republicans and health care
Editorial cartoon on Jimmy Kimmel and health care and President Donald Trump
Editorial cartoon on Obamacare and the American Health Care Act
Editorial cartoon on House Republicans and health care and the Senate

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PHIL HANDS/TRIBUNE CONTENT AGENCY


When confronted with the dire projections about how their bill will make insurance unaffordable for their constituents, most of the representatives who voted for the bill often echo a line that Republican House Speaker Paul Ryan, Secretary of Health and Human Services Tom Price and Trump have used repeatedly: that the Affordable Care Act is in a so-called “death spiral” that will inevitably “explode,” so they need to pass a bill, no matter how terrible, before it does. That narrative is patently false. In fact, most of the instability driving up premiums in the marketplace can be directly traced to Republicans’ efforts to undermine the health care law for their own political purposes.

What CBO Estimates Say About the House Health Bill
Bloomberg

Florida Republican Sen. Marco Rubio, for example, was among the first to land a blow. In 2014, he proudly led a successful effort to cut funding for the “risk corridors” program. Rubio called the payments made from these funds a “bailout” for insurers, but in fact the program was an integral backstop to help control premiums as insurance companies in the marketplaces adjusted to the new population they were covering. The consequence of that ploy to score political points was that some insurers left the marketplace, and many Americans’ premiums went up.

Since Trump took office in January, these kinds of sneak attacks on the law have accelerated. During the final week of the open enrollment period, when consumers can sign up for a marketplace health care plan or choose a new one, Trump officials within the Department of Health and Human Services decided to cancel advertising and outreach for the HealthCare.gov website. That decision came despite the fact that it is well documented that younger, healthier enrollees tend to sign up at the last minute. It was a transparent effort to damage the stability of the health insurance marketplace and to create the illusion that demand for insurance was decreasing.


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They Passed It, and Now We Know What’s In It

CBO had a lot of bad news about the health care bill House Republicans already voted for.


Perhaps the most drastic way that the Trump administration is sabotaging American’s health insurance is by refusing to commit to reimbursing health plans for the cost-sharing reduction payments they make to lower out-of-pocket costs for their lowest income members. Insurance companies are currently in the process of determining their rates for the 2018 plan year, and without a guarantee from the administration that they will receive the payments they are owed, they will factor that added cost into their premiums for next year. And you don’t have to take my word for it – the Kaiser Family Foundation estimates that insurers would need to raise premiums for silver-level plans by an average of 19 percent to compensate if the administration will not commit to making the cost-sharing reduction payments.

One common thread in all these efforts is that Americans who purchase their health coverage through the individual market are the ones harmed, not insurance companies. The administration and Republicans in Congress want you to believe that insurers raising premiums for their plans or exiting the marketplaces all together are consequences of the design of the Affordable Care Act instead of the direct results of their own actions to sabotage the law. Don’t let them fool you.

If you think Obamacare is failing, I have one simple message for you: Open your eyes and stop being the emperor.

Democrat strikes back over healthcare
Reuters

Tags: health care, health care reform, American Health Care Act, Affordable Care Act, Republican Party

J. Mario Molina OPINION CONTRIBUTOR

J. Mario Molina, M.D., is the former CEO of Molina Healthcare, one of the largest health insurance companies serving Medicaid and Marketplace programs. He has three decades of experience caring for low-income patients.

Why Should The Employee (Congress/Senate/President) Get Better Insurance Policies Than Their Bosses, The People?

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