GOP Obamacare replacement bill is even worse than everyone expected

Last week, Senator Aqua Buddha, Rand Paul (R-KY), went all Indiana Jones in search of the top secret GOP Obamacare replacement bill being held under guard in a secure location in the Capitol. I kid you not. Rand Paul still searching for Obamacare replacement bill:

Thursday, Sen. Paul tried to track down a copy of the draft, but he said he was denied access to a room when aides inside told the senator there wasn’t a bill to see. At one point, a GOP staff member allowed House Minority Whip Steny Hoyer, of Maryland, Massachusetts Rep. Joe Kennedy and a dozen or so reporters into the room to inspect it themselves to see that it was, in fact, bill-less.

“This should be an open and transparent process,” Paul said Thursday following his search. “This is being presented as if it were a national secret, as if this was a plot to invade another country, as if this were national security. That’s wrong.”

Screen Shot 2017-03-07 at 11.41.11 AMScreen Shot 2017-03-07 at 11.42.30 AM

Paul wasn’t alone in his health care escapade. Democratic Whip Steny Hoyer went live on Facebook Thursday in search of the legislation and Rep. Nancy Pelosi also tweeted in support of the search.

“I’m looking for the House GOP’s secret ACA repeal bill since they are hiding it from Members and the public,” Hoyer posted on Facebook.

Screen Shot 2017-03-07 at 11.42.54 AM

On Monday, GOP leadership released its Obamacare replacement bill from its secret Capitol basement lair. They should have left it there never to be seen in public.

The so-called American Health Care Act is designed to fail, and is even worse than everyone expected from the post-policy nihilists of the GOP.

For a detailed analysis of what the bill does and does not do, see what has been written by Sarah Kliff (Vox.com), Tierney Sneed (Talking Points Memo), Kevin Drum (Mother Jones), and Michael Hiltzik (Los Angeles Times).

Ezra Klein at Vox.com summarizes the problem as The GOP health bill doesn’t know what problem it’s trying to solve:

[T]he GOP intends to hold committee votes on their bill two days after releasing it, and without a Congressional Budget Office report estimating either coverage or fiscal effects. It’s breathtaking.

* * *

The GOP plan will lead to significant declines in coverage (Loren Adler estimates an eye-popping 15 to 20 million people will lose insurance) as well as accelerating the exhaustion of the Medicare trust fund due to the tax cuts. After years of Republicans complaining that co-pays and deductibles were too high in Obamacare, co-pays and deductibles will be significantly higher under their replacement. The plan will significantly reduce taxes on the rich.

* * *

I honestly have no idea what it will do to the deficit — it’s hard to see any short-term reduction, and if there’s a long-term reduction, it will only be due to deep, deep Medicaid cuts, which will mean a correspondingly large increase in the uninsured. It’s worth noting that the GOP’s main idea for reducing health care costs — ending or capping the tax break for employer-provided insurance — has been left out of this legislation. There is simply no theory of cost control in this bill at all.

* * *

The individual mandate is gone, healthy people can buy coverage at any time with only a 30 percent penalty, and eliminating actuarial values makes it simpler for insurers to pull the young and healthy away from older and sick. Death spirals seem very likely in weak markets. Republicans will fully own those death spirals.

* * *

The plan is strikingly regressive compared to the Affordable Care Act. Cynthia Cox estimates that a 40-year-old making 160 percent of the poverty line would get $4,143 in subsidies under the ACA, but only $3,000 under the GOP plan. By contrast, a 40-year-old making $75,000 would get nothing under the ACA, but $3,000 under the GOP plan.

* * *
Hypocrisy is a minor sin in politics, but still, it is remarkable how much of it there is to be found in this legislation. . . . The GOP bill is similarly aggressive with [delay] tricks, delaying changes to the Medicaid expansion until 2020 and pushing Obamacare’s tax on expensive insurance plans out until 2025.

* * *

It is difficult to say what question, or set of questions, would lead to this bill as an answer. Were voters clamoring for a bill that cut taxes on the rich, raised premiums on the old, and cut subsidies for the poor? Will Americans be happy when 15 million people lose their health insurance and many of those remaining face higher deductibles?

* * *

Nor are movement conservatives pleased with this plan, which leaves the basic architecture of Obamacare intact, and doesn’t begin to phase out the Medicaid expansion until 2020 (raising the question of whether it will ever phase out at all). . . . Rep. Jordan Amash called it “Obamacare 2.0.” [senator Aqua Buddha calls it “Obamacare lite.” Rand Paul: GOP’s ‘Obamacare Lite’ Plan Won’t Pass]

* * *

All this speaks to the Republican Party’s fundamental difficulty on health care, which Peter Suderman captures well: “The GOP’s real problem, in terms of passing legislation, isn’t that the party can’t agree on specifics, or that legislators need to bargain their way toward a compromise that gives everyone something they want. It’s that they don’t agree on, or in some cases even have, basic goals when it comes to health policy.”

* * *
Because Republicans aren’t even trying to win Democratic votes, they’re stuck designing a bill that can wiggle through the budget reconciliation process (another thing they complained about Democrats doing). That means they can’t make major changes to insurance markets like repealing Obamacare’s essential benefit standards or allowing insurance to be sold across state lines. That last part is particularly striking, given that it was one of President Trump’s five demands in his speech last week. . . . but now they can’t get those savings at all — which means sacrificing a key part of their theory of cost control.

* * *

This bill has a lot of problems, and more will come clear as experts study its language, the Congressional Budget Office release its estimates, and industry players make themselves heard. But the biggest problem this bill has is that it’s not clear why it exists. What does it make better? What is it even trying to achieve? Democrats wanted to cover more people and reduce long-term costs, and they had an argument for how their bill did both. As far as I can tell, Republicans have neither. At best, you can say this bill makes every obvious health care metric a bit worse, but at least it cuts taxes on rich people? Is that really a winning argument in American politics?

In reality, what I think we’re seeing here is Republicans trying desperately to come up with something that would allow them to repeal and replace Obamacare. This is a compromise of a compromise of a compromise aimed at fulfilling that promise. But “repeal and replace” is a political slogan, not a policy goal. This is a lot of political pain to endure for a bill that won’t improve many peoples’ lives, but will badly hurt millions.

Keep in mind, the House is voting on this bill this week with little debate and no public input.  Call your member of congress and senators and tell him or her to oppose this bill. Democratic votes combined with the Tea-Publican House Freedom Caucus votes can defeat this godawful bill. G.O.P. Health Bill Faces Revolt From Conservative Forces. Kill this bill!

UPDATE: New York Times analysis, Millions Risk Losing Health Insurance in Republican Plan, Analysts Say: Americans in their 50s and 60s would be especially likely to find coverage unaffordable in a system providing tax credits of $2000 to $4000 per year based on age, rather than income level. Republicans’ Changes to Medicaid Could Have Larger Impact Than Their Changes to Obamacare: The changes would not begin until 2020. But the long-term impact on states would be unequal, with some faring better than others, depending on how much they spent on the program, their demographics and whether they participated in President Obama’s expansion of Medicaid eligibility.

The Times editorializes, No Wonder the Republicans Hid the Health Bill.

UPDATE: The Washington Post analysis, The debate over the Affordable Care Act is really a debate over wealth redistribution: Abolishing a program makes it hard to avoid this central question: What is the minimum society should provide for its most vulnerable? Income separates the winners and losers in Republicans’ health-care plans. House Republicans plan to eliminate nearly every tax increase that was included included in the ACA, many of which target rich people. What the GOP health plan really means for taxes.

Obamacare repeal guts crucial public health funds: The latest GOP health-care plan would eliminate funds for fundamental public health programs of the Centers for Disease Control and Prevention, from prevention of bioterrorism and disease outbreaks to immunizations and heart disease screening. As Matt O’Brien sums up, The Republican plan to replace Obamacare makes no sense.

The Post editorializes: An Obamacare repeal that’s both heartless and reckless.

7 Responses to GOP Obamacare replacement bill is even worse than everyone expected

  1. I am not sure why small business owners aren’t clamoring through hell and high water for some sort of national insurance policy. I don’t even want to fathom how much redundant time, effort, and money is spent with each business having to purchase, manage, and maintain multiple group policies for each of their employees to choose from. I can’t think of any reason why businesses want to actively maintain a failed patchwork system that we only have because it was a way to get out from under wage & price freezes almost 75 years ago.

    The American way really seems to be to choose the most arduous, convoluted, and expensive way of doing everything to make sure the right palms get greased and the right businesses get paid. I thought the GOP was supposed to be the party against Big Government choosing winners & losers in the economy, and yet here we are.

  2. John Huppenthal

    The essence of Obamacare was to destroy the insurance market by saying that people could buy insurance when their house is burning down.

    When the Republicans said that they wouldn’t undo that part, they were saying that they wouldn’t undo Obamacare. So, they are caught in a conundrum.

    However, they are going to that issue in essence by the 30% price increase if you drop insurance after obtaining it. In other words, you get one free pass and that is it.

    We had a retireee insurance market with the same problem in Arizona. I passed legislation doing away with the ability to get insurance when you were sick. You had to buy insurance at the retirement point or not. Immediately the insurance and the market came back to life.

    It doesn’t seem likely that the Republicans will be able to pass their bill. So, Obamacare will continue its death spiral.

    In the end, it doesn’t matter. If the economy gets moving, there will be plenty of money for doctors and healthcare as companies get bigger and more of them provide benefits and as tax revenues for states get back on trend.

  3. “I guess in order to know what is in it, we will have to pass it into law.”

    In a rare moment of honesty, that is the exact quote Nancy Pelosi made whenn asked what was contained in the Affordable Care Act (aka – “Obamacare”). It appears to me that the confused furor over the Republican’s health care plan is the mirror image of what happened when democrats passed the ACA. No one really knew what was in it, how much it would really cost, who would be covered, etc., just like what is happening to the Republicans. Obviously, that is being ignored to allow the left to criticise the Republicans.

    “GOP Obamacare replacement bill is even worse than everyone expected.”

    It didn’t matter what the plan looked like, it was always going to be “worse than expected”.

    • AZ BlueMeanie

      Topher Spiro, vice president for health policy at the Center for American Progress and a former staffer to Sen. Edward M. Kennedy (D-Mass.) recently pointed out the GOP hypocrisy at the Washington Post: We won’t know what’s in the Republican health-care repeal plan until they pass it, https://www.washingtonpost.com/posteverything/wp/2017/03/03/we-wont-know-whats-in-the-republican-health-care-repeal-plan-until-they-pass-it/?utm_term=.0d111d5aa393

      “[The rush to repeal] is a particularly bitter irony for anyone who, like me, worked on writing the ACA originally. Republicans accused Democrats eight years ago of drafting the health-care law in secret, despite dozens of public hearings and work sessions. But now it’s their own process that is highly secretive, with U.S. Capitol Police guarding a basement room where the draft legislation is kept hidden from voters, the news media and even members of Congress.

      The GOP tried to use one quote in particular to drive its message back then. In 2010, then-House Speaker Nancy Pelosi (D-Calif.) said that “we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.” What Pelosi meant was that people would realize the benefits of the law once they became tangible — which is exactly what polling shows has happened. But Republicans spun and truncated the quote to suggest that Democrats were hiding something.

      In fact, the process to enact the Affordable Care Act was thorough and transparent. I was there for the whole thing, as a Democratic staffer for the Senate Health, Education, Labor and Pensions (HELP) Committee.

      In the House, Democrats held a series of public hearings before introducing a public discussion draft in June 2009. The House then held more public hearings before introducing new legislative text in July. All three relevant committees held “markups” — committee work sessions to amend the legislation — and the full House vote on the amended legislation did not take place until November.

      In the Senate, the HELP Committee held 14 bipartisan roundtables and 13 public hearings in 2008 and 2009. During the committee’s markup in June 2009, Democrats accepted more than 160 Republican amendments to the bill.

      Beginning in May 2008 — 20 months before the Senate vote and six months before Barack Obama, who would later sign the bill into law, was even elected president — the Senate Finance Committee held 17 public roundtables, summits and hearings. In 2009, Democrats met and negotiated with three Republicans for several months before the tea party protests caused the GOP to back away from negotiations. The Finance Committee held its markup in September, and the full Senate vote did not take place until December.

      In both the House and the Senate, “scores” by the independent Congressional Budget Office were available before each vote at each stage of the process. These scores are estimates of the effects of legislation on the budget and on the number of people who would be covered by health insurance.

      That’s not remotely like what’s happening in Washington now. It’s Republicans who are rushing to jam through their legislation to repeal the law in a highly secretive process.

      * * *

      Republicans are making their members walk the plank with blindfolds on because they have no other choice. They promised, over and over again, to repeal the ACA, and now they’re going to try to do it no matter how. Their internal divisions are rampant and grow by the day. This is no way in a democracy to consider and shape legislation affecting tens of millions of people with many lives hanging in the balance.

      And ultimately, what was false about the Affordable Care Act is true about the secret basement bill: They have to pass the bill to find out what’s in it.”

      The loudest critics of Ayn Rand fanboy Paul Ryan’s Obamacare replacement bill are his fellow conservatives. G.O.P. Health Bill Faces Revolt From Conservative Forces, https://www.nytimes.com/2017/03/07/us/politics/affordable-care-act-obama-care-health.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=first-column-region&region=top-news&WT.nav=top-news

      The most imminent and serious threat to the plan crafted by House Speaker Paul D. Ryan (R-Wis.) was the growing backlash from conservative lawmakers and powerful outside groups who argue that the draft is nothing more than “Obamacare Lite,” a disparaging reference to the former president’s signature 2010 domestic achievement. Backlash grows against House GOP proposal to replace Obamacare, https://www.washingtonpost.com/powerpost/backlash-grows-against-house-gop-proposal-to-replace-obamacare/2017/03/08/7f0c0148-03f8-11e7-b9fa-ed727b644a0b_story.html?hpid=hp_hp-top-table-main_obamacareweb-805a%3Ahomepage%2Fstory&utm_term=.b754b26b1ecf

      The GOP leadership has created a clusterfuck that is going to blow up in their face.

  4. Repealing the ACA is about destroying the legacy of President Obama, punishing those who supported him, and taking health care away from those who the GOP considers to be undeserving. Secondary to that is the completion of step one in their intended destruction of the social safety net.

    The replacement is a joke. How many times have the House Republicans voted to repeal the ACA during the Obama years without considering a replacement? The whole concept of a replacement is new to them and, at this time, is mainly intended to stop them from being tarred and feathered.

    • For Sure Not Tom

      As usual, Liza is 100% correct.

      The GOP made “Obamacare” synonymous with “Oh Noes There’s a Marxist Muslim Anti-America Freedom-Hating African Man in OUR White House!”

      They never expected to be in a position to have to put up, and they’re in too deep to shut up.

      The rabidly racist foaming at the mouth Teabagger loonies that the GOP spent years courting want the blood they were promised, and primaries are coming!

      And now years of GOP lying about the Patient Protection and Affordable Care Act are being exposed.

      The ACA needs fixing, no doubt, but the truth is we have the lowest percentage of un-insured American people in history. Lives have been saved. Families have been saved.

      If they do the “second to next right thing”*, fix the ACA, which some of their “plans” do, they’re admitting that they could have done this all along, but chose party and obstructionism over American’s health.

      If they repeal, they break the healthcare system. The AMA, AARP, hospitals, clinics, and even a handful of GOP governors across the country are telling them to back down.

      Oh, yeah, and they’ll have to face 20,000,000 Americans come next election.

      Watching these lying GOP scumbags trip over each and fight and change their stories every hour would be fun if the issue wasn’t so serious.

      It would be unfair of me not to give the opposing view, so to quote the leader of the GOP and President of the United States that they elected on purpose – “Nobody knew health care could be so complicated.”

      Trump said that. Out loud. Where people could hear him.

      Faceplam, both hands.

      Turns out Mike Judge’s 2006 movie “Idiocracy” was a prophecy.

      The GOTeaP chickens have come home to roost. Maybe lying for all these years and appealing to the worst in human nature was a bad idea.

      *The first right thing to do is implement Single Payer. Anyone who says American Capitalism can’t provide healthcare for Americans is not a True Patriot and hates America and Freedom.

  5. it wasn’t worse then what I expected. most republicans don’t believe in government health care and would like to repeal aca with no replacement. good government liberal elitists are too optimistic for their own good!