‘Trumpcare’ bill was DOA in Congress, so a desperate attempt at ‘Trumpcare 2.0’

Tea-Publicans in Congress want to hold a vote on their “Obamacare” repeal bill aka “Trumpcare” on Thursday for one reason, and one reason only: it is the seventh anniversary of President Obama signing the Affordable Care Act (ACA) into law. The post-policy nihilism of the GOP is all about empty symbolism and marketing to the conservative media entertainment complex for them.

Just one problem: Tea-Publicans do not have the votes to pass their own bill among their own members in Congress. The radical House Freedom Caucus demands nothing less than a straight-up repeal of the entirety of the ACA (something these lunatics apparently do not realize cannot be done under the budget reconciliation process, which this bill is proceeding under). Concessions to these far-right radicals will lose the mythical moderate Republicans who have the ACA’s expanded Medicaid in their states and who are afraid of voters turning on them for taking away their health care (looking at you Rep. Martha McSally).

The so-called American Health Care Act aka “Trumpcare” bill drafted by the GOP’s alleged boy genius, “the zombie-eyed granny starver from the sate of Wisconsin” and Ayn Rand fanboy Paul Ryan, is dead on arrival (DOA) in Congress. He does not have the votes and he desperately wants to avoid a defeat on Thursday which would demonstrate just how weak a Speaker of the House he is.

So boy genius last night rolled out “Trumpcare 2.0” to try to sway enough GOP members of Congress to go along in the House to avoid an embarrassing defeat. (This new version is no more likely to pass the Senate than the original bill). It is all about saving face, the one thing that really matters to boy genius.

The Washington Post reports, House Republicans unveil changes to their health-care bill:

House Republican leaders, racing toward a planned Thursday vote on their proposed health-care overhaul, unveiled changes to the legislation late Monday that they think will win over enough members to secure its passage.

The tweaks addressed numerous GOP concerns about the legislation, ranging from the flexibility it would give states to administer their Medicaid programs to the amount of aid it would offer older Americans to buy insurance. They are the product of two weeks of negotiations that stretched from the Capitol to the White House to President Trump’s Florida resort.

The bill’s proponents also appeared to overcome a major obstacle Monday after a key group of hard-line conservatives declined to take a formal position against the bill, known as the American Health Care Act.

The House Freedom Caucus has threatened for weeks to tank the legislation drafted by House Speaker Paul D. Ryan (R-Wis.), arguing that it does not do enough to undo the seven-year-old Affordable Care Act. Their neutrality gives the legislation a better chance of passage: If the group of about three dozen hard-right GOP members uniformly opposed the bill, it could block its passage.

Their decision not to act as a bloc frees House leaders and White House officials to persuade individual Freedom Caucus members to support the measure — a process that the Freedom Caucus’s chairman said was ­underway.

“They’re already whipping with a whip that’s about 10 feet long and five feet wide,” said Rep. Mark Meadows (R-N.C.). “I’m trying to let my members vote the way that their constituents would want them to vote. . . . I think they’re all very aware of the political advantages and disadvantages.”

House leaders hope to pass the bill Thursday and then send it to the Senate.

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Some of the changes unveiled Monday were made to placate conservatives, such as accelerating the expiration of the ACA’s taxes and further restricting the federal Medicaid program. But a major push was made to win moderate votes, including a maneuver that House leaders said would allow the Senate to beef up tax credits for older Americans who could see major increases in premiums under the GOP plan.

There were signs Monday that the bill had growing support among the moderate wing of the House GOP. Rep. Tom MacArthur (R-N.J.), who had voted against the leadership in an early procedural vote on the health-care legislation, said that he was “satisfied enough that I will support the bill.”

MacArthur said he was assured that the bill would do more for older and disabled Americans covered under Medicaid and that an additional $85 billion in aid would be directed to those between ages 50 and 65.

“That’s a $150 billion change in this bill to help the poor and those who are up in years,” he said.

Several House Republicans from Upstate New York won an amendment that would allow counties in their state to keep hundreds of millions of dollars of local tax revenue that they forward to the state government to fund its Medicaid program. One member, Rep. Claudia Tenney (R-N.Y.), told the Syracuse Post-Standard on Monday that her support of the bill was conditioned on the amendment’s inclusion.

Opponents of the bill — Republicans and Democrats alike — called the deal a sordid giveaway on social media networks Monday night. Many compared it to the state-specific deals that were cut to pass the Affordable Care Act in 2009 and 2010 and panned by Republicans — such as the Medicaid reimbursement boost that then-Sen. Ben Nelson (D-Neb.) secured for his home state that Republicans mocked as the “Cornhusker Kickback.”

The Freedom Caucus had pushed for a variety of alterations, from an earlier phaseout of the ACA’s Medicaid expansion to a more thorough rollback of the insurance mandates established under the law. But for political and procedural reasons, few of the group’s major demands stand to be incorporated into the bill.

“It’s very clear that the negotiations are over,” said Meadows, who met with White House officials at Trump’s Mar-a-Lago resort in Florida on Saturday.

Many Freedom Caucus members who left the group’s Capitol Hill meeting Monday night said they remained sharply opposed to the legislation.

“Nothing’s changed,” said Rep. Jim Jordan (R-Ohio), a co-founder of the caucus. “We’ve still got lots of problems with this bill. . . . The president’s a good man, and the White House has been great to work with, but opposition is still strong with our group.”

Under the group’s rules, it can take a formal position to oppose the bill if 80 percent of its members agree. No Democrats are expected to support the bill, meaning Republican leaders can afford to lose no more than 21 of their own members.

Meadows said after Monday night’s meeting that taking a hard position against the bill “creates some dynamics within the group that perhaps we don’t want to create,” hinting at tensions in the group’s ranks. One of its members, Rep. Gary Palmer (R-Ala.), decided to support the bill last week when he met with Trump in the Oval Office, emboldening House leaders who think that even hard-liners will be hard-pressed to oppose Trump.

“This is a defining moment for our nation, but it’s also a defining moment for the Freedom Caucus,” Meadows said. “There are core things within this bill as it currently stands that would violate some of the principles of the Freedom Caucus.”

Sooo, devotion to right-wing ideology over what’s good for the country. Good to know their priorities.

Attending the Freedom Caucus meeting Monday were three senators opposed to the House bill — Ted Cruz (R-Tex.), Mike Lee (R-Utah) and Rand Paul (R-Ky.) — who hold leverage to block the bill in their own chamber, where Republicans hold a two-seat majority. Cruz said he told the House members that the leadership strategy of pursuing distinct “phases” of legislation was a dead end and that they needed to push for changes in the present bill.

* * *

Trump’s visit to the Hill on Tuesday signals that GOP leaders and the president consider larger-scale talks with key blocs of House members to be essentially complete. The effort now turns toward persuading individual members to vote for the package.

Trump’s visit Tuesday will be his first appearance at the weekly House Republican Conference meeting since becoming president. He last privately addressed Republican lawmakers as a group at the party’s policy retreat in Philadelphia in late January and has met with small groups of members on several occasions since.

Trump won the backing of Palmer and several other conservative House members Friday when he agreed to make changes to the Medicaid portion of the bill, including giving states the option of instituting a work requirement for childless, able-bodied adults who receive the benefit. Those changes were included in the leadership-backed amendments that will be incorporated into the bill before it comes to a final vote.

To address concerns expressed by a broader swath of GOP lawmakers — conservatives and moderates alike — leaders said they hoped to change the bill to give older Americans more assistance to buy insurance.

* * *

House leaders said they intended to provide another $85 billion of aid to those ages 50 to 64, but the amendment unveiled late Monday did not do so directly. Instead, the leaders said, it “provides the Senate flexibility to potentially enhance the tax credit” for the older cohort by adjusting an unrelated tax deduction.

That workaround, aides said, was done to ensure that the House bill would comply with Senate budget rules and to ensure that the CBO could release an updated analysis of the legislation before the Thursday vote.

But it also means that the House members who pushed for the new aid will have to trust the Senate to carry out their wishes.

Eduardo Porter explains What’s at Stake in a Health Bill That Slashes the Safety Net at the New York Times:

Voters, pay attention. The House speaker, Paul D. Ryan, will try to sell his plan by leveraging Americans’ atavistic fear of Big Government, offering people the freedom to choose whether to have health insurance. You may want to focus instead on what the United States stands to lose.

Mr. Ryan’s proposal, the American Health Care Act, doesn’t merely undo the expansion of Medicaid to the near poor. It converts the entire program into a block grant to the states and gradually strangles it by increasing federal funding more slowly than projected spending growth. Not even the Clinton administration’s welfare reform of 1996, the other notable revision of the American safety net, proposed such a redistribution.

Note: In Arizona, 380,000 Arizonans may lose Medicaid according to an analysis by the state’s Medicaid (AHCCCS) plan.

Welfare reform did hurt many poor people by converting antipoverty funds into block grants to the states. But it was accompanied by a big increase in the earned-income tax credit, the nation’s most effective antipoverty tool today. More than reducing antipoverty funds, the strategy for welfare reform changed who got them and under what conditions.

The American Health Care Act, by contrast, is decidedly about cutting people off. David M. Cutler, an expert on the economics of health care at Harvard University, put it like this: “No other Congress or administration has ever put forward a plan with the intention of having fewer people covered.”

Under the House Republican plan, 24 million more Americans will lack health insurance by 2026, according to the nonpartisan Congressional Budget Office. Of those, 14 million will lose access to Medicaid and “choose” not to spend money — money they don’t have — on health insurance. Millions more near-poor people in their 50s and early 60s will likewise be left without a policy they can afford.

And that is just the first pass.

We have a pretty decent idea of what poor people do when they lose health insurance. In 2008, Oregon expanded Medicaid coverage to several thousand people selected by a lottery, giving researchers an opportunity to understand the effects of the program by comparing what happened with winners and losers. Knowing how people’s lives change when they gain access to Medicaid can also tell us what happens when Medicaid is lost.

What will happen? Millions of Americans — poor ones, mainly — will use much less health care. They will make fewer outpatient visits, have fewer mammograms and cholesterol checks. Access to Medicaid in Oregon increased use of health care services by some 25 percent. Losing Medicaid is likely to reduce use by a similar amount.

Losers under Mr. Ryan’s plan may not immediately see their physical health deteriorate — researchers did not detect improvements in the health status of lottery winners in Oregon during their first two years under Medicaid. Still, some will be more likely to die, especially those not quite of Medicare age.

Among those who survive, more are likely to report themselves in poorer health. Their rates of depression are likely to rise. Critically, their finances will certainly suffer. This provides a direct glimpse into how cutting off health insurance won’t just reduce access to health care among the poor. It will ricochet across society.

On average, an uninsured person who is hospitalized leaves $6,000 in unpaid bills. Those costs don’t vanish, but show up elsewhere in the system — in lower hospital profits, or maybe in higher medical bills and insurance premiums for the insured. One study concluded that 60 cents out of every dollar spent on Medicaid goes to offsetting those costs.

These considerations will not persuade small-government Republicans who see the repeal and replacement of the Affordable Care Act as a not-to-be-missed opportunity to cut hundreds of billions of dollars spent on low-income Americans to finance deficit reduction and tax cuts. They might pause to consider the consequences of a strategy that so openly redistributes money from the poor to the rich.

The Ryan plan — caught between right-wing Republicans in the House who would like to cut health care subsidies further and centrists in the Senate who are loath to leave so many Americans uninsured — may not pass in its present form. The administration could short-circuit the Affordable Care Act by dragging its feet on enforcing the insurance mandate or simply not advertising plans on the exchanges. In any event, public health insurance will take a big hit.

Who knows where this retrenchment takes the country? Maybe attaching a work requirement to Medicaid, as conservatives propose, will prod the poor to get a job. Or perhaps it will just cut more people from Medicaid’s rolls. Further up the income ladder, losing a job will become more costly when it means losing health insurance, too.

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I realize this sort of speculation can sound excessively dramatic for what is ultimately a change in health insurance. Yet it is worth remembering that among advanced nations, the United States is a laggard in life expectancy and has one of the highest infant mortality rates. Men and women in the United States die younger than those in other rich countries for all sorts of causes. American teenagers have more babies. American men go to jail more often.

Better health insurance will not solve all of this, of course. But it will help some of it. As noted in a recent report by the National Academies of Sciences, Engineering and Medicine, Americans are more likely than those in other high-income countries “to find their health care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.”

If American history provides any sort of guidance, it is that continuing to shred the social safety net will definitely make things worse.

Contact your member of Congress and senators and tell them to oppose the so-called American Health Care Act aka “Trumpcare” bill.

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