The Trump administration has expanded its sabotage efforts of “Obamacare” into a full-scale undermining of the American healthcare system. Under Trump, Obamacare outreach groups face budget cuts as high as 98%:
The Trump administration has informed government-funded Obamacare outreach groups of deep impending budget cuts next year, with some nonprofits having budgets slashed by as much as 98 percent.
The Health and Human Services Department announced August 31 that it would cut funding for the health law’s in-person assistance program by 41 percent. Late Wednesday night, the administration sent each group its individual budget. It shows widespread variation in how big those funding cuts will be.
Last year’s budget for the navigator program ran out on September 1. This year’s grants were released just before midnight on September 13, meaning that the outreach groups went two weeks with no funding at all. This led to some groups laying off workers or shutting down operations entirely.
Last week the Congressional Budget Office (CBO) issued a new report showing that Trump is making Obamacare premiums more expensive:
The Trump administration’s management of Obamacare is causing higher premiums and lower enrollment in the individual market, a new report from the Congressional Budget Office finds.
The nonpartisan office estimates that average premiums in the health law marketplaces will be 15 percent higher next year “largely because of short-term market uncertainty — in particular, insurers’ uncertainty about whether federal funding for certain subsidies that are currently available will continue to be provided.”
The CBO also estimates that there will be less competition in the marketplaces next year, which it also attributes to the uncertain federal environment surrounding the health law’s future.
The subsidies the CBO refers to are the Affordable Care Act’s cost-sharing reduction subsidies, which cover copays and deductibles for low-income health care enrollees. The Trump administration has not said whether it will continue to pay these subsidies next year, causing many insurance plans to raise their premiums to prevent any possible shortfall in revenue.
The CBO also points to “announced reductions in federal advertising, outreach, and other enrollment efforts” as additional factors that will make Obamacare sign-ups smaller next year than they otherwise would have been.
President Trump has often described the Affordable Care Act as “imploding on its own.” The CBO report suggests this isn’t the case at all; rather, the Trump administration is making specific policy decisions that are leading to an individual market that will be less functional, with fewer people signed up and higher premiums for those who do enroll.
As of Tuesday, the bipartisan effort to stabilize the “Obamacare” marketplace by coming up with a bipartisan agreeement on cost sharing reductions (CSRs) to health insuers is over. GOP leadership shut down the bipartisan effort to leave only one option available to GOP members, the zombie “Trumpcare” bill from Sens. Graham and Cassidy. Senators scrap bipartisan effort to stabilize Obamacare markets, saying no deal was possible:
Sen. Lamar Alexander pulled the plug Tuesday on his push for a bipartisan bill to stabilize the individual health insurance market, saying he and a key Democrat had been unable to reach a deal that could pass.
Alexander, a Tennessee Republican, said he and Democratic Sen. Patty Murray of Washington “had hoped to agree early this week on a limited, bipartisan plan to stabilize 2018 premiums in the individual health insurance market that we could take to Senate leaders by the end of the month.”
“During the last month, we have worked hard and in good faith, but have not found the necessary consensus among Republicans and Democrats to put a bill in the Senate leaders’ hands that could be enacted,” said Alexander, chairman of the Senate Health, Education, Labor and Pensions Committee.
Murray placed the blame squarely on Republican leaders.
“We identified significant common ground and I made some tough concessions to move in Chairman Alexander’s direction when it comes to giving states more flexibility,” said Murray, the committee’s top Democrat. “I am disappointed that Republican leaders have decided to freeze this bipartisan approach and are trying to jam through a partisan Trumpcare bill, but I am confident that we can reach a deal if we keep working together — and I am committed to getting that done.”
Andrew Prokop at Vox.com explains The bait and switch at the heart of the new Obamacare repeal bill:
As Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) try to wrangle Senate votes for their Obamacare repeal bill before September 30, they’re relying on one argument most of all: Their bill, they say, will give much more flexibility to individual states to figure out how to make health care work.
Cassidy and Graham like to emphasize that their bill would roll back Obamacare’s spending and regulations and would instead simply send states money in a block grant. States, they say, would be free to figure out how to use that block grant money however they see fit — they’d be able to experiment with their own approaches. Even moderate Republicans are likely tempted by an argument like that.
Here’s the catch: The bill doesn’t just move around Obamacare’s spending. It severely cuts federal spending on health care overall — both for Obamacare and for traditional Medicaid. And since covering people costs money, the result will inevitably be that millions of people will lose coverage.
The Graham-Cassidy bill is essentially a Trojan horse for these dramatic cuts on health spending that Republican leaders have been pushing all along. Three features of the bill in particular make this clear:
1) The bill dramatically cuts and restructures traditional Medicaid. Like previous Obamacare repeal bills Republicans have put forward, Graham-Cassidy goes far beyond just rolling back Obamacare, to instead restructure the finances of the Medicaid program as a whole.
It does this by converting Medicaid to a “per capita cap” system, in which the federal government would no longer commit to open-ended funding to help states afford enrollees’ health bills. Instead of matching the money states spend on Medicaid enrollees, the federal government would provide a set amount of money to states to spend on recipients.
Using numbers from previous Congressional Budget Office scores, the Center on Budget and Policy Priorities estimates that this proposal would cut about $175 billion from traditional Medicaid between 2020 and 2026. Experts argue that per capita caps also give states incentives to kick more expensive patients off Medicaid or roll back coverage.
2) In turning Obamacare’s spending into a block grant, Cassidy and Graham aren’t just redistributing it — they’re reducing it: In theory, it would be possible to restructure Obamacare’s existing spending into block grants for states — and even to distribute it differently among states — without cutting spending overall.
But that’s not what Graham-Cassidy does. Per CBPP’s analysis, the way the bill’s block grant formula is designed, it would dole out “$239 billion less between 2020 and 2026 than projected federal spending for the Medicaid expansion and marketplace subsidies under current law.”
Cassidy has tried to dismiss the CBPP numbers as coming from a liberal think tank. But since the CBO hasn’t released its analysis yet — and won’t have time to before Senate Republicans’ September 30 deadline — these are the outside numbers we have to work with.
3) The new block grant ends entirely after 2026, and there is nothing to replace it afterward. Yes, the vaunted block grants that Graham and Cassidy say will give states such flexibility have a built-in expiration date. They have claimed that this is because of the Senate’s budget reconciliation rules, though it’s not clear how or whether that’s true.
The practical effect, though, would be to set up a major fight several years down the road about whether these block grants should be continued at all, or whether they should be reduced even further. And since the default outcome if no action is taken is for the block grants to vanish, conservatives who want even deeper spending cuts will have the advantage in this showdown.
We can see the CBPP’s estimated impact of these three provisions together in the below chart:
From 2020 to 2026, there will be cuts from the transformation of Obamacare funding into a smaller block grant (in dark red) and the restructuring of traditional Medicaid (in pale red). Then in 2027, the block grants disappear entirely, meaning enormous cuts unless Congress manages to agree on a deal to continue them.
So the argument about giving states “flexibility” leaves out a whole lot. Less money would be available to states overall in those newly flexible block grants, and on top of that, traditional Medicaid would be cut — which clearly points toward millions losing coverage overall. And that’s even before the whole system is set to fall off a cliff in 2027.
With all this in mind, Graham-Cassidy looks a whole lot like all the previous GOP Obamacare repeal bills this year. At its core, it’s basically another way to cut hundreds of billions in federal health spending and toss millions off coverage.
Finally, the Graham-Cassidy zombie “Trumpcare” bill violates the “Jimmy Kimmel Test,” or more accurately, the “Bill Cassidy Test” that Sen. Cassidy previously agreed to with late night host Jimmy Kimmel when discussing the emergency care needed to save the life of his newborn son earlier this year. Jimmy Kimmel: new Obamacare repeal bill flunks the Jimmy Kimmel Test:
Jimmy Kimmel became an unlikely figure in the Republican health care debate a few months ago when he reached an accord of sorts with Sen. Bill Cassidy (R-LA), setting standards that any bill to repeal and replace Obamacare should meet.
On Tuesday, Kimmel slammed Cassidy, the author of the GOP’s last-ditch plan to overhaul US health care, for failing to meet those standards in his own legislation.
Watch the video.
“This guy, Bill Cassidy, just lied right to my face,” Kimmel said in his opening monologue, which was posted online shortly before his show aired.
Back in May, Kimmel interviewed Cassidy about the GOP’s health care plans after the late-night host had been outspoken about his newborn son’s open-heart surgery. He and Cassidy discussed what became called the “Jimmy Kimmel test.” Cassidy has used that term repeatedly throughout the past few months of the health care debate.
Kimmel defined it like this: “No family should be denied medical care, emergency or otherwise, because they can’t afford it.”
The host ticked through related requirements that he said Cassidy had set for his own health care plan:
- Provide health coverage for everyone
- Prevent discrimination against people with preexisting conditions
- Lower premiums for middle-class Americans
- Prohibit lifetime caps on insurance benefits
“The new bill does none of those things,” Kimmel said on Tuesday night. “Not only did Bill Cassidy fail the Jimmy Kimmel test, he failed the Bill Cassidy test.”
“He wasn’t very honest,” the host said to open his monologue. “It seemed like he was being honest. He got a lot of credit and attention for coming off like a rare reasonable voice in the Republican Party when it came to health care.”
The bill produced by Cassidy and Sen. Lindsey Graham (R-SC), which Republican leaders are trying to build support for and put on the Senate floor next week, is widely expected to result in fewer people having health coverage. Insurers would also be permitted, if individual states choose to allow it, to charge people higher premiums based on their medical history, as Vox’s Sarah Kliff reported.
The net effect on premiums is not expected to be known before the Senate would vote, because the nonpartisan Congressional Budget Office said it would not have enough time to fully analyze the bill. But some people could see higher premiums, if prices based on health status are once again allowed.
Finally, by allowing states to waive Obamacare’s rules for which essential health benefits insurance plans must cover, annual or lifetime limits could be reintroduced for services that states decide are not mandatory
“With this [bill], your child with a preexisting condition will get the care he needs, if and only if his father is Jimmy Kimmel,” Kimmel said Tuesday. “Otherwise you might be screwed.”
Asked for a response to Kimmel’s comments, Cassidy focused on the looming September 30 deadline for Senate Republicans to pass a health care bill.
“We have a September 30 deadline on our promise. Let’s finish the job,” he said in a statement provided by his office.
That’s right, we have to blow up one-fifth of the U.S. economy and deny health care to millions of Americans for Tea-Publican politicians to “keep our promise” to repeal Obamacare to our GOP crazy base primary voters who may vote us out of office. This is ideology, not sound public policy. And it is political cowardice in the face of a small minority of voters.
Do all you can to persuade your senators to vote against this GOP attempt to undermine the American health care system and to deny health care to millions of Americans.
Then vote every one of these morally bankrupt evil GOP bastards up and down the ballot out of office next year.