Contradictions and confusion over fate of ‘Obamacare’

Recent reporting on the fate of “Obamacare” has been both contradictory and confusing to anyone trying to follow the machinations of Congress and the Trump White House.

Tom Price at the Department of Health and Human Services (DHS), a Teabagger opponent of “Obamacare,” continues his efforts to sabotage “Obamacare.” The Same Agency That Runs Obamacare Is Using Taxpayer Money to Undermine It:

The Trump administration said on Thursday that it would slash spending on advertising and promotion for the Affordable Care Act, but it has already been waging a multipronged campaign against it.

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[T]he Department of Health and Human Services — an agency with a legal responsibility to administer the law — has used taxpayer dollars to oppose it.

Legal experts say that while it is common for a new administration to reinterpret an existing law, it is unusual to take steps to undermine it. Here are three ways the health department has campaigned against Obamacare. [Quick Summary]


Instead of using its outreach budget to promote the Affordable Care Act, the department made videos critical of the law.


The department targeted the Affordable Care Act with a marketing campaign as Republicans in Congress tried to repeal the legislation.


The department removed useful guidance for consumers about the Affordable Care Act from its website.

Joan McCarter adds at Daily Kos, Trump ramps up sabotage, stops funding outreach budget for Obamacare:

Donald Trump has essentially told Senate Republicans to give up on Obamacare repeal. That could be because he’s figured out his administration can do tremendous damage to the law without repeal.

In addition to the massive budget cuts the administration has announced to outreach efforts, it’s simply not providing the funding it has already for the 2018 enrollment period, and it’s creating chaos.

The Trump administration has let funding for Obamacare’s $63 million in-person outreach program lapse, leading to layoffs and confusion among nonprofits that enroll vulnerable populations in coverage.

The sudden funding halt comes at a critical time for the Affordable Care Act. Navigator groups were just beginning to ramp up outreach for the health law’s open enrollment period, which begins November 1. Now, some have done an about-face: They’ve canceled outreach work and appointments with potential enrollees because they have no budget to cover those costs.

These groups often work with the most vulnerable populations enrolled under the Affordable Care Act. One-third of those who seek in-person help signing up for coverage do not have internet at home, and one in 10 do not speak English.

The funding might be cut loose by the end of September, HHS hasn’t said for sure, but it has indicated that funding will not be retroactive to cover activities for the month—anything done in September won’t be paid for.

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But as of now, these groups have nothing to work with, no way to prepare for the enrollment period that kicks off on November 1. Trump doesn’t need Congress to damage Obamacare, he can do it on his own.

And let’s not forget that the Trump administration has yet to announce its position on cost-sharing reduction (CSR) subsidies to health insurers to help low-income people make co-payments at the doctor or hospital, in House v. Price. This is Trump’s “nuclear option” to blow up “Obsmacare” and to create massive disruptions in the health insurance marketplace.

This is where Congress is now taking a contradictory tack to its long-standing efforts to sabotage “Obamacare.” Last week, Work Toward Bipartisan Fix for Health Markets Begins in Senate:

The chairman of the Senate health committee said Wednesday that he hoped the panel would reach a consensus by the end of next week on a small, bipartisan bill to stabilize health insurance markets and prevent prices from skyrocketing next year under the Affordable Care Act.

Lamar Alexander laid out elements of a possible compromise at a hearing on Wednesday: Republicans would agree to continued payment of subsidies to insurance companies to compensate them for reducing deductibles and other out-of-pocket costs for low-income people. Democrats would agree to give states freedom to relax some insurance requirements in the Affordable Care Act.

“To get a result,” Mr. Alexander said, “Democrats will have to agree to something — more flexibility for states — that some may be reluctant to support. And Republicans will have to agree to something, additional funding through the Affordable Care Act, that some may be reluctant to support. That is called a compromise.”

The senior Democrat on the panel, Senator Patty Murray of Washington, said: “Threading this needle won’t be easy. But I do believe an agreement that protects patients and families from higher costs and uncertainty, and maintains the guardrails in our current health care system, is possible.”

And — shockers! — House Freedom Caucus Chair Rep. Mark Meadows (R-NC) and the guy who brokered the Obamacare repeal vote in the House, Rep. Tom MacArthur (R-NJ) have an agreement on stabilizing the Obamacare markets, in line with the action the Senate is considering. House Freedom Caucus agrees to stabilizing Obamacare and blocking Trump’s sabotage? Really?

To make it slightly more nuts, MacArthur wants more funding for the CSRs—three years instead of one, as Sen. Lamar Alexander is proposing. “What I’ve heard is Lamar is talking about CSRs for one year,” he said. “That’s not going to stabilize the markets and so I go out longer than that.” The sticking point, as in the Senate, will be opening up those waivers and how much of the protections the Affordable Care Act provides can be constrained. MacArthur wants to do even more than the Senate, though, “something to try to bring the cost of drugs down,” he says. He’s keeping the details of that secret for the moment, though, while he tries to get senators on board.

Among all the unexpected things to happen this week, a Freedom Caucus maniac agreeing to work to make Obamacare more stable is probably the weirdest (though it is only Wednesday). This development does raise the chances of legislation actually happening considerably, though.

Governors from both parties testified before the Senate on behalf of modest changes to the Affordable Care Act, but the White House and some senators have not given up on repeal. Governors Rally Around Health Law Fixes as White House Pushes Repeal:

Governors from both political parties told Congress on Thursday that they supported immediate action on modest, bipartisan steps to repair the Affordable Care Act without repealing it, even as the Trump administration continued to encourage efforts to dismantle the law.

Testifying at a hearing of the Senate health committee, governors from Colorado, Massachusetts, Montana, Tennessee and Utah endorsed proposals to stabilize health insurance markets by providing federal money for continued payment of subsidies to insurance companies to offset the cost of discounts provided to low-income people.

They also urged Congress to give states more latitude to modify some insurance requirements in the Affordable Care Act and to devise their own coverage programs. The subsidy money and the flexibility for states are the two main components of a bipartisan consensus emerging in the Senate.

“Congress should take steps now to prevent the total collapse of the health insurance market” by providing money for the “cost-sharing” subsidies, said Gov. Bill Haslam of Tennessee, a Republican.

Complicating matters, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) are pushing their own repeal-and-replace plan  — an alternative to the package that failed in July. Arizona Senator John McCain briefly flirted with the idea of supporting his puppet boy Little Lindsey Graham before backing off: “While I support the concept of the Graham-Cassidy proposal, I want to see the final legislation and understand its impact on the state of Arizona before taking a position.”

This last-ditch effort at “repeal and replace” will be it, There’s one Obamacare repeal bill left standing. Here’s what’s in it, because time is running out on the reconciliation rules that the Senate has been using for a simple majority vote for “repeal and replace.”

Steve Benen explains, ACA repeal crusade starts to look like ‘the zombie apocalypse’:

A week ago, when the Senate parliamentarian announced that Senate Republicans have until the end of the month to pass their health care bill with just 50 votes, it looked like the GOP’s repeal crusade was just about dead. Indeed, one of the most striking political aspects of this was that practically no one on the right responded to the parliamentarian’s ruling by saying, “Quick, let’s get this done before it’s too late!” Instead, the news was met with quiet resignation.

Sen. John McCain (R-Ariz.) seemed to throw a lifeline to the repeal campaign this week, before clarifying that he expects any health care bill to follow regular order, which involves a process anti-health care forces simply don’t have time for.

GOP leaders, reluctant to keep banging their heads into this particular wall, and still recovering from its last attempts at health care legislating, sent every signal that they’d welcome the Sept. 30 deadline and leave this issue behind them.

The trouble is, there are 52 Senate Republicans – and they’re not all on the same page.

Donald Trump has told GOP lawmakers he still wants them to tackle a health care bill one more time, and he’s expressed support for the outrageously regressive Graham-Cassidy-Heller proposal (the last Republican health care plan standing). Its proponents still believe their scheme can pass, and aren’t ready to quit just yet.

And so, a plan of attack has taken shape: Republican Sens. Lindsey Graham, Bill Cassidy, and Dean Heller intend to wrap up work on their plan and unveil the legislative text by Monday. At that point, the bill would go to the Congressional Budget Office for scrutiny, which could take a week or two.

That would leave Republicans with about five days on the legislative calendar to bring the bill to the floor, debate it, consider amendments, and pass it though both the Senate and House, before the window of opportunity closes.

Is this likely to happen? GOP leaders are saying no; proponents of the Graham-Cassidy-Heller plan are saying yes. We’ll find out who’s right very soon, but health care advocates who assumed the fight was over should probably think again.

Asked yesterday about the developments, Sen. Chris Murphy (D-Conn.) said, “It’s like the zombie apocalypse,” which sounds about right. At least between now and Sept. 30, the crusade to take coverage from millions simply won’t die.

Note: It is not at all clear to me whether the 90 day Continuing Resolution (CR) Congress passed last week to fund the government will also extend the deadline for use of the reconciliation rules in the Senate from September 30 to early December. It would seem that it does, because it relates to the budget and appropriations bills that Congress has not yet passed for last year, let alone the FY 2018 budget year.

In any event, it appears that President Trump and Congress have decided to move on from “Obamacare repeal and replace” to their agenda for tax cuts for corporations and the one percent. They still retain the option of sabotageing”Obamacare” if Congress cannot pass a fix for the cost sharing reduction (CSR) subsidies to insurers.

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