Evil GOP bastards are still trying to destroy health care — contact your senators

While everyone is distracted today with James Comey laying the predicate for an obstruction of justice charge against Donald Trump (and any co-conspirators), keep your eye on Congress because the evil GOP bastards (right) are still busy trying to take health care away from 24 million Americans and to destabilize the health insurance market for everyone else, with less coverage and higher premiums.

Joan McCarter at Daily Kos writes, McConnell starts fast-track process for Trumpcare in the Senate:

Senate Majority Leader Mitch McConnell (R-KY) began the procedure Wednesday for fast-tracking Trumpcare to get it to the floor with a minimum of transparency and a maximum of pressure.

McConnell began the process under what is known as Rule 14, according to the Senate minority whip’s office, to allow a repeal bill to be put directly on the Senate calendar so that it is available for a floor vote when Republicans are ready to vote on it. The move comes as GOP senators continue their closed-door meetings to hash out a deal that would secure the 50 votes they’ll need to pass legislation dismantling the Affordable Care Act, which they they are pushing through a process known as reconciliation that avoids a Democratic filibuster.

Rule 14 allows a bill to bypass committees and be sent directly to the floor, without going through normal procedural requirements, like the two-day availability of a committee report prior to floor consideration. The one thing McConnell has to do is get a Congressional Budget Office score before a vote. Former Sen. Harry Reid’s Chief of Staff, Adam Jentleson (who knows McConnell as well as anyone on the Hill) agrees with our speculation that McConnell is following the Ryan model—push this thing through as fast as he can, pressuring his conference to get the 50 votes he needs.

Jentleson says that this is McConnell “saying ‘boo’ to his conference and seeing who jumps. He wants to walk his conference to the edge of the cliff and make them stare down at the option of failing on their ‘repeal’ promise. After putting the fear of God into them, he will rally them with speeches like ‘failure is not an option.'” Jentleson speculates that the magic number is four—if McConnell has fewer than four strong “no” votes right now, “he’ll think he can win them over—and he’s probably right.”

Joan McCarter continues, Senate Republicans are either close to or far away from Obamacare repeal:

Depending on which Republican senator a reporter talks to, they are either ready to push through a Trumpcare bill that repeals Obamacare and ends insurance for millions, or they’re not. After a conference-wide working lunch Tuesday, more are saying they’re much closer.

Senators still lack an actual bill, and the compromises needed to pass the Senate could imperil the legislation in the House, which will also have to back it. But Tuesday was a pivotal day for discussions in the upper chamber ― and seemingly a positive one ― as Republicans try to build a 50-vote coalition to repeal Obamacare.“We’re getting close to having a proposal to whip and to take to the floor,” Senate Majority Leader Mitch McConnell (R-Ky.) told reporters, after nearly three hours of closed-door meetings. […]

As for why they were increasingly optimistic, GOP senators wouldn’t offer very many details and McConnell suggested that some key issues linger. But the broad outline discussed among members points to a slower phaseout of Obamacare’s Medicaid expansion than the House bill entails and a shifting of tax credits from younger people to older people. Unlike the House version, the Senate bill may not allow insurers to set higher prices for people with pre-existing conditions than for healthy people.

That legislative vision appeared to sway some on-the-fence members who could prove critical to cobbling together 50 GOP votes. Sen. Bill Cassidy (R-La.), who had been outspoken in his opposition to the House-passed bill, signaled that he was comfortable with the broad strokes of the Senate legislation, though he warned that he hadn’t seen the final text.

McConnell can afford to lose two votes, and at the moment it appears that Sens. Susan Collins (ME) and Rand Paul (KY) are the two that will defect. But that’s before there’s any legislative text beyond the Zombie Trumpcare bill from the House (which has cleared the hurdle of complying with Senate budget reconciliation rules and can be considered) and before a Congressional Budget Office score, which the Senate can’t proceed without, unlike the House.

As of now, it looks like the Senate bill will include the state waivers that caused so many problems for the House—states could opt of essential health benefits (bringing back the annual and lifetime caps insurers could impose on payments), the Obamacare regulation on how much of the premium revenue insurers have to use on covering care, and the age rating limits in Obamacare.  But what isn’t under consideration, supposedly, to be waived is the ACA provisions that insurers have to cover people with pre-existing conditions and that they can’t charge them more than healthy people. Those are the things that convinced the Freedom Caucus maniacs in the House to get on board, by the way. So getting House agreement on that is something else they have to think about.

And then there’s Medicaid, which they still want to destroy. They’ll just do it more slowly than the House. And they’ll still give a massive tax cut to the wealthy. Because this isn’t a health bill, it’s a tax cut bill.

The New York Times tries to reassure us today that any compromises designed to attract mythical moderate GOP senators to the Senate bill will only alienate the more conservative Tea-Publicans in the Senate, and certainly in the House for any conference bill. Senate Health Bill May Alienate G.O.P. Conservatives:

Senate Republicans are closing in on a bill to repeal President Barack Obama’s signature health care law, diverging from the House on pre-existing medical conditions and maintaining federal subsidies that proponents see as essential to stabilizing insurance markets around the country.

The changes appear largely designed to appeal to Republican senators who hail from states where the Affordable Care Act is popular and who were critical of the House bill, which would eliminate insurance for millions of Americans covered under the current law, according to the Congressional Budget Office.

But the revisions may well alienate the Senate’s most conservative members, who are eager to rein in the growth of Medicaid and are unlikely to support a bill that does not roll back large components of the current law. Even with more moderate Republicans on board, party leaders would have a very narrow margin for passage on the Senate floor.

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Senate Republicans, meeting daily behind closed doors, are coalescing around a proposal that would provide money for “cost-sharing reduction” payments, which insurance companies receive under the Affordable Care Act so they can reduce deductibles and other out-of-pocket costs for low-income consumers.

House Republicans filed a lawsuit in 2014 asserting that the Obama administration was paying the subsidies illegally because Congress had never appropriated money for them, and a Federal District Court agreed last year. The conflict puts the Senate on a potential collision course with both the House and the White House, which has sent decidedly mixed messages on what it wants to do with the subsidies, causing insurers to panic.

See White House touts the ACA’s demise even as insurers seek help in stabilizing its marketplace: “Sabotage is the operative word,” Sen. Richard Blumenthal (D-Conn.).

Senator Rob Portman, Republican of Ohio, said Congress needed to provide money for the cost-sharing subsidies. “The administration has delayed a decision from month to month,” he said. “We need to deal with it as soon as possible to provide some stability in the market.”

Mr. Portman noted that Anthem, one of the nation’s largest insurers, cited uncertainty about the payments when it announced this week that it would pull out of Ohio’s health insurance exchange next year, leaving consumers in some counties without options.

Insurers, doctors, hospitals and the United States Chamber of Commerce have been urging President Trump to ensure payment of the subsidies. But Mr. Trump has threatened to withhold them as a way to force Democrats to negotiate with him on a replacement for the 2010 health care law.

Seven million people benefit from the cost-sharing subsidies, which cost the federal government $7 billion a year. The House bill did not include money for them, and Mr. Trump’s mixed signals have spooked insurers.

The Trump administration has also indicated that it will loosen enforcement of the requirement for people to have coverage or pay a penalty.

Harvard Pilgrim Health Care cited uncertainty about that requirement, the individual mandate, as one reason it proposed rate increases that would raise the average monthly premium in the Maine marketplace by 39.7 percent, to $655 in 2018 from $469 this year.

Republican senators are still waiting for more details, and an evaluation by the Congressional Budget Office of the Senate measure’s cost and impact, before agreeing to support any legislation that would fulfill years of Republican promises to unravel the health care law.

Democrats, who have been left out of a process that requires only 51 votes, are almost certain to be critical of the measure, which goes well beyond changes needed to solve problems now roiling insurance markets in many states.

“We have not been included in any of these discussions,” said Senator Patty Murray, Democrat of Washington. “Clearly, they want to move forward and get this monkey off their backs, but it is a monkey, and they’re going to pay the price if they go that direction.”

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Under the bill passed by the House last month, states could opt out of certain provisions of the Affordable Care Act, including one that requires insurers to provide a minimum set of health benefits and another that prohibits them from charging higher premiums based on a person’s health status.

Senate Republicans generally agree that it is desirable to give states more flexibility, allowing them to obtain waivers from the federal definition of “essential health benefits,” such as maternity care, emergency services and mental health coverage.

But many Republicans are reluctant to dilute the protections for people with pre-existing conditions. Asked if insurers should be allowed to charge higher rates to people with such conditions, Mr. Cassidy said, “The simple answer is no.”

Congress has roughly 30 legislative days to pass a bill before the August recess. If the Senate is able to pass one by then — a goal of Mr. McConnell — it is very unclear whether its provisions could be melded with those in the House version.

Despite the Times reassurances, Greg Sargent at the Washington Post warns, Make no mistake. Republicans can still succeed in destroying Obamacare.

With a Senate vote now expected this month, they are bracing for several scenarios in which Republicans produce surprise tactics at the last minute that enable them to pass something. This would then get them through to the next stage — negotiations between the House and Senate — which would have the virtue of increasing the pressure on reluctant holdouts to pass the final bill, pulling the trigger and destroying the Affordable Care Act for good.

One such scenario involves writing a bill that defers dealing with some of the tough details just to get through to conference committee, where the Senate and House bills would be reconciled, a Democratic aide tells me. In this rendering, the aide says, McConnell “puts together something very limited to go to conference, putting off hard decisions until the final bill is written with the White House at the table.”

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Democratic aides are preparing for several tactics that Senate Republicans could employ to get moderates to support the bill. One is to create a “placeholder” or “shell” bill that does not work out too many details of the Medicaid cuts, allowing moderates to say they will protect Medicaid in conference negotiations, a senior Democratic aide tells me. “If they try this route, Democrats will absolutely hold every single Republican senator accountable for that vote,” the aide says. “Republicans will be voting to dismantle our health-care system, and we’ll make sure people understand that.”

“Republicans are dead-set on getting to 50 votes so they can jam some version of Trumpcare through the Senate,” Sen. Patty Murray (D-Wash.) told me in an emailed statement. “So Democrats are looking at every possible scenario.”

“Conceptually, they could leave unaddressed many of the details of the Medicaid cuts and work them out in conference,” Sarah Binder, a congressional expert at George Washington University, tells me, while cautioning that this is speculative. “They can deal with a vague Senate provision and a detailed House provision in conference.”

A second scenario might be to insert language into the bill that obfuscates its true legislative impact. “They could put language in the bill that would make a political statement about, say, protecting those with preexisting conditions, even as the policy consequences would be different,” Binder says. Or, Binder suggests, it could include weaselly language on Medicaid cuts, such as: “Nothing in this bill should be construed to limit people entitled under the law to Medicaid coverage.” Binder explains: “The goal would be to insulate themselves from criticism that they are throwing people off Medicaid.”

Of course, all of this is a reminder of a basic fact about this whole debate: The GOP’s massively regressive designs on the ACA — which at bottom constitute rolling back health coverage for untold millions of people to finance a huge tax cut for the rich — are deeply unpopular. By exposing those true designs to the public, this debate has succeeded in making Obamacare more popular and has underscored public opposition to rolling back the historic coverage expansion it has achieved, despite all its real flaws and need for improvement.

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The bottom line is that whatever tactics Republicans use, if they can get something passed in the Senate, and get Senate and House Republicans into some form of negotiations designed to reconcile the two versions, the prospects of final success go up substantially.

“The virtue of getting everyone into the same room is to get them out of the public eye, where they can come to a final agreement that then would be put to an up or down vote in both chambers,” Binder tells me, adding that at that point, the situation would be, “this is it: Are you for or against getting rid of Obamacare? This would increase the pressure on individual Republicans who are skittish.” To be sure, it’s possible that Republicans could still fail. But “success” is also a very real possibility.

Contact your senators and give them a piece of your mind.