The Beltway conventional wisdom was that the awful Zombie Trumpcare bill passed by the House was dead on arrival in the Senate, and senators would draft a more favorable bill to appeal to mythical moderate senators. Or the “Obamacare” repeal effort would die in the Senate.
Beltway conventional wisdom is almost always wrong, however, because the pundits always ignore the iron law of GOP politics: the mythical moderates always cave to the radical conservatives. That’s what makes them”mythical,” moderate Tea-Publicans do not actually exist.
Sarah Kliff reports at Vox.com, Obamacare is in real danger:
Senate Republicans began to coalesce around the framework of a plan to repeal and replace the law last week. Their plan would, like the bill the House passed in May, almost certainly cause millions of low-income Americans to lose coverage by ending the Medicaid expansion. It would help the young and healthy at the expense of the older and the sick.
Senate Republican Whip John Cornyn (Texas) told reporters this past week that the Senate bill will overlap the House bill by as much as 70 or 80 percent.
Meanwhile, across the nation, health insurance plans are beginning to flee the Obamacare marketplace. They’ve cited the uncertainty around the health care law’s future, sown by congressional Republicans and the Trump administration. The number of counties with zero health plans signed up to sell 2018 coverage keeps growing.
The possibility that Republicans will repeal Obamacare or drive it into collapse is an increasingly real one. That’s a reality where millions fewer have health insurance and lower-income Americans struggle to afford coverage.
The Senate repeal plan is coming together — and looks a lot like the House repeal plan
Behind closed doors, Senate Republicans have worked out a path toward Obamacare repeal. The plans under discussion would end Medicaid expansion, causing millions of low-income Americans to lose health coverage. They may allow health insurance plans to charge higher premiums to people with preexisting conditions, too.
In other words: The emerging bill looks a whole lot like the unpopular bill the House passed last month. It creates the same group of winners (high-income, healthier people) and the same group of losers (low-income, sicker people).
The Republican plan is coming together because moderate senators are beginning to drop some of their initial repeal objections. Sens. Rob Portman (R-OH) and Shelley Moore Capito (R-WV), for example, now back a plan to end the Medicaid expansion.
Both were ardent critics of the House bill’s deep Medicaid cuts, which would cause 14 million Americans who rely on the public program to lose coverage. Portman put out a harsh statement the day the House passed its health care bill.
But now Portman has endorsed a plan to phase out the Medicaid expansion entirely, just to do so on a longer timeline than the House bill. Portman and Moore Capito want a seven-year phase out, rather than the House bill’s three-year off-ramp.
At the end of the day, though, phasing out Medicaid expansion over seven years has the same effect as three years: You end coverage for millions of low-income Americans.
There are still major issues that divide Senate Republicans on repeal. There is disagreement, for example, over how much to cut the Medicaid program and what kind of subsidies to give people in the private market. But the fact that Republicans are coalescing around ending Medicaid expansion — once thought to be a major sticking point — suggests the path to repeal may be easier to find than initial expectations.
Senate Republicans are working to finish their draft health care bill, but have no plans to publicly release it, according to two senior Senate GOP aides.
“We aren’t stupid,” said one of the aides. [“We’re evil.”] One issue is that Senate Republicans plan to keep talking about it after the draft is done: “We are still in discussions about what will be in the final product so it is premature to release any draft absent further member conversations and consensus.”
As Paul Waldman of the Washington Post explains:
So they’re doing an end run around the normal committee process, writing it in secret, hoping to send it to the Congressional Budget Office for a score before anyone gets to see it, then they’ll take a quick vote before opposition gets too loud. For a bill to remake one-sixth of the American economy and determine the course of everyone’s health care.
The arrogance of believing they can get away with that is just stunning, particularly when you recall how much they complained that the Affordable Care Act was “rammed through” when it was debated for an entire year, including dozens of hearings and markups and one of the longest floor debates in history.
Joan McCarter at Daily Kos reminds us:
While Senate Leader Mitch McConnell is jamming through a Trumpcare bill that could entirely blow up the health care system, which accounts for one-sixth of the nation’s economy, here’s a reminder about how crafting laws is supposed to be done:
In June and July 2009, with Democrats in charge, the Senate health committee spent nearly 60 hours over 13 days marking up the bill that became the Affordable Care Act. That September and October, the Senate Finance Committee worked on the legislation for eight days—its longest markup in two decades. It considered more than 130 amendments and held 79 roll-call votes.The full Senate debated the health care bill for 25 straight days before passing it on Dec. 24, 2009.
“After years of howling at the moon about Democrats rushing through the Affordable Care Act,” said Senator Chuck Schumer of New York, the Democratic leader, Republicans are now racing to pass the repeal bill because “they don’t want anyone to know what’s in the bill.”
This is what authoritarianism and Tea-Publican tyranny looks like. Laura Chapin at US News & World Report writes, An Insult to Democracy:
Brian Beutler of the New Republic described what Majority Leader Mitch McConnell, R-Ky., and Senate Republicans have planned for their health care bill – aka Trumpcare – as “the legislative equivalent of a mugging.” That sounds about right. Senate Republicans are poised to steal health care from millions of Americans and hand it to rich people in the form of a tax cut – and they’re doing it in secret.
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No one even knows what’s in the bill except for the Senate Republicans – including Colorado Sen. Cory Gardner, who is reportedly one of the people writing whatever cruel travesty of a policy emerges in its final form. On Wednesday, McConnell invoked a rule bypassing the entire regular legislative procedure for a Senate bill. There will be no hearings, no committee markups, no public testimony, no input from physicians, nurses, hospitals, insurers or the public. Just a giant middle finger to the democratic process and the people who rely on Obamacare to keep them alive.
This is banana republic stuff, folks.
And what authoritarian Tea-Publicans can’t achieve by legislation, they will do through sabotage. Sarah Kliff continues:
Health insurance plans are fleeing the Obamacare marketplaces
Insurance plans are scaling back their Obamacare participation or quitting the marketplace entirely. Most cite the growing uncertainty over the law’s future — whether it will be repealed and how the Trump administration will implement it.
In the past week, the number of counties with zero health plans signed up to sell Obamacare has doubled. There are now 38,000 Obamacare enrollees scattered across 47 counties where no insurers want to participate in the marketplaces.
In these places, Obamacare’s coverage expansion could vanish regardless of whether Congress passes a repeal bill. People with Obamacare subsidies would still technically get that help, but would have no place to actually buy coverage.
Anthem announced last week that it would exit the Ohio marketplace, leaving 20 counties and 15,000 Obamacare enrollees with no 2018 option.
Anthem has been lukewarm on the 2018 marketplaces. Reports earlier this spring from analysts who follow the company said it was “leaning towards exiting.” But Anthem has decided to stick with a few marketplaces. An Anthem exit in the rest of the states where it currently sells would be devastating to the law, leaving 300,000 Obamacare enrollees without coverage.
When Blue Cross Blue Shield Kansas City quit on May 24, it blamed the “uncertain direction of this market.”
The Affordable Care Act relies in large part on private health plans volunteering to sell coverage on these public marketplaces. There are not mechanisms in the law to force insurers to participate.
“We elected to have a system that is completely market-based so companies get to make individual decisions,” says Andy Slavitt, who served as Medicare administrator in the Obama administration.
Under the Trump administration, it has become increasingly difficult for health plans to make the decision to participate on a marketplace that the president says is “exploding.” Who wants to build a business around a law that the White House is actively trying to tear down?
“The information we’ve seen coming from the administration actually creates more uncertainty rather than creating greater certainty,” says Brad Wilson, chief executive of Blue Cross Blue Shield North Carolina.
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When Republican legislators talk about why they need to repeal Obamacare, they point to the areas that are struggling to attract health insurers. They point to Obamacare’s bald spots and make the argument that a new law is needed to fix the problem.
“What kind of protection is Obamacare if there are no plans to choose from?” House Speaker Paul Ryan said at the Rose Garden ceremony last month to celebrate the House bill’s passage.
When insurance executives talk about why they’re leaving, they point the finger back at the uncertainty Republicans are sowing. They don’t want a new law; they want more certainty around existing law. Specifically, they want to know whether the administration will pay for a key subsidy program that it has so far waffled on implementing.
“The discussion that is happening in Washington, that creates additional uncertainty,” says Geoff Bartsh, a vice president at health plan Medica, which sells on the marketplaces. “When you’re dangling the cost-sharing subsidies — they’re on the table, they’re off the table — that creates uncertainty.”
Insurers’ exits from Obamacare don’t just mean fewer (or no) choices for the millions of Americans who rely on the law. They also give Republicans more ammo for pushing their repeal plan forward — and make the path toward passing a Senate bill an easier one to forge.
David Leonhardt of the New York Times writes that the lobbying groups for doctors, hospitals and many others opposed to the Republican health care bill are being far too timid in their opposition. The Halfhearted Opposition to the G.O.P.’s Health Care Misery:
The Republican health care bill now sneaking its way through the Senate has a good chance of becoming law, even though it would do miserable damage. And it has a good chance partly because some of the bill’s most influential opponents have not had the courage of their convictions.
I realize that sounds harsh. These opponents generally have good intentions. But they haven’t been very effective so far, and they don’t have much time to summon the courage to become more effective.
The opponents I’m talking about include almost every major health care interest group: the lobbying groups for doctors, nurses and hospitals as well as advocates for patients with cancer, diabetes, lung disease, heart diseaseor birth defects. Each understands that the bill would deprive millions of Americans of insurance. Each has criticized the bill, and some, including AARP, have done more, like organizing phone calls.
But they have not come close to the sort of public campaign that would put intense pressure on senators.
Any senator who votes for this tyrannical travesty of a bill should be ridden out of town on a rail. Call your senators and let them know that this is a litmus test for you: vote for this bill and your political career is over. You’re gone.