David Leonhardt writes, C.B.O. Report Reveals Trumpcare’s Fatal Flaws:
The Congressional Budget Office’s analysis of the House health care bill is a devastating indictment.
The new report shows that millions of Americans would lose health insurance and the quality of insurance for millions more would deteriorate. The savings from that carnage — to borrow a favorite word of President Trump’s — would pay for tax cuts for the wealthy.
And yet the immediate reaction to the C.B.O. report also shows why you should be worried that the Senate will nonetheless decide to pass a version of the House bill.
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Distraction is a tactic of the politicians who are trying to take away health insurance from people. These politicians can’t sell their proposals on the merits. That’s why both the House and, thus far, the Senate have refused to hold any hearings. They know that virtually every expert across the ideological spectrum — including groups representing doctors, nurses, hospitals, patients and senior citizens — opposes the bill.
Unable to win a debate on its merits, Republican leaders need to change the subject. They can’t let their proposals be judged on whether they improve the American health care system, because they don’t. They need to create a lower standard by which the plan will be judged.
Senate leaders are showing signs of following the same path — and the C.B.O. report gives them a chance to start down it. The report will encourage top Republicans to claim that their bill is already getting better and that the Senate will keep improving it in coming months.
In truth, the bill is fatally flawed. Its objective is to reduce federal spending on health insurance for the middle class, poor, sick, elderly and disabled in order to cut taxes for the wealthy. Maybe the final version, once the Senate has made its tweaks, will take insurance from 23 million people, or maybe 15 million people. But any law based on the House bill is guaranteed to worsen the health care system.
Jeanne Lambrew warns, Republicans, Get Ready for the Trumpcare Headlines:
In promising to repeal and replace the Affordable Care Act, many Republicans cited headlines from last year such as “Obamacare Premiums to Soar 22 Percent” and “As Obamacare Choices Dwindle, Feds Face Consumer, Political Backlash.”
Yet based on a new analysis by the nonpartisan Congressional Budget Office, headlines would be even worse under the health care bill to repeal Obamacare, which was passed by the House this month.
If the Senate makes this flawed bill law, Republicans will have the chance to watch, all the way up to the midterm elections, as Americans pay higher premiums and lose coverage. By the time the bill’s full changes went into effect in 2020, many of those who voted for it could be long gone.
That’s the overwhelming message of the C.B.O. report.
Here are the types of headlines Republicans can expect (copy edited for brevity).
“Trumpcare Premiums to Soar by 26 Percent.”
“60-Year-Olds to Pay Over 50 Percent More Under Trumpcare.”
“Insurers Fleeing Trumpcare.”
“Biggest Rise in Uninsured in History.”
“Untreated Opioid Addiction Surges.”
“Trumpcare Is a Windfall for Millionaires.”
President Trump has repeatedly said that Obamacare should be blamed for any problems in the individual market this year and next. Yet many of the predicted premium increases are actually a reaction to the attempts to repeal Obamacare, an attempt on the part of insurance companies to protect themselves from the uncertainty induced by the congressional debate and President Trump’s executive actions. And poll after poll shows a majority of Americans dislike the Republican approach and will hold Republicans responsible for any future problems.
So Republicans citing Obamacare headlines should take a moment to imagine the likely Trumpcare headlines and what they will mean for their job security.
As to Lambrew’s last point, Abbe Gluck explains How the G.O.P. Sabotaged Obamacare:
Obamacare is not “collapsing under its own weight,” as Republicans are so fond of saying. It was sabotaged from the day it was enacted. And now the Republican Party should be held accountable not only for any potential replacement of the law, but also for having tried to starve it to death.
The Congressional Budget Office on Wednesday released its accounting of the House Republicans’ replacement bill for the Affordable Care Act, and the numbers are not pretty: It is projected to leave 23 million more Americans uninsured over 10 years, through deep cuts to insurance subsidies and Medicaid. The report underscores how the bill would cut taxes for the rich to take health care away from the less well-off.
The A.C.A. is not perfect, and improvements to it would be welcome. But it worked in many respects and would have worked much better had Congress been a faithful guardian of the law.
It is worth making a record of those Republican saboteurs’ efforts. The A.C.A.’s opponents brought a lawsuit against its requirement that people buy insurance — a Republican idea — the very day the statute was signed into law. The Supreme Court rejected that claim. But the court gave opponents a major victory on another front, ruling that Obamacare’s expansion of Medicaid was optional for states. Yet another lawsuit seized on some sloppy language in the law to make the implausible argument that Congress did not provide for the insurance subsidies on which the law depends. The Supreme Court also rejected that challenge.
But if the Republicans lost those cases, they succeeded in sowing the insurance markets with doubt and forcing states to slow down implementation while awaiting the court’s decisions. That in turn may have reduced sign-ups, further destabilizing the insurance market. The second case challenging the subsidies was not decided until 2015, more than a year after the statute’s critical 2014 deadline for implementation.
Even worse, these lawsuits helped make the A.C.A. the salient partisan issue of the Obama administration, turning the law into the ultimate Republican litmus test: Implementing a state insurance exchange or expanding Medicaid, even when it seemed in a state’s interest, became treasonous for the party. Nevertheless, about a dozen principled Republican governors bucked their party and expanded their programs.
In 2014, the House brought a lawsuit, arguing that a critical piece of A.C.A. funding — the cost-sharing subsidies that pay insurers to lower premiums — had not been properly appropriated. For insurers, not knowing whether that money could be cut off — President Trump is still threatening not to pay them — has caused anxiety about whether to remain in the A.C.A. markets. More than 100 other suits have been filed, including challenges to contraception provisions and the requirement that employers provide insurance.
On the political front, the Republicans targeted provisions of the law that provided crucial transitional financing to steady the insurance markets early in the program. Senator Marco Rubio of Florida, calling the money an insurance “bailout,” sponsored a measure that prevented appropriation of some of those funds. The courts have issued mixed rulings on whether the federal government must pay, adding yet more instability to the insurance markets.
The Affordable Care Act, like any major statute, surely could use adjustments. For example, the insurance subsidies were probably set too low initially. The Obama administration’s decision to allow more people to stay on their old plans than originally expected may also have narrowed the new pool of insurance customers in ways that contributed to premium hikes. The Republican-controlled House never provided any additional implementation money after the initial appropriation set forth in the Affordable Care Act itself, forcing the Department of Health and Human Services to scrounge for needed funds.
A caretaking Congress would have fixed what wasn’t working. Instead, opponents did everything possible to shut off all the A.C.A.’s financing — starvation intended to wreak havoc in the insurance markets and to make it falsely appear that the A.C.A.was collapsing because it was just bad policy.
The irony is that the A.C.A. was vulnerable to this strategy because the Democrats had tried to compromise with the Republicans in an ultimately unsuccessful effort to build bipartisan support for the law. If the Democrats had instead enacted a single-payer policy — such as Medicare for all — the entire health care system would have been in the hands of the federal government, instead of dependent on the states and private insurers.
Now the Republicans find themselves in a mess. The Affordable Care Act has brought health care to an estimated 20 million more Americans and has expanded services — including access to drugs and preventive screening — for many more. A good number of Americans, including Republicans and the president himself, say they like elements of the law. It’s not a coincidence that the Trump administration’s first proposed health care regulation was aimed at stabilizing the insurance markets.
Still, Republicans are using the Affordable Care Act’s so-called collapse as an argument for a much stingier law, one that would leave states responsible for paying many health care costs. Some conservatives are using the assault on the A.C.A. not to assail its novel insurance provisions — which many people like — but rather to grind an old ax against the entire Medicaid program, which was enacted in 1965 to help the poor.
As the Senate turns to its own bill, it still has time to preserve the parts of the Affordable Care Act that are working and, more importantly, strengthen those that could succeed with proper support. That would be responsible — and, indeed, is what should have happened all along.
Not going to happen in the post-policy nihilism of the GOP. They only serve their corporate masters who demand a massive transfer of wealth upward to the top 1%. They want it all in their unbridled greed, consequences — and lives lost — be damned.