A headline at Axios yesterday: GOP health care plan has momentum. This is the new plan where, aside from kicking 24 million people off health insurance, the Republicans gut protections for the sick (by eliminating protections for people with pre-existing conditions)-- and all to allow a tax cut for the super-rich. The far right extremists at the Freedom Caucus think it does enough damage to have earned their support. Whats known as the Meadows-MacArthur amendment allows states to waive a set of "essential health benefits" and a ban on charging sick people higher premiums in limited circumstances and if the state has established a high-risk pool. Radical anti-health care extremists like Dave Brat (R-VA), Raul Labrador (R-ID) and Jim Jordan (R-OH) are urging other extremists to vote for it-- and that may come as soon as Friday.The bill's impacts will be so bad for consumers that congressional Republicans exempted themselves and their staffers from the worst of the provisions, something that didn't go unnoticed by Democrats. Madison-based Democrat Mark Pocan called then right out on it: "House Republicans showed their hand when they exempted themselves from their own plan. If this latest version of Trumpcare isn’t good enough for Members of Congress, it’s not good enough for the American people. The reason Trumpcare failed, was that the American people took a long hard look at what the President and Speaker Ryan put on the table and flatly rejected it. Now, House Republicans are trying to introduce a worse version of Trumpcare that will likely cause more people to lose health insurance, make it harder for people with preexisting conditions to get coverage, and leaves people at the mercy of insurance companies."Meanwhile the Regime has some healthcare sabotage up its sleeve-- just in case. Mick Mulvaney spoke with Nancy Pelosi Tuesday night and threatened to cut off crucial ObamaCare payments as soon as next month.
Canceling the payments to insurers, known as cost-sharing reductions (CSRs), would cause chaos in the insurance market. The payments are the subject of ongoing litigation, with a judge ruling them unconstitutional last year because Congress had not appropriated the money."Mulvaney indicated that while the Trump administration had continued the CSR payments, they had not yet decided whether they would make the May payment," the aide said. "Mulvaney made clear that, absent Congressional action, the judge's order would stand and the administration would cease making payments."Pelosi is pushing for the payments to be funded in the spending bill Congress is negotiating this week.If Mulvaney follows through on his comments, then that would raise the pressure on Congress to appropriate the payments so that they are not canceled, as the administration is threatening.Top congressional Republicans, though, are resisting funding ObamaCare payments in the spending bill, leading to a standoff.
That could be awkward for mainstreamish conservatives in swingy districts. Politico and the rest of the Beltway media refers to them as "moderates," which they're not, but Politico's Kyle Cheney and Rachel Bade were correct in pointing out that much of this resuscitation mess is the fault of fake-moderate Tom MacArthur (R-NJ). "MacArthur," they wrote, "has singlehandedly kept the embers of the failed repeal-and-replace effort burning, huddling with the hard-line conservative Freedom Caucus to try to forge a deal. The negotiations have allowed the White House and GOP congressional leaders to insist that despite their embarrassing failure to pass health care legislation last month, they're still making progress. But the MacArthur-as-Republican health care savior narrative has bothered some GOP moderates, who say the New Jersey lawmaker is flying solo in negotiations with the Freedom Caucus. Though he's one of three co-chairs of the Tuesday Group-- a 50-member bloc of House Republican moderates-- MacArthur has negotiated without the group's blessing in his quest to keep the health care talks alive, other Tuesday Group members say."
Some in the group “are pretty hot about this thing right now,” said a Tuesday Group member. “MacArthur is kind of on his own.”MacArthur acknowledged as much in an interview with The Hill, suggesting his effort to find compromise was not on behalf of the Tuesday Group.As a result, it's not clear that any deal MacArthur strikes can actually deliver the votes of moderates that President Donald Trump and House Speaker Paul Ryan need to get their legislation, dubbed the American Health Care Act, across the finish line. That's a dangerous dynamic that could sink the revived health care discussion just as Freedom Caucus members are warming to the bill.So far, House moderates have remained quiet about reports of progress between MacArthur and the Freedom Caucus, chaired by North Carolina Rep. Mark Meadows. The two were seen huddling daily in the back of the House chamber before lawmakers departed for their two-week Easter recess. But other Tuesday Group members have been wary of working with the Freedom Caucus, which came under fire from Trump and mainstream Republicans last month for rejecting the first iteration of the GOP health care plan.At the time, Rep. Chris Collins, a Tuesday Group member and Trump ally, accused the Freedom Caucus of proposing negotiations simply to deflect blame for scuttling the first bill.“The Tuesday Group will never meet with the Freedom Caucus. Capital N-E-V-E-R,” Collins said in late March.As reports of a deal surfaced during the recess, moderates remained silent. Even MacArthur's Tuesday Group co-chairs-- Reps. Charlie Dent and Elise Stefanik of New York-- said they weren’t yet sold on the negotiations....[I]t's unclear whether MacArthur's efforts have moved any moderates closer to "yes" on the stalled health care bill. Politico reached out to the offices of more than two dozen moderate Republicans who had either signaled their opposition to the AHCA or hadn’t yet taken a position. Though many declined to respond, none said they had been swayed by the negotiations."The amendment doesn't address the things that I had concerns about-- the things I think are detrimental to the people I represent," said Rep. Dan Donovan, a centrist, who added that he learned about the proposal when details leaked to the press Friday....At the heart of the negotiations is a trade-off. Conservatives are seeking a proposal that would let states opt out of Obamacare's regulatory framework, including provisions intended to keep costs down for people with pre-existing conditions. In exchange, MacArthur negotiated to reinstate Obamacare's minimum coverage requirements and to require that any state choosing to opt out of the Obamacare regulations must set up a high-risk pool intended to help cover sick patients whose premiums might surge.Freedom Caucus sources indicated these changes could win over at least some of their holdouts, putting the AHCA tantalizingly close to passage. House leaders are hopeful they can nudge just enough moderates to back the bill to send it to the Senate. With no Democrats expected to support the bill, Republicans must secure support from 216 members of the 238-member caucus to pass it.Since talks collapsed last month, House leaders and President Donald Trump have indicated they were heartened by continued negotiations among lawmakers. Vice President Mike Pence and White House Budget Director Mick Mulvaney continued shuttling to and from Capitol Hill in search of votes. Then, as Trump's 100-day mark in office approached, the White House began indicated it expected a vote on an amended health care package as soon as this week.The Meadows-MacArthur talks were at the heart of it.For MacArthur, the impromptu talks aren't just risky for the Republican agenda, they could imperil his own political future. He represents one of a few dozen swing districts. Though his district narrowly voted for Trump in November, it backed Barack Obama in 2008 and 2012. MacArthur's role in salvaging a health care plan that energized protesters on the left and drew poor marks across the political spectrum has only enhanced the target on his back for Democrats.MacArthur's efforts have also put him on the president’s radar. Trump personally thanked MacArthur, a former insurance executive, the day before leaders pulled the legislation for lack of support.But during the presidential campaign, MacArthur, 56, kept his distance from Trump, endorsing the GOP standard-bearer after his primary rivals quit the race. MacArthur survived his reelection campaign despite relentless efforts by Democrats to tie him to Trump.In recent weeks, conservative and liberal activists squeezed MacArthur with attack ads in his district for his role in AHCA talks. But the conservative Club for Growth may help provide him some cover.
Keep in mind that the DCCC has already signaled that they will not be trying to unseat either Meadows or MacArthur in 2018. Yesterday the AP reported that Charlie Dent doesn't like what he's seeing of the MacArthur/Meadows "compromise," since it ignores his concerns that TrumpCare will "cut too deeply into the Medicaid program for the poor and leave many people unable to afford coverage."Trump and the GOP's threats against the Affordable Care Act have created the kind of uncertainty for the insurance market that is forcing premiums up for millions of Americans.
Many experts have already warned that if Trump refuses to enforce the Affordable Care Act’s, or ACA’s, individual mandate or fund subsidies for low-income enrollees, consumers will see premiums skyrocket. But even without taking direct action, the Trump administration is still pushing insurers to raise premiums. Trump’s rhetoric creates a climate of uncertainty for health insurers that puts upward pressure on rates and discourages them from future participation in the exchanges.We expect this generalized market uncertainty will itself raise premiums for 2018. If insurers raise rates by an additional 8.5 to 17 percent to account for a 25 to 50 percent risk that the Administration will undermine ACA subsidies and mandate enforcement, the average annual premium would rise by an extra $480 to $960 in 2018. While ACA subsidies will protect most enrollees from these uncertainty rate hikes, millions will see their premiums rise and taxpayers will foot the bill for increased subsidy costs.The administration has already taken steps that will hurt the market and increase premiums, including halting outreach efforts at the end of the 2017 open enrollment period and drastically shortening the enrollment period for next year. The administration can prevent even larger premium hikes, but, given the widespread uncertainty that the president and congressional Republicans have already created, they need to act now. Trump and Congress must take concrete steps in the coming weeks to make clear that subsidy payments will be made on a permanent basis, that the individual mandate will be fully enforced, that the administration will conduct similar outreach and operational efforts as in past years to drive enrollment, and that they will stop their damaging efforts to repeal the ACA....Trump is already attempting to use millions of Americans’ health insurance as a bargaining chip for his own political gain. In an effort to force Democrats to negotiate with him on repealing the ACA, Trump threatened to hold hostage subsidies for low-income enrollees....A study by The Commonwealth Fund suggests that eliminating cost-sharing reductions payments could increase premiums by 14 percent, in addition to causing a large number of insurers to leave the exchanges. Other studies have suggested an even higher increase if the compensating premium increase occurs among silver plans alone, from 19 to 29 percent. Similar estimates have been put forward by insurers, actuaries, and insurance commissioners, as well as by hospitals, doctors, and the U.S. Chamber of Commerce.To remove this uncertainty, President Trump and Congress must make clear that they will not play political games with people’s lives, that they will fulfill their obligations under the ACA, and they will fully fund cost-sharing reduction payments on a permanent basis.The size of the uncertainty rate hike would vary by state, as shown in Table 2. If we assume an uncertainty rate hike of 8.5 percent above the normal increase, equivalent to insurers hedging against a 25 percent chance of loss of the mandate and cost-sharing reductions, the extra annual premium increase would range from $300 on average in Massachusetts to an average of $1,060 in Alaska. If insurers build in a 50 percent chance the administration takes both these major actions to undermine the exchanges, the average rate hike would be more than $1,000 in close to half the states.
UPDATE: Doctors Write To CongressThis is the letter that went to Congress Wednesday:
Dear Speaker Ryan and Minority Leader Pelosi:The Honorable Nancy Pelosi Minority Leader U.S. House of Representatives Washington, DC 20515 Our organizations, which represent over 560,000 physicians and medical students, remain concerned with ongoing efforts that in our view could destabilize our nation’s health care system. We believe that pending legislation proposals would dramatically increase costs for older individuals, result in millions of people losing their health care coverage, and return to a system that allows for discrimination against people with pre-existing conditions. We are especially concerned about the changes to Medicaid and Medicaid financing contained within AHCA.Our members are the frontline physicians who provide physical and mental health care services to millions of men, women, and children each day. They provide care to children, the aged, those with chronic conditions, people battling substance use disorders, and the many individuals who are seeking prevention and wellness services in an attempt to be healthier. Our members see firsthand the important role that health care coverage and access to affordable, high quality care plays in people’s lives and their pursuit of better health and well-being. They also recall those days when patients faced discrimination based on their age, gender, or health conditions, and remember when those with mental and behavioral health needs were denied coverage.This experience with the health care system is why our organizations strongly oppose the compromises that have been recently reported. These compromises are built on the flawed foundation of the American Health Care Act (AHCA), which would result in millions of Americans and, according to the CBO, over 7 million with employer-sponsored insurance, losing their coverage.Further, these compromises would allow individual states to obtain waivers to opt-out of important benefit and patient protection provisions in current law. Under the proposed “Limited Waiver” authority, insurers in such states would once again be allowed to charge unaffordable premiums to people with pre-existing conditions based on their individual health risks, and decline to cover ten categories of essential services including prescription drugs, physician and hospital visits, preventive services, and mental and behavioral health benefits. We are especially concerned that these changes would:• Allow insures to deny millions of people facing addiction access to treatment and therapy, when such services are needed more than ever to address the opioid epidemic in the United States. • Make health care even more expensive and further reduce access to care for millions, especially those over the age of 50; • Force individuals with multiple chronic conditions into underfunded state-sponsored high risk pools, which have been proven ineffective numerous times;• Allow for gender rating by enabling states to opt out of maternity care coverage.We urge Congress to reject these “compromises” and instead focus on enacting policies that improve upon current law, thus ensuring that more people have access to affordable health care coverage. Our organizations have provided several recommendations on how current law could be improved to accomplish these goals. A few of those recommendations are:
• Ensure that coverage remains affordable by maintaining premium and cost-sharing subsidies available under current law. • Stabilize the individual market.• Take immediate action to provide long-term, adequate funding for the CHIP program.• Identify and implement policies that make primary, preventive, and mental health more readily available to all Americans. • Identify and implement policies that lower costs for individuals and families, especially the costs of pharmaceutical treatments. •Reform our medical liability laws.• Reduce the administrative and regulatory burdens that add costs and inefficiencies to our delivery and insurance systems, and take away valuable time for us to care for our patients.We recognize that our health care system is not perfect and reforms are needed. Our organizations and our members stand ready to work with Congress and the Administration to improve our health care system. However, we urge Congress to reject the AHCA and instead focus on the implementation of policies that aim to improve our health care system versus those that seek to destabilize it and would make quality health care less available to millions of Americans. Sincerely, American Academy of Family Physicians American Academy of Pediatrics American College of Physicians American Congress of Obstetricians and Gynecologists American Osteopathic Association American Psychiatric Association
And the AARP added this to the debate this morning:40% of older adults ages 50-64-- or about 25 million people in this age group-- could be denied health coverage because of a preexisting condition if they sought to buy an individual plan.
