Is the GOP health care reform bill dead on arrival?
I have no idea what the answer to the above question might be.
How’s that for incisive, cutting-edge blogging?
House conservatives are saying they have the votes to defeat the bill as it now stands. The bill’s proponents (who include President Trump) are furiously whipping the votes to get enough House members in line to pass it. Perhaps all the concessions to the conservative wing have already been made; perhaps there are more to come.
I’m not the only one who doesn’t know. I don’t think anyone knows.
This fight highlights the conflicts that have existed in the GOP for a long, long time, probably for most of my lifetime. And many people noted during the 2016 campaign that, particularly on the subject of health care reform, Trump was no conservative.
Now Republicans can’t just criticize Obamacare or even pass bills to repeal it when the repeal will vetoed. Now they must come up with a better bill to do something that is inherently very very difficult: redesign a health care coverage system that pleases most of the people most of the time.
Can the Republicans and the Trump administration just try scoring some easy wins first before tackling the toughest task of them all? two months have passed since inauguration and the republicans still have nothing to show for it. just repeal the whole darn thing, who cares about the few millions who will lose insurance, they probably voted for Hillary anyway.
I really don’t understand why we should worry about someone who voted for Hillary losing their insurances. They should just ask the rich liberals who love big government to buy them coverage, no one is stopping rich liberals like Bill Maher, Bill Gates and Zuckerburg to personally help taking care of those Hillary voters with pre-existing conditions. I am just a poor conservatives, I can’t afford my insurance bill now, when are the liberals going to care about me and my financial well being? Insurance bills skyrocketed after the Unaffordable Care Act can someone just do something about it?
Pulled out my trusty tea cup, and the leaves say, it passes.
The Freedom Caucus blinked, which will allow individual members to support the bill, as the caucus chairman indicated would be based on their individual constituents wishes.
The bill is as conservative as it’s going to be, so it’s only going to become more generous. Will at the end of the day save any money? Will it bring down premium costs? Will anybody notice?
I do think it’s inevitable that medical care in this country becomes two-tiered (and I suppose that’s true in most single payer countries)– a modest level of care for many people, and more comprehensive care for those that can afford it.
That’s true today, of course. It’s just segregated by region. Those of us living in rural areas are pretty much relegated to the doctor’s that can be cajoled into coming here. Some of the doctor’s are top notch– some not so much.
If you have a critical condition, you have to be ready to drive hours to access top quality care.
Mark Zuckerburg need to give all his money away to help the poor, don’t talk the talk, walk the walk. Why should we bankrupted the government to help the unfortunates like the rich liberals demanded if they don’t set an example by doing so themselves?
Next time Bernie Sanders wants to bankrupt our government in the name of helping the poor, just say “give all your money away to help the poor or shut up!”
Dave:
See this.
Another example of Republican’s short term thinking.
Had they not sent repeal bills that they knew wouldn’t be passed, they were happy. Did it ever occur to them that at some point they might actually have to do something?
Had they not made these token attempts, they could have just waited until it died of its own weight and then proposed some true reforms (though it’s probably true that the core issues- price transparency, insurance portability, etc. might be beyond congress).
It’s not all bad. There are some modest reforms. It would be nice if the GOP could be honest and just admit that the reforms ARE modest– and some of the necessary changes are going to come in future legislation. Oh wait. They have said that. Getting the really hard stuff passed in the future is where the real fight comes.
Brian E:
I strongly disagree.
I think the GOP had to send those repeal bills or those voters who voted for them and sent them to Congress would have been even angrier at their inaction. The upshot might have been a Democratic Senate in 2016 and a stronger Democratic presence in the House as well.
Meanwhile, during all that time the GOP was working on a replacement bill. Many were proposed, and I wrote a number of posts on them during the last couple of years of the Obama administration. Those proposals didn’t get much attention because they were works in progress and there was no way they were becoming law while Obama was president. But it was obvious even back then that the difficulty the GOP had in fastening on one of them reflected dissension among GOP members of Congress and the different wings of the party. That, coupled with the inherent difficulty of effectively reforming the health care system, has led to the current problems.
Note from the last two paragraphs of the article on the Wonderful Donations from Mr. Zuckernberg and his Significant Other (how Significant I don’t know, but they’ve now got a Foundation together and a child in the works, IIRC — or else already present, I forget which):
neo-neocon Says:
March 21st, 2017 at 2:46 pm
* *
Excellent points, and you have made them repeatedly.
It occurs to me that the fact the GOP can’t settle on a single healthcare plan strongly indicates that there shouldn’t be a government “plan” at all.
The Feds (and arguably the states) should do nothing but police fraudulent insurance companies and policies, and possibly assist the truly needy with catastrophic coverage. Philanthropic foundations can underwrite preventive care (many already do), and HSAs should be generous. No mandates about coverage, or barriers to interstate sales; and take the employers’ thumb off the scales.
Get back to INSURING DISASTERS not prepaying medical maintenance – there are better ways to do the latter.
Some people will be hurt in the transition back to a ground zero playing field, but many were hurt by the march to where we are now plus the Obamacare fiasco. Someone is always hurt whenever the government intervenes in what should be private activities, regardless of the direction of the intervention.
Hopefully, after the initial phase, FEWER people will be hurt in the future than we are bashing on right now.
The AHCA does not have to satisfy most of the people. The vast majority of people have health care insurance and most are relatively satisfied with it. The task is to transition as many of the 18 -22.6 million people who are actually on Obamacare to the new paradigm.
Those who gained their Obamacare insurance through Medicaid (8 -11.3 million depending on who provides the figures) will not be affected until 2020. Then the states they live in will have to decide how they are going to cover them. The Feds will provide block grants and let the states do their own thing.
The 11.3 million people who bought Obamacare policies as individuals are the ones who will be most affected. According to Obamacare Facts: “87% of the people who selected marketplace plans for 2015 qualified for financial assistance.” That’s 9.8 million of the policy buyers. That means that they all have incomes of less than $47,250 (single person) or less than $97,500 (family of four). A good actuary or accountant who has the numbers from the Obamacare marketplace (which I’m sure the Congress can get) could design a tax credit program that would allow most of those people to stay insured.
That is step one.
Step two is to have the Secretary of HHS cancel many of the costly rules/regulations that are affecting cost, access, and efficiency in the insurance marketplace and the health care industry.
Step three is to get tort reform , insurance sales across state lines, better bargaining with pharmacy companies, Health Savings Accounts and other such laws that would improve the system passed.
Once Obamacare is repealed and replaced with something that transitions most (not all) present Obamacare policyholders to the new paradigm, the Democrats will look really bad if they don’t vote for laws that will improve things. Not all will, of course, but only eight are needed.
The narrow vision of the Freedom Caucus and Rand Paul on this issue is maddening. They are as letting the perfect stand in the way of the good.
ir soulsRe Neo’s link:
Zuckerberg is paying his admirers as suckers.
He is setting up an LLC, which he will run. Not a foundation. It is all bravado.
Gates’s Foundation is worth ~40 Billion. He has approx 30 billion left over. Obama would say that at some point you have enough money.
So this is all pretend. Sanctimony. They think they can buy their way into a Progressive heaven. Their souls will be surprised! They’ll be equal with everyone else there.
These people never thought much about the Rockefellers, Rockefeller University, or Andrew Carnegie and his thousand (or so) libraries.
Trying to redesign a health care system that pleases the most people is doomed to failure because it places the cart before the horse. Health care has nothing to do with feelings, with trying to please people. In making that the primary goal, the creation of another dysfunctional system is unavoidable.
As history proves, a free market health care system is, by far the most efficient at advancing the state of health care for everyone. Eliminate disparity and you eliminate progress.
The GOP establishment’s mindset is defensive because they are placing political expediancy before medicine’s economic pragmatism.
Explain your thinking, then ignore naysayers who advocate socialized medicine and full speed ahead.
TRUMP
Jan 2017 Approval: Rep- 89%; Ind- 42%; Dem- 13%.
March 2017 Approval: Rep- 88%; Ind- 36%; Dem- 9%.
GW BUSH
Feb 2001 Approval: Rep- 88%; Ind- 53%; Dem- 32%.
March 2001: Approval: Rep- 89%; Ind- 56%; Dem- 33%.
Oct 2004 Approval: Rep- 94%; Ind- 40%; Dem- 11%.
Jan 2009 Approval: Rep- 75%; Ind- 28%; Dem- 6%.
OBAMA
Jan 2009 Approval: Rep- 41%; Ind- 62%; Dem- 88%
March 2009 Approval: Rep-26%; Ind- 59%; Dem- 91%
Oct 2011 Approval: Rep- 11%; Ind- 30%; Dem- 80%
Jan 2017 Approval: Rep- 14%; Ind- 61%; Dem- 95%
I posted this on another thread, but I think it’s very relevant to this issue, only I added Obama’s approval ratings.
The first thing that stands out is the utter lack of approval for Trump by democrats. And rather tepid approval for Trump by independents.
Adding in Obama, Republicans were willing to give Obama a chance with pretty decent approval ratings.
Notice what happened to Obama in Oct 2011. The ACA had been passed, but not implemented yet. Notice independent approval was only 30%, and Republicans were at 11%.
Then look when Obama left office– Independent approval ratings were 61%. Is this because for a majority of Americans, the ACA didn’t have an effect on them (employer health insurance) or Medicaid expansion had helped them. It was the folks on the exchanges that are being hammered. This would explain why a program that had such poor approval ratings when it initially passed had become popular, according to polls.
What is never mentioned in all of this is how much Obamacare has and is going to add to the debt. And by repealing the individual mandate, the cadillac tax and medical device tax how is the Republican plan going to save money? How have they proposed to pay for the AHCA?
It looks to me like the Republicans are between the proverbial rock. Sometmes you just have to do the right thing. I think the reforms are the right thing, but they do need to be paid for. Medicare D was never fully paid for. Medicare A & B aren’t paid for. Medicaid isn’t paid for.
https://www.usnews.com/news/articles/2016-01-25/health-care-programs-contribute-to-increasing-federal-deficit
Here’s an interesting proposal– Universal Catastrophic Coverage, in case the AHCA doesn’t make it into law or possibly instead of AHCA passing.
“Mr. Trump won the presidency in part because of some big promises, including a vow to break from conservative orthodoxy on entitlements. If Congress fails to deliver on that promise, Mr. Trump could correct it by going boldly in a direction anathema to many on the right but potentially acceptable to some Democrats: universal coverage for catastrophic care.
Many Americans’ greatest fear is that their health care costs will bankrupt them. The quality of care we receive is high – I experienced this myself this month after a cardiac incident left me reading the Republican plan in an emergency room – but the expense is opaque, and Americans are not wrong to worry about these costs.
By providing catastrophic care for all, President Trump could ensure that everyone has an ultimate backstop against medical bankruptcy, while freeing the states to experiment with options for reform. It would also enable the private sector to offer new insurance products to supplement the basic catastrophic care coverage.
This idea has some support among conservatives. In 2012 Kip Hagopian and Dana Goldman estimated in National Affairs that to insure all 209 million Americans not already covered by public insurance programs would cost about $2,000 per person, or $7,200 per family per year – about half the projected $1.7 trillion cost of Obamacare over the coming decade. Individuals and families could then purchase additional coverage given their particular health needs, but would not be bankrupted by severe illness or accident.”
https://www.nytimes.com/2017/03/21/opinion/how-trump-can-fix-health-care.html
Small is beautiful, keep it simple stupid. From my POV medical care is not a right unless we add another amendment to the Constitution spelling out exactly what the general welfare clause means in great detail. IMO anyone who can not pay for catastrophic insurance should be covered as each sovereign state so determines. Yes, I know DC will never stop meddling, but a guy can dream.
donating everything after one person dies is the most pretentious form of virtue signaling ever, of course giving up things when you no longer have a need for it is easy. I don’t mind giving up everything i own when I die either. How about giving up every dollar he has like now, right now. Virtue is bs without scarification, and giving up material belongings only after you die is no scarification, just a absurd pretense to earn praise now without giving up anything really.
The simplest way for the liberals to push their agenda is to invite a few refugees to live with them in their mansions, easy to do while being the simplest way to slap Trump in the face. Surprising to me not even one liberal in Hollywood is willing to do just that. When Trump was asked to fly that boy with a rare disease who needed a plane with dedicated medical equipment to NY from LA even if it was for show Trump generously offered to help immediately, and ironically not even one liberal is willing to take in one refugee, even just for show.
Dave Says:
>just repeal the whole darn thing, who cares about the few millions who will lose insurance, they probably voted for Hillary anyway.<
Cancer does not distinguish between Republicans of Democrats. It matters if people lose their insurance. It should matter to you.
Dave
>The simplest way for the liberals to push their agenda is to invite a few refugees to live with them in their mansions<
Do you oppose abortion? Are you willing to adopt some children into your home? Why not? You must not be serious about your opposition to abortion…. Do you see how that argument doesn't make sense? Either does yours.
And note Trump paying for a boy to fly for care is very different than asking refugees to live in your home. The equivalent would be if Trump let the boy live in his home – with him. Would he do that? I doubt it. Try to make comparisons that make sense. Plenty of 'liberals' pay into charities that help children.
Montage,
Abortion = illegal aliens. Wow, how clever. Killing unborn babies is now equivalent to ignoring, and deamed nobel to throwing all immigration laws into the gutter? What part of illegal do you not understand? If you want to live in a land where there are no laws, more power to you. But do not attempt to enter uninvited my home. You will have a marco aggression shortened life span measured in micro secends.
Becareful what you wish for.
I have finally realized that liberals supported ACA bc most liberals simply did not know that there was a thing called medicaid that was already covering most low-incoming families. They had this ridiculous belief that there are poor unfortunate people dying of lack medical treatments in the streets everyday because they have no insurance. Believing the stupid lies from the MSM, most liberals did not know that low income people were already receiving world class medical treatments in the form of Medicaid, no one had ever died of cancer because they couldn’t afford the treatments, no one. My addict uncle, who lives in Arizona, a registered sex offender as well, gets all of his medical treatments free. he gets food stamps, live on unemployment benefits like every 6 months (a professional mechanic by trade, he would get on unemployment for six months, work for six months, then find ways to get fired and get unemployment again for six months, vice versa…) He got his tooth implants free, he was diagnosed of GERD and got a scope free. Every time he has a medical problem he goes to the ER and get it fixed FREE. I know it because I drove him there a few time. Poor people needs no insurance stupid liberals, by law they are entitled to emergency treatments, they are entitled to medical treatments through safety net systems like the medicaid, even in the event of a bankruptcy they have absolutely no properties that they need to be afraid of being taken away. The middle class is the only people who need insurance and they are the ones being most negatively affected by ACA, thanks Obama for trying to help those who never needed any helps and ruined those who needed helps the most.
let me continue, a family friend, in her 40s, may be 50s by now who is diabetic, used to have a great insurance that covers everything through work. She was working in a casino, good paid, good benefits too. After the implementation of ACA, she got laid off because now everyone working in the casino needed to be covered and downsizing was the inevitable result. She is now out of the labor force, she doesn’t need to work because her son is an engineer and can support her, but being out of the labor force is not by her choice, she would rather be working. She now buys a crappy obamacare coverage from the exchange with like a $10,000 deductible and like a $50 copay. before ACA, she had a good job and a premium insurance; after ACA, she has no job and a crappy insurance, explain to me how exactly is ACA beneficial to anyone?
BIG negotiations usually go down to the wire.
It’s a requirement for the rival camps to appear as strong as possible.
As a master negotiator… don’t bet against Trump.
The trouble with the AHCA is that, like the ACA, very very few of us know much about what is in it. What does it actually specify?
Accordingly, we have little rational basis for opinions on it. Being the GOP plan that will replace the Obamacare plan is really not enough for an endorsement or approval.
One of the big issues is Medicaid, which creates a giant sucking sound on state and Federal monies. 85% of the lamented previously uninsured got “insured” by Medicaid under Obamacare, and their “insurance” will continue to be provided, with continued additional enrollment, until 2020. We of course pay the premiums.
ACHA requires coverage of pre-existing conditions, but does away with the insane one-price-fits-all “community rating” of Obamacare, so that folks at higher risk will get charged higher premiums, and those of lower risk lower premiums, just like auto insurance! And there is a 30 % surcharge on policies issued to people uncovered for >63 days. Which is not small.
This really is all a game about covering the Medicaid population, whether a GOP plan or a Dem plan, which fortunately excludes most Americans. And extending coverage to individuals seeking individual coverage instead of group coverage; in the latter pre-existing conditions are allowed at no premium increase to the individual.
So in our fervor to take care of all, we continue to move to a two-tiered (actually, three-tiered when Medicare is included) system. There will be more Medicaid mills, providing (!) poor, even abysmal “care” of the uninformed. Medicare mills are also developing as fewer docs tolerate high-handed unilateral and arbitrary Medicare regulations.. At a “Center for the Aged” my aged (90) stepfather’s care in leftist Washington State is by a NP; he never sees a real doc.
As an MD, I do not believe healthcare is a right, just like I do not believe it is a woman’s right to arrange for the murder of her unborn child.
I do believe it is my responsibility as a doc to care for the afflicted, and the many non-profit hospitals should do the same, with care greater than that of Medicaid mills. For that, malpractice litigation reform is essential. Death to trial lawyers! They are enormous contributors to the Democratic Party.
Insurance premiums went up significantly in some markets from 2016 to 2017. I assume some/much of this is due to insurance companies adjusting for the reality of the market versus projections of enrollees. Also, I think, the subsidy that the government gave to insurance companies to cover these discrepancies ended.
A 50% increase seems to be typical, but some states the increases were below 10% while Phoenix was an astounding 147%, followed by Birmingham at 71%.
The chart I’m looking at is the premium for a silver plan by a 40 year old non-smoker making $30,000.
What I don’t understand, is why the same un-subsidized plan costs $492/mo in Birmingham, $286/mo in Atlanta, $572/mo in Charlotte, $419/mo in Nashville, but only $229/mo in Louisville. The disparity can’t be because people are healthier in Nashville, or the cost of living is lower since in Boston it only costs $247/mo. These rates must be because the medical charges are just lower in Louisville. If that’s the case, why do doctors and hospitals charge less in Louisville than Charlotte?
If the AHCA does change the law to allow insurance companies to sell policies across state lines, all that will happen is these premiums will just be averaged– so the premiums in Charlotte will come down some, while the premiums in Louisville will go up.
I don’t think the AHCA is going to have much effect if this proposal (eliminating state lines) were to be enacted, and it is going to take a monumental change in law for that to happen.
Now the AHCA will lower costs to the federal government since the subsidized cost to this imaginary person living in any of these cities is the same (well almost) as his cost is $208/mo. Since the tax credit in the AHCA is based on earnings, not medical costs, some people with pay the same while some premiums will cost the individual more– assuming the medical costs to the insurance company remain the same.
http://kff.org/health-reform/issue-brief/2017-premium-changes-and-insurer-participation-in-the-affordable-care-acts-health-insurance-marketplaces/
I’m going to agree with Big Maq, who has been critical of Trump on his handling of the Health Insurance bill.
At the outset, Trump should have said something to the effect:
“I campaigned on the promise that we would fix the horrible problems plaguing Obamacare, horrible problems that are only going to get worse. But I also promised that we would make coverage better for every American. I realize that many conservatives don’t agree with this position. They are interested in making government smaller, less intrusive and in may areas, I agree with them. But not with healthcare. It’s too important for too many Americans, and we have to find common ground to repeal the horrible parts of Obamacare, but at the same time, make great coverage possible for every American.”
As I alluded to, the polling indicates that from the passage of the ACA in 2010, there has been a significant shift in attitudes about the program, as many Americans found out it made coverage more affordable. I’m afraid that’s true among some Republicans and most Independents.
In this case the conservatives are holding a losing hand.
parker
> Abortion = illegal aliens.
Yeah, I never wrote that. Not even close — not least because I was writing about refugees not illegals. I’m not making a literal comparison. What I made was an argumentative comparison with regards to a claim made by Dave who wrote that “the simplest way for liberals to push their agenda is to invite a few refugees to live with them in their mansions.” I am saying that is absurd and similar to saying “if you oppose abortion then you should adopt children who would normally be aborted otherwise you are not serious.” The point being that taking a political position — whether it is about refugees or abortion — should not mean you have to make a personal sacrifice in order to have an opinion on the matter. Plenty of people have no problem with refugees on principle but that opinion is not undermined by not inviting them to come to your home. Similarly, plenty of people are opposed to abortion on principle [or on religious, scientific & ethical grounds] but just because they don’t want to adopt unwanted babies does not mean their opinion is not serious.