Senate Republicans finally reveal godforsaken healthcare bill

[SueEllenRules!]

The Better Care Reconciliation Act: the Senate bill to repeal and replace Obamacare, explained
Senate Republicans on Thursday revealed the Better Care Reconciliation Act, their plan to repeal and replace the Affordable Care Act.

The bill asks low- and middle-income Americans to spend significantly more for less coverage.

The bill would roll back the Affordable Care Act’s expansion of the Medicaid program, which currently covers millions of low-income Americans, and include additional cuts to Medicaid. It would rework the individual market so that enrollees get less financial help to purchase less generous health insurance with higher deductibles.

Here is how the Senate bill works:

• The Senate bill begins to phase out the Medicaid expansion in 2021 — and cuts the rest of the program’s budget too. The Senate bill would end the Affordable Care Act’s expansion of Medicaid to millions of low-income Americans. This program has provided coverage to more Americans than the private marketplaces.
• It would also cut the rest of the public insurance program. Better Care would also limit government spending on the rest of the Medicaid program, giving states a set amount to spend per person rather than the insurance program’s currently open-ended funding commitment.
• The Senate bill provides smaller subsidies for less generous health insurance plans with higher deductibles. The Affordable Care Act provides government help to anyone who earns less than 400 percent of the federal poverty line ($47,550 for an individual or $97,200 for a family of four). The people who earn the least get the most help. The Senate bill would make those subsidies much smaller for many people, and only provide the money to those earning less than 350 percent of the poverty line ($41,580 for individuals and $85,050 for a family of four). The Senate bill will tether the size of its tax credits to what it takes to purchase a skimpier health insurance plan than the type of plans Affordable Care Act subsidies were meant to buy. Essentially, these tax credits buy less health insurance.
• The Senate bill seems to allow states to opt out of Obamacare’s marketplaces and essential health benefits requirement. A new waiver process would allow states to overhaul their insurance markets, including ending the essential health benefit requirement and specific subsidies that benefit low income Americans, so long as those changes do not increase the deficit.
• The Senate bill repeals the individual mandate — and replaces it with nothing. The bill gets rid of the Affordable Care Act’s unpopular requirement that nearly all Americans carry health coverage or pay a fine. This could cause significant disruption in the individual market because it takes away a key incentive healthy people have to buy coverage, meaning only sick people may sign up.
• The bill would cut taxes for the wealthy. Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The AHCA would get rid of those taxes. Obamacare was one of the biggest redistributions of wealth from the rich to the poor; the AHCA would reverse that.
• The Senate bill defunds Planned Parenthood for one year. This would mean Medicaid patients could no longer seek treatment at Planned Parenthood clinics. Experts expect this would result in low-income Americans getting less medical care and having more unintended pregnancies, as access to contraceptives would decline.
• All in all, the replacement plan benefits people who are healthy and high-income, and disadvantages those who are sicker and lower-income. The replacement plan would make several changes to what health insurers can charge enrollees who purchase insurance on the individual market, as well as changing what benefits their plans must cover. In aggregate, these changes could be advantageous to younger and healthier enrollees who want skimpier (and cheaper) benefit packages. But they could be costly for older and sicker Obamacare enrollees who rely on the law’s current requirements, and would be asked to pay more for less generous coverage.

The Senate bill will end Medicaid expansion in 2021 — and cut the rest of the program too

One of the main ways Obamacare increased insurance coverage was by expanding the Medicaid program to cover millions more low-income Americans. Prior to the health law, the entitlement was restricted to specific groups of low-income Americans (pregnant women, for example, and the blind and disabled).

Obamacare opened up the program to anyone below 138 percent of the poverty line (about $15,000 for an individual) in the 31 states (plus the District of Columbia) that opted to participate.

The Medicaid expansion gave states generous funding to cover this particular population. Typically, the federal government picks up about half the cost of the Medicaid program and states cover the rest.

For Medicaid expansion, however, the federal government currently pays 95 percent of the costs — an especially good deal for states meant to assuage their budget concerns during the original Obamacare debate.

The Senate bill would begin ratcheting down that Medicaid expansion funding in 2021. By 2024, states would get that same match rate they typically get to cover other populations. In 2021, for example, the match rate would fall to 90 percent, then decline in steps to 75 percent by 2023.

The Congressional Budget Office has projected in a separate analysis that this policy change would mean no additional states expand Medicaid — and that some current expansion states would drop out of the program, resulting in millions losing coverage.

“CBO anticipates some states that have already expanded their Medicaid programs would no longer offer that coverage,” the agency wrote in its analysis of the House bill, which makes a similar change.

The Senate bill would cut the rest of the Medicaid program too

There are significant changes to Medicaid in the Senate bill outside of the expansion too. This bill would convert Medicaid to a “per capita cap” system, where states would get a lump sum from the federal government for each enrollee. Or states would have the opportunity of a block grant — a sum of money untethered from the number of people involved.

This is very different from current Medicaid funding. Right now the federal government has an open-ended commitment to paying all of a Medicaid enrollee’s bills, regardless of how high they go.

The Senate bill would set different amounts for different groups of people. It envisions, for example, likely higher payments to cover Medicaid enrollees who are disabled (and tend to have higher costs) than Medicaid enrollees who are kids (generally healthy with lower costs).

The rate at which these payments grow is also important. The Senate bill would have the funding growth tethered to the Medical Consumer Price Index plus 1 percentage point through 2025, and then switch to the urban Consumer Price Index. Analysis of this type of proposal suggests this change would amount to funding cuts for Medicaid, as the program’s spending typically goes up faster than these growth rates.

We do not know exactly how much this bill would cut the Medicaid program because we are still waiting on an analysis from the CBO, which is expected to be released early next week.

The Senate bill would cut the subsidies for people on the individual market

The Affordable Care Act provides financial help to low- and middle-income Americans who purchase their own health coverage. It provides subsidies to people who earn less than 400 percent of the federal poverty line ($47,550 for an individual or $97,200 for a family of four) and gives the most generous help to people who earn the least.

For example: People who earn $17,000 are only expected to spend 3 percent of their income on premiums for a midlevel insurance plan — the government will kick in the rest. People who earn $40,000, however, are expected to spend 9.66 percent of their income on those monthly payments.

The Senate bill would overhaul these tax credits. It would make fewer people eligible for the help, limiting the subsidies to people who earn less than 350 percent of the poverty line ($41,580 for individuals and $85,050 for a family of four).

It would also allow people who earn less than the poverty line to qualify for tax credits; the Affordable Care Act makes those people ineligible for the subsidies because they were expected to receive coverage through the Medicaid expansion.

This became problematic, however, when the Supreme Court ruled that the Medicaid expansion had to be optional and 19 states decided not to adopt it. So this change would be an improvement for low-income Americans who live in places like Texas and Florida, which did not expand the program. They currently have access to no subsidies under the Affordable Care Act.

It would also change the definition of what counts as “affordable” health insurance to amount for a greater chunk of Obamacare enrollees’ income. Right now the Affordable Care Act counts health insurance as “affordable” if it costs less than 9.7 percent of an individual’s income (and a lower amount for lower-income Americans).

The Senate bill would raise the amount individuals are expected to kick into their health plans for people who are low to middle income. A 60-year-old who earns $35,640 (300 percent of the poverty line) would be expected to spend 16.2 percent of her income ($5,773) before she gets any help from the government.

Under the Affordable Care Act, she would only be expected to spend $3,442.

The Senate would subsidize less generous insurance. Under the health care law, the size of the tax credit is tethered to how much it costs to buy a midlevel health plan. The Affordable Care Act defines “midlevel” as a plan that, on average, covers 70 percent of enrollees’ costs. In insurance terms, this number is known as the “actuarial value,” and it’s used to give a sense of how much the typical enrollee pays out of pocket for coverage.

The Senate bill would tether its tax credits to less generous health insurance. Specifically, it would provide subsidies that make a plan with a 58 percent actuarial value (meaning, on average, it covers 58 percent of enrollees’ costs) affordable.

This means that the plans people could afford under the Senate bill would likely have more copays and higher deductibles as a way to bump up the amount enrollees have to chip in for their own coverage. Someone who has earnings right around the poverty line (about $12,000) would still be expected to spend 2 percent of her income on premiums. But in return, she’d get a health plan that covers less than what she gets under the Affordable Care Act.

The Senate bill would also bar Americans from using their tax credits to purchase a health plan that covers abortion. This requirement would take effect immediately, while other changes would not phase in until 2020.

The Senate bill allows states to opt-out of big Obamacare provisions, like the requirement to cover essential health benefits, through a re-vamped waiver process

The Senate bill overhauls a section of the Affordable Care Act that allows states to experiment with different ways to provide health insurance coverage. Under current law, states are allowed to propose different ways to deliver health insurance so long as the new plans “provide coverage that is at least as comprehensive as the coverage” defined under the ACA” and “cover at least a comparable number of residents.” In other words: as long as states can cover the same number of people with a similar plan, they’re allowed to experiment with things such as single-payer health care.

The Senate bill would allow states to seek waiver from key Obamacare requirements, things like the essential health benefits package, which requires health plans to cover key services like maternity care and prescription drugs. But the Senate bill would not require these new plans to cover as many people or provide comparable plans. It eliminates those requirements, and says states can get waivers as long as they don’t increase the deficit.

Under these requirements, a state could ask for a waiver to allow insurers to longer cover things like maternity care or mental health services — two things that individual plans often left out before the Affordable Care Act mandates. They would not be bound by the current Affordable Care Act requirement that coverage under these waivers be just as generous as the standard plans.

The Senate bill eliminates the individual mandate, doesn’t penalize those with breaks in coverage

One of the Affordable Care Act’s least popular provisions was the requirement that nearly all Americans carry health insurance coverage or pay a fine. The reason this mandate existed was to convince healthy people to buy health insurance, which would hold down premiums for everyone else.

The Senate would eliminate the individual mandate by setting the penalty for not carrying health insurance to zero dollars. They can’t completely wipe it off the books due to the complex rules of the budget reconciliation process, but this would have the same effect.

The Senate bill does not have any replacement policy for the individual mandate, any negative financial consequence for skipping out on health insurance. This is different from the House bill, which had a requirement that Americans keep “continuous coverage” or else face higher premiums when they reenter the market.

The Senate bill still requires insurance companies to accept all patients, regardless of how sick they might be or what preexisting conditions they have. Building a health insurance system without an individual mandate or any replacement policy runs a significant risk of falling into a death spiral, where only the sickest people buy coverage and premiums keep ticking upward.

The Senate bill repeals a long list of Obamacare taxes

The Senate bill will eliminate many of the taxes that financed the Affordable Care Act’s insurance expansion. It includes the repeal of:

• A tax on investment income
• A tax on the wealthy to finance the Medicare program
• A tax on tanning salons
• A tax on the health insurance industry
• A tax on the medical device industry

Many of these tax changes would, as my colleagues have previously written, disproportionately benefit high-income Americans.

“The typical American, in short, isn’t going to see any money from these tax cuts,” Matt Yglesias has written. “But when you take all that money out of the system, something has to give. And in the case of the various iterations of Affordable Care Act repeal, the thing that gives is the quality of health insurance provided to Americans with below-average incomes or above-average health needs.”

The Better Care Reconciliation Act: the Senate bill to repeal and replace Obamacare, explained - Vox
https://apple.news/A9sSB-IViTri-y-hfTxosWg

 

[Frank Underwood]

So basically it's a windfall for the rich, and a giant middle finger to the poor.

 

[Frank Underwood]

Bernie Responds to Republicans' Health Care Bill:

 

[Snarky Oracle!]

 

[SueEllenRules!]

CBO analysis of Senate GOP health bill: 22 million more uninsured by 2026
It’s a small decrease from its estimate of the House plan.

• Senate Republicans’ bill to erase major parts of the Affordable Care Act would cause an estimated 22 million more Americans to be uninsured by the end of the coming decade, while reducing federal spending by $321 billion during that time, according to the Congressional Budget Office.
• The forecast issued Monday by Congress’s nonpartisan budget scorekeepers appeared to rapidly erode Republicans’ confidence in the bill, with at least four GOP lawmakers saying by late Monday that they would vote against even starting debate on it.
• By evening, several senators and aides appeared nervous and unsure about the path forward. They hedged on the timing of that procedural vote and suggested the workweek could stretch beyond Friday. Still, there was some hope for salvaging the effort, and GOP leaders were still looking for ways to make last-minute bill changes that might garner crucial support.
• But the breadth of the resistance highlighted Majority Leader Mitch McConnell’s increasingly difficult challenge.
• The projection of uninsured numbers and federal spending had been awaited as a crucial piece of evidence while McConnell (Ky.) and other Republican leaders try to hurry a vote on the bill this week. They already were navigating an expanding minefield of criticism from their party’s moderate and conservative wings.
• The release of the 49-page CBO report late Monday afternoon seemed to worsen the bill’s prospects. No new senators immediately said they would back the legislation, and Sens. Susan Collins (Maine), Rand Paul (Ky.) and Ron Johnson (Wis.) signaled that they would vote against starting debate Tuesday on the bill in its current form. A fourth senator, Dean Heller (R-Nev.), had expressed his opposition last week.
• Collins, a moderate Republican, tweeted that the measure would “hurt [the] most vulnerable Americans” and failed to solve the problems of access to care in rural Maine where, she wrote, “hospitals are already struggling.”
• The Senate bill could undergo further changes before such a vote is scheduled, which could prompt these senators to reconsider. But if the Democrats vote as a bloc, McConnell can afford to lose no more than two Republicans for a procedural motion to succeed.
• Asked whether McConnell and other Senate leaders had amassed enough support to pass the measure, Sen. Roy Blunt (R-Mo.) responded, “Anyone would tell you they don’t.”
• The CBO estimated that two-thirds of the drop in health coverage a decade from now would fall on low-income people who rely on Medicaid. And among the millions now buying private health plans through ACA marketplaces, the biggest losers would roughly parallel those under legislation passed recently by the House: The sharpest spike in insurance premiums would fall on middle-aged and somewhat older Americans.
• Its analysis of the Senate measure’s impact on federal spending — $321 billion over a decade — compared with $119 billion for the House’s version.
• Paul labeled the Better Care Reconciliation Act “a terrible bill” and repeated his contention that it would not go far enough in repealing the sprawling health-care law enacted seven years ago by a Democratic Congress and president.
• McConnell took to the Senate floor just before the report’s release to press anew for rapid action. He made it clear that the bill, already tweaked early Monday, could be negotiated further to try to win over holdouts.
• “The American people need better care right now,” McConnell said. “This legislation includes the necessary tools to provide it.”
• Democrats quickly seized on the CBO’s projection of how much the ranks of the uninsured would grow.
• “Republicans would be wise to read it as a giant stop sign,” Senate Minority Leader Charles E. Schumer (D-NY) told reporters. “No matter how the bill changes around the edges, it is fundamentally rotten at the center.”
• Former CBO director Doug Holtz-Eakin, a Republican who is now president of the American Action Forum, said the report draws basically the same conclusions as the budget office’s earlier analysis of the House measure. He predicted that GOP senators are “going to get beaten on the head with the CBO report like it’s a club.”
• The fresh figures come as President Trump, in a sharp pivot from the praise he initially lavished on the House bill, has been urging the Senate to provide Americans more generous help with health insurance. On Sunday, the president repeated during a “Fox and Friends” TV appearance a word he had used in a private White House lunch with a group of GOP senators earlier this month: that the House’s version is “mean.”
• On Monday, the White House again sought to cast doubt on the budget office’s credibility. “The CBO has consistently proven it cannot accurately predict how healthcare legislation will impact insurance coverage,” it said in a statement. “This history of inaccuracy, as demonstrated by its flawed report on coverage, premiums, and predicted deficit arising out of Obamacare, reminds us that its analysis must not be trusted blindly.”
• According to the latest report, the Senate bill would mean that an estimated 15 million fewer Americans would have coverage next year, compared with the number if the ACA, commonly called Obamacare, remained in place. At the end of the decade, the 22 million increase in the ranks of the uninsured would include 15 million low-income Americans who would otherwise be on Medicaid and 7 million with private insurance.
• The Senate plan would reduce federal spending to help people afford premiums for individual health insurance policies significantly more than under the House version. The Senate’s version would cut spending on tax credits by $408 billion by 2026 — compared with a $276 billion reduction in the House plan. The difference lies, in part, because the Senate’s version would not permit people with incomes as high to qualify for tax credits and would restrict federal help to health plans sold through the ACA’s marketplaces. The Senate would tie the tax credits to skimpier health plans than the current subsidies.
• And while the Senate bill would phase out the ACA’s Medicaid expansion more slowly than the House legislation, cuts to the public insurance program for the poor still would account for by far the largest share of the reduction in federal spending under the Senate bill — $772 billion over the coming decade. In a briefing for reporters, CBO staff members said that they had not analyzed the bill’s effects on Medicaid cuts beyond the coming decade but that the reductions inevitably would be greater for a second decade.
• While they differ in important details, both the Senate GOP’s plan and the American Health Care Act narrowly passed by House Republicans in May share the goal of undoing central aspects of the ACA.
• Both bills would eliminate enforcement of the law’s mandate that most Americans carry health insurance, relying on subtler deterrents to keep people from dropping coverage. The House version would let insurers temporarily charge higher rates to those who let their coverage lapse, while the Senate added a provision Monday that would let health plans freeze out customers for six months if they let it lapse.
• In different ways, both would replace federal subsidies that help the vast majority of consumers buying coverage through ACA marketplaces, instead creating smaller tax credits that would provide greater assistance to younger adults while making insurance more expensive for people from middle age into their 60s.
• After two years, both also would end subsidies that now help about 7 million lower-income people with ACA health plans afford deductibles and copays. And both would repeal an array of taxes that have helped to pay for the ACA’s benefits, including levies on health insurers and on wealthy Americans’ investment income.
• For the Senate bill, the CBO’s estimates of insurance coverage and federal spending are influenced by the fact that its forecast covers a 10-year window and the legislation’s most profound changes for the nation’s health-care system are tilted toward the latter part of that period.
• The bill would, for instance, leave in place the ACA’s expansion of Medicaid through 2020. After that, it would begin a three-year phaseout of the federal money that under the ACA has paid almost the entire cost of adding 11 million Americans to the program’s rolls in 31 states.
• That means the extra funding wouldn’t disappear until the mid-2020s — roughly when sharp new restrictions on federal payments for the entire Medicaid program would take effect.
• Over the weekend, the senior Democrat on the Senate subcommittee that oversees the CBO said in a tweet that he had asked the budget office to estimate the Senate bill’s effect on insurance coverage over a longer time horizon. “GOP is hiding the worst Medicaid cuts in years 11, 12, 13 and hoping CBO stays quiet,” Sen. Chris Murphy (D-Conn.) wrote.

CBO: Senate GOP health-care bill would leave 22 million more people uninsured by 2026 - The Washington Post
https://apple.news/AxgHVtJbgQ7GAH8PB5wo2Lw

 

[SueEllenRules!]

American Medical Association Slams Senate GOP Health Care Bill
"We sincerely hope that the Senate will take this opportunity to change the course of the current debate," the doctors' group says.

• The American Medical Association, the nation’s largest doctors’ group, opposes the Senate health care bill, the organization announced in a letter to Senate leaders Monday.
• “Medicine has long operated under the precept of Primum non nocere , or ‘first, do no harm.’ The draft legislation violates that standard on many levels,” American Medical Association CEO James Madara wrote to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Chuck Schumer (D-N.Y.).
• The American Medical Association is the latest health care sector group to express opposition to, or at least serious concerns with, the Senate bill, known as the Better Care Reconciliation Act. McConnell unveiled the bill Thursday and aims to bring it to the Senate floor for a final vote as soon as this week. With 52 Republicans in the Senate, McConnell can only lose two GOP votes if he wants to get the 50 needed to advance the bill. Five Republican senators, however, are already on record against it.
• The physicians’ lobbying organization cites numerous problems with the Senate GOP bill, starting with its likely effect of causing many millions of currently insured Americans to lose their health coverage and be unable to afford medical treatments.
• “It seems highly likely that a combination of smaller subsidies resulting from lower benchmarks and the increased likelihood of waivers of important protections such as required benefits, actuarial value standards, and out of pocket spending limits will expose low and middle income patients to higher costs and greater difficulty in affording care,” the AMA’s letter says.
• The group also takes issue with the legislation’s deep cuts to federal Medicaid spending.
• “The Senate proposal to artificially limit the growth of Medicaid expenditures below even the rate of medical inflation threatens to limit states’ ability to address the health care needs of their most vulnerable citizens,” the letter says.
• The legislation would make tax credits for private health insurance created by the Affordable Care Act available to fewer people, reduce their value and tie them to plans that have larger deductibles and higher out-of-pocket costs than the policies sold under Affordable Care Act rules.
• The bill also would permit states to make sweeping changes to insurance market rules, which would allow insurers to offer very skimpy plans that don’t come with a basic set of guaranteed benefits and that could exclude treatments and medicines for people with high-cost ailments.
• Although insurers would still be forbidden to reject customers with pre-existing conditions or charge them higher rates ― as is the case under the Affordable Care Act ― relaxing the benefit rules and introducing plans that require patients to pay more out-of-pocket would make the coverage less valuable, especially to people with pre-existing conditions.
• The Senate bill would undo the Affordable Care Act’s expansion of Medicaid and end the current open-ended federal commitment to pay more than half the expense of covering any eligible Medicaid enrollee. Instead, federal Medicaid funding would be capped at a flat amount per person or a flat amount per state, based on a state’s preference, that would grow more slowly than current Medicaid spending and more slowly than rising health care costs overall.
• The Congressional Budget Office analysis of the Senate bill is scheduled to be released Monday. The CBO earlier concluded that the House-passed American Health Care Act, which is similar to the Senate measure, would lead to 23 million fewer people having health coverage over the next 10 years.
• “We sincerely hope that the Senate will take this opportunity to change the course of the current debate and work to fix problems with the current system. We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect, and we renew our commitment to work with you in that endeavor,” the AMA’s letter concludes.
• Also on Monday, the National Association of Medicaid Directors, which represents the state officials who oversee the program, rejected the Medicaid components of the Senate bill.
• The legislation would give states greater leeway to decide who is eligible for Medicaid and what benefits the program must cover, but these regulators argue that flexibility doesn’t make up for the much lower funding amounts. Several governors have expressed similar concerns.
• “No amount of administrative or regulatory flexibility can compensate for the federal spending reductions that would occur as a result of this bill,” the Medicaid officials said in a statement.
• “Changes in the federal responsibility for financing the program must be accompanied by clearly articulated statutory changes to Medicaid to enable states to operate effectively under a cap,” they went on. “The Senate bill does not accomplish that. It would be a transfer of risk, responsibility, and cost to the states of historic proportions.”
• The National Governors Association, which represents state chief executives from both parties, also weighed in on the Senate bill Monday, urging McConnell to slow down.
• “Governors must be given adequate time to determine the impact any health care bill will have on their states and residents, and ensure that the bill does not adversely harm the people we were elected to serve,” Virginia Gov. Terry McAuliffe (D) and Massachusetts Gov. Charlie Baker (R) wrote to McConnell on behalf of all 50 governors. “We urge you to give states sufficient time to review the legislation before proceeding, so that the full impact of the legislation may be understood and explained to the American people.”
• Numerous other health care groups also have misgivings or are outright opposed to passage of the Senate health care bill. They include:

--The American Academy of Family Physicians

--The American Academy of Pediatrics

--The American Hospital Association

--The Federation of American Hospitals

--The Children’s Hospital Association

--America’s Essential Hospitals

--The Catholic Health Association of the United States

--The American Cancer Society Action Network

--The American Lung Association
AARP

American Medical Association Slams Senate GOP Health Care Bill - HuffPost
https://apple.news/ApGroAjO2RWaZRT0rh7yJ2w

 

[SueEllenRules!]

Medicaid cuts in the Senate healthcare bill could be brutal for people living in nursing homes
The cut in Medicaid funding could have devastating consequences for those living in nursing homes.

• Medicaid covers health care expenses of 74 million low-income Americans, including nursing home care for those who can't afford it.
• Medicare, a program that covers medical expenses for Americans over 65 does not cover nursing homes.
• The New York Times reports that 42% of Medicaid spending goes to services like nursing home care. Cutting spending in the program would hit the elderly, or put pressure on nursing home operators to cut back.
• Republicans in Congress are eager to make cuts to government spending on health insurance plans for low-income people. On June 22, Senate Republicans released their version of a plan to repeal and replace Obamacare. The plan, like one passed by the House of Representatives, rolls back many of the provisions of Obamacare, including taking deep cuts from Medicaid - the federal program that covers medical expenses for low-income Americans.
• That rollback in Medicaid funding could particularly hit one unexpected group of people: elderly people living in nursing homes. Even though elderly Americans get medical coverage from Medicare - that program doesn't cover long-term stays in nursing homes. For the most part, people pay out of pocket for nursing homes. Once that gets depleted, residents start to qualify for Medicaid to cover their stay.
• Medicaid covers more than 74 million Americans, including low-income people, families, and kids, as well as pregnant women, people with disabilities, and the elderly. The New York Times detailed the impact of Medicaid cuts on nursing home care in a story this weekend, and reports that - even though they only make up 6% of all Medicaid enrollees - those who use long-term services like nursing homes account for about 42% of total Medicaid spending.
• Cuts to Medicaid spending could put those services on the chopping block.
• "Moms and kids aren't where the money is," Damon Terzaghi, senior director at the National Association of States United for Aging and Disabilities told The Times. "If you're going to cut that much money out, it's going to be coming from older people and people with disabilities."
• Under the Senate's bill, titled the Better Care Reconciliation Act, the Medicaid expansion that took place under the Affordable Care Act (or Obamacare) would be phased out. In other words, those who gained coverage through the expansion would be without once again, though they could access coverage through the individual insurance market.
• The bill also scales back federal funding for Medicaid - which is more than half the spending for the program at the state level. That would leave states - which also fund the program - with fewer resources.
• By law, state Medicaid programs have to cover nursing homes. If those states receive less funding from the federal government, it could increase the pressure on the operations of nursing homes, in turn possibly limiting who can qualify for care.

Medicaid cuts in the Senate healthcare bill could be brutal for people living in nursing homes - Business Insider
https://apple.news/A5HyZEd5uT5us1H19k3Ywjw

 

[SueEllenRules!]

The 9 GOP senators who will decide the fate of the Republican healthcare bill
The GOP healthcare bill faces an uncertain future in the Senate this week after its long-anticipated introduction.

• Even though Senate Majority Leader Mitch McConnell wants to vote on the Better Care Reconciliation Act (BCRA) by the end of the week, many Republican senators have not embraced the bill with open arms.
• Some more conservative senators want the bill to go further in its repeal of the Affordable Care Act, or Obamacare, and four members released a statement on Thursday saying they would vote against the bill along those lines.
• Some moderates, on the other hand, think the bill goes too far and want to keep some of the more popular parts of the ACA intact.
• Here are the nine GOP senators likely to shape the fight over the BCRA - and what they might want in terms of changes.

Rand Paul of Kentucky

• What he's said: Paul was among the four senators that came out publicly against the BCRA on Thursday, arguing that it did not deliver on its promise to repeal Obamacare. "The current bill does not repeal Obamacare," Paul said in a statement. "It does not keep our promises to the American people. I will oppose it coming to the floor in its current form, but I remain open to negotiations."
• What he wants: Paul wants to roll back much of the regulations set up by the ACA and eliminate much of the funding to provide insurance subsidies. He said during the legislation's drafting of the bill that he doesn't want to create "a new entitlement" by solidifying the tax credits into law under the plan. Basically he wants less of everything: funding, regulation, and taxes.

Susan Collins of Maine

• What she's said: After the release of the bill, Collins' office released a statement suggesting that the senator's decision was still up in the air. "Senator Collins will carefully review the text of the Senate health care bill this week and into the weekend," said the statement. "She has a number of concerns and will be particularly interested in examining the forthcoming CBO analysis on the impact on insurance coverage, the effect on insurance premiums, and the changes in the Medicaid program."
• What she wants: While Collins' state has not expanded Medicaid, the slower growth caps for the program could be enough to push her away from the bill. Additionally, Collins opposes defunding Planned Parenthood, which the Senate bill would do for one year. Collins' term is up in 2020.

Ted Cruz of Texas

• What he's said: Cruz was also one of the four conservatives to come out against the Senate bill. "I want to get to yes, but this first draft doesn't get the job done," Cruz said in his own statement. "Over the next week and beyond, I will continue working to bring Republicans together to honor our promise, repeal Obamacare, and adopt common-sense, consensus reforms that can actually be passed into law."
• What he wants: Cruz had a litany of demands in his statement, including some provisions that would not be admissible in the bill under the budget reconciliation process Republicans are using to try to pass it. What can be included is a full repeal of so-called essential health benefits, which Cruz called for, along with a desire to do more to lower premiums. Cruz is up for reelection in 2018.

Dean Heller of Nevada

• What he's said: Heller faces a tight reelection bid in 2018 in a state that recently passed a bill, which was eventually vetoed by the governor, to expand Medicaid access to everyone in Nevada. He said Friday that he opposes the legislation in its current form.
• What he wants: Heller took issue with the proposed phaseout of the Medicaid expansion and the funding growth-rate formula.

Lisa Murkowski of Alaska

• What she's said: "I will be working closely with the state over the next several days to analyze the text and crunch the numbers," Murkowski said Thursday. "It's no secret that health care needs to be reformed, but it needs to be done right. So know that I remain committed to ensuring that all Alaskans have access to affordable, quality health care and will vet this bill through that lens."
• What she wants: Murkowski also supports continuing the expansion of Medicaid and keeping funding for Planned Parenthood. Additionally, Alaska's premiums are much higher than the rest of the country, so Murkowski may push for more generous tax credits. Murkowski was reelected in 2016.

Mike Lee of Utah

• What he's said: Lee was also one of the four conservatives against the bill on Thursday. "There are provisions in this draft that represent an improvement to our current health care system but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs," the statement said.
• What he wants: Lee wants to see a quicker phaseout of the Medicaid expansion and repeal of various insurance market regulations. Lee was reelected in 2016.

Rob Portman of Ohio

• What he's said: "There are some promising changes to reduce premiums in the individual insurance market, but I continue to have real concerns about the Medicaid policies in this bill, especially those that impact drug treatment at a time when Ohio is facing an opioid epidemic," Portman said in a statement. "I look forward to examining this new proposal carefully and reviewing the analysis by the Congressional Budget Office when it is available."
• What he wants: Ohio was one of the states to expand Medicaid under Obamacare, so a slower phaseout will likely be on his list of asks. Additionally, the bill supplies only $2 billion to combat the opioid crisis, less than the House's legislation. More funds to fight the crisis, one of Portman's core issues in a state hit especially hard by it, could be on his list of proposed alterations. Portman won reelection in 2016.

Shelley Moore Capito of West Virginia

• What she's said: "Over the course of the next several days, I will review the draft legislation released this morning, using several factors to evaluate whether it provides access to affordable health care for West Virginians, including those on the Medicaid expansion and those struggling with drug addiction," Capito said.
• What she wants: West Virginia has a large Medicaid population and expanded the program under the ACA. Capito expressed desire for a seven-year phase out of the expansion. The discussion draft proposes to phase it out over four years. Capito also wants more money to fight the opioid crisis. Capito is up for reelection in 2020.

Ron Johnson of Wisconsin

• What he's said: Johnson was also among the four members who said they would vote against the bill, but told reporters his biggest request for changes was "more information."
• What he wants: A more complete repeal of Obamacare, much like Cruz, Lee, and Paul.

A few more...

• While those nine are the most likely to raise objections, there are few other Republicans who could come into play depending on how the negotiations proceed.
• Some lawmakers in states that expanded Medicaid, like Sens. Jeff Flake of Arizona and Tom Cotton of Arkansas, have so far been noncommittal. Other Republicans like Sen. Pat Toomey of Pennsylvania could raise objections to tax credits.

The 9 GOP senators who will decide the fate of the Republican healthcare bill - Business Insider
https://apple.news/Ab-LiLN4pQFWtJxizfHjdaA

 

[SueEllenRules!]

So Paul, Cruz, Lee, and Johnson may not vote for it because it doesn't suck badly enough.

Collins, Murkowski, Portman, and Capito may not vote for it because they [possibly] have a heart.

And Heller may not vote for it because he's up for re-election next year.

 

[SueEllenRules!]

President Trump Tells GOP Senators It's 'Okay' If Health Care Bill Doesn't Pass
"If we don't get it done, it's just going to be something that we're not going to like. And that's okay."

• President Donald Trump told Senate Republicans meeting at a White House meeting Tuesday that repealing the Affordable Care Act was a chance to benefit the American public, but it would be “okay” if the bill did not ultimately become law.
• “This will be great if we get it done,” said Trump. “And if we don’t get it done, it’s just going to be something that we’re not going to like. And that’s okay, and I understand that very well.”
• Trump did, however, say that the Senate was getting close to passing a bill, and he characterized Obamacare as a “total disaster.” “We have really no choice but to solve this situation,” he said.
• The President had invited the Republican Senators to White House to discuss the bill. Senate Majority Leader Mitch McConnell announced Tuesday that a vote on it would being delayed until after the July 4th recess.
• “We’re gonna continue the discussions within our conference, on the differences that we have and that we continue to try and litigate,” McConnell said in brief remarks to reporters about the decision. As of Tuesday evening, 9 Senators openly oppose the legislation, although three announced their opposition after the vote was officially delayed.
• The non-partisan Congressional Budget Analysis released a report Monday estimating that the legislation would increase the number of uninsured by 22 million within a decade.

President Trump Tells GOP Senators It's 'Okay' If Health Care Bill Doesn't Pass - TIME
https://apple.news/Alsut8zBUTPyQ-UKexIJHaw

 

[SueEllenRules!]

Analysis: GOP Trapped in Health-Care Maze
‘Repeal and replace’ was once a unifier for the GOP. Now it’s an albatross.

• For Republicans, Obamacare was always the great unifier. In a fractious party, everyone agreed that the Affordable Care Act was the wrong solution to what ailed the nation’s health-care system, with too much government and too little freedom for consumers.
• Replacing Obamacare has become the party’s albatross, a sprawling objective still in search of a solution. The effort to make good on a seven-year promise has cost the Trump administration precious months of its first year in office, with tax restructuring backed up somewhere in the legislative pipeline, infrastructure idling somewhere no one can see it and budget deadlines looming.
• Republicans have been here before on health care, on the brink and scratching for votes. The House eventually found a way through this political and substantive maze. Now it’s left to Senate Majority Leader Mitch McConnell (R-Ky.) to find the puzzle pieces and President Trump, perhaps, to supply some muscle, lest the GOP be forced to admit failure on the party’s top legislative priority.
• Was it only Monday that Majority Whip John Cornyn (R-Tex.) boldly declared there would be no turning back this week, that the Senate health-care bill would be put to a vote before lawmakers leave for the July 4 recess? “I am closing the door,” he tweeted. “We need to do it this week.” So much for that.
• If it was a bluff by the leaders, other Republican senators called it. McConnell, a shrewd legislative poker player, quickly folded Tuesday. Instead of moving forward, the bill is now on ice. The original Senate leadership plan called for negotiations in secret by a small group, springing the results on the other members and forcing a quick vote before outside opponents could mobilize. Instead, the calculation that time was of the essence crashed into the reality of vote counting. The new calculus is that delay is better than defeat.
• But will more time help to melt away the opposition? It did in the House, after the sudden and spectacular collapse of the leadership’s bill hours before a scheduled vote in late March. By early May, after weeks of negotiations between Freedom Caucus conservatives and members of the less-conservative Tuesday Group, the House approved a bill. The president was so hungry for even a partial victory that he held a ceremony of celebration with House members in the Rose Garden. Later, he privately and then publicly called that House bill “mean,” and it was left to the Senate to make amends.
• In a worst-of-all-worlds environment, Republicans continue to struggle with what they’re selling, beyond the stated goal of repealing or revising the Affordable Care Act. Whatever overarching arguments they hope to make on behalf of their legislation have been lost in a welter of competing claims and demands among senators with different priorities and dissimilar ideological viewpoints.
• The Republicans’ major selling point is that Obamacare is collapsing. Even Democrats acknowledge weaknesses with the current law, though some Democrats have accused Trump and Republicans of deliberately trying to make those problems worse. McConnell said Tuesday that a Republican solution will be superior to the status quo. Exactly how, Senate Republicans haven’t been able to say. But in terms of corralling the votes, McConnell should not be underestimated.
• On Monday, the Congressional Budget Office (CBO) put a dagger in the Senate GOP’s efforts. The CBO analysis said the Senate bill would result in 22 million more Americans without health care than under current law, just 1 million fewer than the House bill. Reductions in Medicaid spending pose another obstacle, particularly to GOP senators from states that expanded Medicaid under Obamacare.
• The CBO report wasn’t all bad news for the senators. The Senate bill would save significantly more money than the House bill, giving McConnell and company funds to use to ease the opposition of some senators. But money alone won’t resolve all the differences, particularly among those who want to see the Affordable Care Act largely dismantled. It will be a tedious, though not impossible, process to find the votes.
• McConnell was always prepared to tweak the first product that emerged from weeks of closed-door discussions. He was willing to make immediate adjustments to woo and win over the holdouts. He was prepared to do that before the bill hit the floor this week. He was ready to see it changed further through amendments on the floor.
• But the timetable proved to be too ambitious, perhaps too highhanded. The resisters wanted changes — and several demanded more time. That was a toxic combination that McConnell could not overcome. Echoing Trump, McConnell acknowledged the complexity of the task. “It’s a very complicated subject,” he told reporters at the Capitol. Such legislation often takes longer to put together than people think, he added. That was a game way of saying he’s on to Plan B, with no guarantees of success.
• Health care has highlighted the divisions within the party. After the House vote, Rep. Tom MacArthur (R-N.J.) resigned as co-chair of the Tuesday Group due to unhappiness with the deal he made with conservatives. On Friday, Sen. Dean Heller (R-Nev.), a vulnerable incumbent facing reelection next year, announced that he could not vote for the Senate bill in its current form. Trump’s political action committee announced that it would mount an advertising assault on him, which began Tuesday. That kind of intraparty hardball could only make Heller weaker.
• The health-care fight has left the president frustrated and at times looking helpless. He is torn between his desire for the ultimate victory and the many things he said about the subject during his campaign and even since, such as that he wants coverage for everyone. He has reduced all that to saying he wants something with heart. Does a bill that reduces coverage as significantly as the CBO says the GOP bills would do meet that definition?
• The Republican Party’s health-care objectives haven’t changed, nor have the principles upon which Republicans want to create the new health-care system. It’s the details that they haven’t mastered. House leaders had one advantage over McConnell and the Senate: a larger margin for error. McConnell can’t afford to lose more than two Republicans. The road ahead will test him as perhaps never before.
• If successful, Republican lawmakers will have a second test, which will be to sell their alternative to the public. The Affordable Care Act split the country, with supporters and opponents in hardened camps through most of the Obama administration. Today, Obamacare has become more popular, according to recent polls. In contrast, early measures of the Republicans’ plans show minimal support and sizable opposition.
• What are the party’s options? Fail and be held accountable by a conservative base that for years has been promised that Obamacare would be gone once the GOP held power. Pass something that looks like either the House or Senate bills and be left with the potential political consequences of being accused of eliminating coverage for 20 million more Americans.

Analysis | ‘Repeal and replace’ was once a unifier for the GOP. Now it’s an albatross. - The Washington Post
https://apple.news/AEWuIqt5KTyCbPfIXLjh6Gg

 

[Snarky Oracle!]

Polls show that only 12 to 17% of the public approves of the GOP's "health care" bill, yet the only thing that slows the bill down is a handful of Republicans who don't feel the bill is draconian enough.

Removing health insurance from 22 to 25 million people apparently is too genteel.

People have been calling the bill "class warfare on steroids" and "genocide" because of the countless thousands who will die as a result of the bill.

The House and Senate bills are in fact not health care bills at all. They simply take 800 billion dollars from medicaid paid for with your taxes and places that 800 billion into the bank accounts of the super rich... and a few other choice things, of course.

They're going further and further towards pushing us back to a nineteenth century plutocracy.