Obamacare´s repeal/replacement

    is now expected to pass  the house this week.

    The devil is in the details of course, and those won´t be known until the senate acts , but I think the glass is half full.

    We´ve now become a nation that believes  in  Government Health Care. Repeal without replace turned out to be a non-starter.  .  

    A consequence is that from now on the health care debate won´t be about whether but   how .

    At least some degree of Government responsibility will be a given. And most importantly some lives will be saved/improved as a result.

    More narrowly ,the political consequence is that the democrats will gain seats.

    You can ´t shoot Santa Claus . Whatever the details of Trumpcare it will be less extensive . People will die .And once it is in effect - I guess in 2019 -we ´ll be reading the stories of those people. And we´ll elect a Democrat president..





    Tom Toles:

    So why are the lemmings proceeding to amble off this cliff then? Because of the last feature of the GOP health-care bill that gets the least coverage, but what it is in fact all about. If this latest bill passes, it will share the one feature that all the GOP health-care bills share. I’ll pause for a three-count while you guess. That’s right! A huge tax cut for the rich!  

    Yes, for the slow learners in the class, it’s about huge tax cuts for the rich, again. It is always about huge tax cuts for the rich. All that the GOP needs to do is the ritual hand-waving about how it’s really about health care, or that dying uncovered and broke is really what freedom is all about, or whatever. It no longer matters. The rich are running the GOP before, during and after the Trump “populist” revolt...

    I went over how the Republicans sole objective was to cut the investment tax on the 2% which funds the ACA subsidies in It was Never about Health Care for the GOP:

    Forbes on Obamacare taxes on the rich:

    The biggest revenue raiser in Obamacare is the net investment income tax, which levies an additional 3.8% surtax on interest, dividend, rent, royalty and passive business income of high-income taxpayers; those earning more than $250,000 (if married, $200,000 if single). Thus, once again, the tax impacts only the wealthiest 2% of Americans.

    Expect the Senate GOP will add some more deficit financed money into it but keep the tax cuts on the rich.

    This could lead to an eventual collapse of health care in many parts of the country as the legal requirement to treat the coming deluge of Muricans with no insurance meets insufficient federal $$ to break even on providing care.

    Trump and his HHS guy Tom Price were going to kill the ACA anyway, probably best the Republicans kill it fast and with their presence and culpability clear even to the clueless and naive who vote for them.

    The young will also in effect get a tax cut. Which is actually a good thing. Help them form a good habit.

    Economically Obamacare always came down to 3 points you could summarize on a post card

    o  insurers couldn´t reject pre existing conditions

    o to offset that InCo. money loser , everyone had to join or be fined-which Hillary learned in 93 and Barak from her in 2008- the primaries actually served a function

    o and the rich were slapped with a surcharge to provide funds to address select problems.

    That ´s  it.. And the result in Bidenspeak,  a BFD.

    Brilliant politics. But that can happen when you have a Hillary running against a Barak.Enough to

    make you believe in democracy.

    Don't understand your o stuff.

    I've read anyone making under 50k will lose, as they will not get ACA subsidies for quality coverage health plans. 

    Why anyone expects GOP voters to punish House Republicans for passing a bill that harms them is a mystery. Hope it happens however.

    The o points were  my summary of what made  Obamacare  a brilliant achiev.  a BFD. I haven't the data or the skill to summarize what 's wrong with today´s bill.

    What comes to mind is Mary McCarthy´s description of something by Lillian Hellman  :¨every word a lie.... including if , an and but¨.

    By this point in 2009 Obama .had saved GM, Chrysler and capitalism. Which I think was a good thing . In 2009.

    He said he ´d bring change and for a change we actually had a government  , full stop.

    Flav, re: The o points. To do real bullet points is easy,  i see that you clearly know how to highlight your text because you used the strikethrough on "brilliant achiev". All you had to do is highlight the text you wanted in bullet points and hit the button that looks like bullet points on the menu after "size". (It's the second one on that middle menu.) Just the same way you did the strikethrough, only a different button.

    I used to be able to do that back when I was 86.

    Sarah Kliff @ Vox explains the "tax effect" of the bill, as one could call it, well, as usual:

    Rich people do well. Sick people don’t.


    Winner: People who are young, healthy, and high-income

    If you earn a good salary, are young and healthy, and want to buy a cheaper, skimpier insurance plan, the American Health Care Act could be pretty good for you. It would give Americans who earn upward of $100,000 tax credits to help purchase insurance. Right now, Obamacare’s tax credits are only available to individuals who earn less than $64,000.

    The Republican bill makes it easier for insurers to charge lower prices to young people, too. Right now, insurance plans are required to only charge the oldest enrollees three times as much as the youngest enrollees. AHCA would change that rule to allow insurers to charge the oldest enrollees five times as much. This would raise premiums on the elderly but lower them for young Americans. Christine Eibner, a researcher at the RAND Corporation, estimates that this particular policy would lower annual premiums for a 24-year-old from $2,800 to $2,100

    AHCA would let states apply for waivers so that insurers in those states could charge people with preexisting conditions higher premiums. For healthy people without preexisting conditions, this would be a benefit: They would no longer have to pay more so that the insurance company could cover the high medical bills of other enrollees. Instead, the Republican bill would move the individual market closer to the one that we had before Obamacare, where health insurance premiums were meant to reflect how much an individual’s own coverage is expected to cost.

    If you’re someone who uses little health care, that could be a good deal. If you’re someone who is expected to have high bills, however…

    Loser: people who are older, sick, and low-income


    That said, Sarah has re-tweeted the tweeted news that it might not be wise for the average person to spend as much time understanding the House bill as she did:

    The Health Care Reporter’s Full Employment Act, I presume. https://t.co/QBBwnds9ub

    — Sarah Kliff (@sarahkliff) May 4, 2017

    And something really does have to be done by Congress or Trump's threats about Obamacare dying will self-fulfill.It's not like everything is going to go okay with health insurance coverage if they don't touch it! Once Trump made those threats that Obamacare is gonna die, that gave coverage to insurance cos. to make the decision to really cover their ass with high rates or drop out! I'm seeing lots of news like this as offerings and rates are filed for the state exchanges for 2018:

    Some big rate hikes from the Blue Cross plan in Maryland. They want to raise rates by 46 percent in the marketplace. https://t.co/BwI1uF8Cnv

    — Sarah Kliff (@sarahkliff) May 4, 2017

    News: Obamacare rate filings are in for Maryland, plans request hikes between 9 and 53 percent. https://t.co/BwI1uF8Cnv

    — Sarah Kliff (@sarahkliff) May 4, 2017



    Keep in mind that Obamacare is still a profit-incentive system. The insurance cos. don't need the exchange clients, they didn't really want them before Obamacare and they can easily opt out again and just go back to selling health insurance to employers.. Even if GOP bills fail, many more are going to be reluctant to offer on the exchanges if they are not sure the government isn't fully going to cover their ass and make sure it can be profitable. Why should they bother otherwise?

    To believe that Obamacare is going to continue the same as it is if nobody does anything is also folly.

    If 2018 Obamacare is a disaster the Republicans will put it down to O-care´s inherent weaknesses.

    But there´s some chance  the affected voters will want to punish the Reps.  ¨Chance¨ because that voter reaction will be susceptible to stage management by the parties  and I ´m worried that Donald &Co. are automatically favored by their tighter internal lines of communication.   

    Senate will do their own bill, confirmed @ TheHIll.com

    GOP senators: We're doing our own healthcare bill

    By Rachel Roubein 6h ago

    and edit to add: probably related, posted @ The Hill @ 2:56 so Senators would have known it:

    American Medical Association condemns House healthcare bill passage


    all bogus kabuki bullshit? hearing similar by talking heads on CNN right now:

    By Paul Kane @ WaPo
    They knew it would give Democrats ammunition and that the Senate may choke on the legislation, but they wanted to show that the GOP majority could actually govern.

    Edit to add: especially because this is not how you do it if you care about major money interest groups, i.e., the health care lobbyists and Wall St. too:

    The rescue effort began with Reps. Tom MacArthur (N.J.) and Mark Meadows (N.C.), representing moderates and hard-line conservatives respectively, trading offers back and forth on a Word document. 
    @ WaPo

    I just can't see how those that voted for this did so expecting it to stand through the Senate and everything else. It's a cynical bill written by "two guys" fiddling with a Word doc, Ryan and Trump not caring at all. You have to at least show you are willing to listen to input from the industries, from AMA, from AARP, from Kaiser, etc. This is not the way it's done successfully. I just can't take it seriously because it's such a cynical effort just to give House guys something to say they voted for and then blame the Senate. It is intended for it to be totally changed.

    the actual bill, it's really just a sloppy mess, as the WaPo editorial board is pointing out:

    note my underlining especially

    What a joke: Rep. Fred Upton (R-Mich.) objects to the loss of protection, and then pretends that a paltry $8 billion over five years will fix the problem.

    And what hypocrisy: House Speaker Paul D. Ryan (R-Wis.) claims to be restoring fair process to his chamber, and then orchestrates a vote on this hugely consequential bill before the Congressional Budget Office can tell lawmakers what it would cost or how many people would lose access to health care as it took effect.

    Carelessly, the bill would threaten the integrity of even employer-based health-care plans in every state, apparently by accident. Recklessly, its drafters introduced just one day before the vote legislative language that an independent expert called “incoherent, arbitrary, and technically complex.” Tragically, the repeal-and-replace effort is causing so much uncertainty that, even if this bill dies in the Senate, it may unravel the existing health-care system.

    I'd bet their approval rating is going to drop to near zero.

    Just saw a video clip on CNN of Nancy Pelosi saying that those who voted for this are going to bear this vote like a tattoo or a scar for the rest of their lives. And she was smiling as she said it! Now the Congressional reporter @ CNN saying "Democrats were just waiting to seize on this", that they wanted to see it, they basically think that tactically, it's a win.


    In Rare Unity, Hospitals, Doctors and Insurers Criticize Health Bill @ NYTimes.com, May 4

    merely a red meat Kabuki vote for the really stupid portion of the GOP base.

    Just an opening salvo, throwing some shit at the fan, seeing what sticks. But they "voted" on something and can now move on to anything else, leaving the work to the Senate. I wouldn't be surprised if everyone in the GOP was in on this, i.e. "let's let the Senate do it."


    they basically think that tactically, it's a win

    Yay! With all this winning, the Dems can look forward to picking up all of ONE seat in the house in 2018! 


    Until more districts start moving into the "leaning D" column, these tactics, which seem to involve the cunning plan of sitting back and hoping the GOP just implode by themselves, are a failure. The fact that republicans voted en masse for this dogshit bill just illustrates how little they fear any democratic opposition in 2018. 

    I guess Pelosi is so happy because everyone is suddenly meeting their fundraising targets on the back of this repeal storm. But unless that translates into serious challenges for red districts, and a serious messaging rethink to go after those districts, all it does is let Dem house reps have a few more days off from donor engagement. I don't think Perez's hot new line "let's put hope on the ballot" is going to go very far. I don't think pushing Hillary half-of-you-people-are-deplorable Clinton to the front is going to help either. Not that I think Sanders' messaging is necessarily helping democrats as he keeps railing about them being corporate enablers...

    I don't think it has anything to do with fear or lack of fear of democrats. They've been running on repealing the ACA for years. They voted about 60 times to repeal it. They convinced their base that it was the worst thing ever and now they had to repeal it for them. I'm not sure if they have any long term plan after getting it through the house. I think they're just trying to accomplish that short term goal. I guess we'll see what happens next.

    Could be. But notice that the one GOP rep whose district is tipping blue voted no. 

    Democrats See Health Vote as Path to Retake House

    ‘No District Is Off the Table’: Health Vote Could Put House in Play


    House Republicans, already set to play defense in 2018 because of their unpopular president, must now contend with an energized, angry Democratic Party.

    Another NYTimes piece shows how publicly known support of it is already seen as poison:

    G.O.P. House Candidate in Montana Is Caught on Tape Praising Health Bill


    [....] Mr. Gianforte’s attempt to appeal to two different audiences — Montana voters skeptical about the House’s repeal bill and Washington Republicans eager to undo President Barack Obama’s signature domestic accomplishment — illustrates the complicated politics surrounding the health law. While Republicans expect their elected officials to fulfill their longstanding vows to tear up the Affordable Care Act, the broader electorate is uneasy about abandoning the law’s protections and benefits it has come to depend on [.....]

    Pelosi was correct in saying what she said, that those who voted for it will be very sorry they did. Didn't sound like an idle threat about planned protests or the like when I saw the clip of her saying it on TV, sounded more like she knew it from polls and studies of districts, something along those lines.

     I suspect Pelosi knows partly because: she had to do a ton of across-the-aisle work getting Obamacare on the books in the first place! She probably knows what a lot of constituents in swingy districts thought about it at the time, what worried them about Obamacare, and also how those kind of people might feel more comfortable with it down the line once they knew more about it. Because she had to try to convince reps from those swingy type districts to vote for it.

    Here's the Cook political report:


    where the big shift is three red districts moving into the "toss-up" column. Color me unimpressed. A hugely unpopular bill shambolically shoved through the house and it has barely moved the dial so far. 

    The Democrats need to do more than just jeer at GOP malfeasance and incompetence. 

    We won't see any effects on voting patterns until it passes and people see its effects on people's health care. If it passes and it has the negative effects most predict then, hopefully, people will vote against the republicans.

    Exactly. And it won't pass the Senate. Anything that does pass the senate will do so with Democratic votes, so it can't be used as an election cudgel in any case. 

    My point is that pace AA, Pelosi was NOT "correct in saying what she said, that those who voted for it will be very sorry they did". Exactly 3 of the GOP now have to work a bit harder to get reelected. The other 214 GOP reps have little to worry about. 

    Yeah Pelosi was overly optimistic. It seems unlikely to pass the senate. But with reconciliation it only takes 50 votes. Josh weighed in on this.

    this should remind us of what I’ve previously called the Iron Law of Republican Politics. That is, the ‘GOP moderates’ will always cave

    I confess that after the first debacle and the sharp move of public opinion in favor of Obamacare, I thought Ryan would have a much harder time pulling this off. After all, the GOP moderates in the House didn’t get anything. The bill moved further to the right, further to gutting coverage on the second round. They caved anyway.

    This brings me to the First Corollary of the Iron Law of Republican Politics: Josh should never doubt the Iron Law of Republican Politics.

    I don’t see how it can get through the Senate. But remember The Iron Law of Republican Politics.

    Senate Republicans will pass it with cosmetic changes. 

    The other iron law of Republicans is their base will won't care and will still vote Republican.

    new stuff just put up at WaPo on the political implications:

    At stake is the long-term future of the health-care system and the near-term future of the GOP-controlled government. Senate Majority Leader Mitch McConnell, a consummate political insider, and President Trump, the ultimate outsider, will need to balance each other to score a major legislative victory.
    The Fix


    Even if a watered-down version of House Republicans’ legislation becomes law, states are probably going to be on the hook for billions of dollars of health-care costs, especially for the poor and sick.

    KY was one of the few states where ACA was widely considered an unqualified success. I woulda thought that McConnell could be made vulnerable on this point--though the governor breezed to victory on dismantling the ACA. Strange state.

    Trump’s forbidden love: Single-payer health care

    Trump insists he doesn't want single-payer. Years of commentary suggest otherwise.

    @ Washington Post/The Fix •  Analysis.by Aaron Blake

     Includes the video of him telling the Australian prime minister the other day that "you have better health care than we do" and other choice examples that might be useful to post on social media espec. if one has more conservative friends or family.

    Doing more than posting on social media: Sanders to Trump: 'We'll quote you' on support for universal healthcare

    @ The Hill, May 4

    “The terms of [the healthcare] debate are entirely on the grounds of the liberal argument that everybody ought to [have insurance]. Once that happens, you're going to end up with a single-payer,” Krauthammer said on Fox News’s “Special Report with Bret Baier.”

    In short, we've won the war even if this battle isn't going so well.

    Articles like this make the mistake of thinking the blather that comes out of Trumps mouth means anything. Sure one might be able to find statements over the years of Trump saying nice things about single payer. But it's not like he seriously considered the strengths and weaknesses of the American health care system. He didn't look at the various ways to improve upon the weaknesses. He didn't come to the conclusion that a single payer system would be the best way to solve the problems.

    Trump could not come here and write a blog on health care describing the alternatives an making a serious argument that single payer is the best way forward. He could not enter into a discussion on any topic and make rational arguments. I don't think I'm qualified to be president nor do I think anyone here is. But Trump does not even have the basic knowledge nor the specific policy knowledge to hang with the people here. His ignorance would be so obvious he'd be the joke of dagblog.

    Good points, exactly right, he is clueless and seemingly incapable of attention span for understanding policy. That said,I think it's helpful to dig into what his voters thought they were buying when they voted for him, especially the promises he repeated over and over on the campaign trail (not things he said prior to his campaign.) Some may indeed have been expecting universal coverage from him and may have no time to check out that this bill is not that, or don't trust media on it.

    House GOP leakers trying to make sure the buck stops with Trump on this one:

    [....] Trump did not want to talk about the merits of the legislation — he didn’t care much about those specifics, senior officials said. What mattered to him was how a failed vote would hobble his presidency and the ability to get other legislation through Congress. [....]

    Interviews with dozens of key lawmakers, congressional staffers and administration officials for this story the past few weeks revealed how the pressure of an impatient White House — and fears of repercussions for not following through on campaign promises — finally produced a bill backed by all corners of the GOP Conference [....] But while GOP leaders welcomed the White House’s assistance in trying to win over conservatives, the involvement of the president and administration this second go-round often rankled senior Republicans, who viewed it as counterproductive in many cases [....]


    'The White House just couldn't let this go' The inside story of how Trump and the Republicans got Obamacare repeal through the House. (Hint: It wasn't pretty.) @ Politico.com, May 5

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