Nel's New Day

July 26, 2017

GOP Can’t Create

Filed under: Health Care — trp2011 @ 11:31 PM
Tags: , , ,

Debate started today on Trumpcare in the senate after 50 GOP senators voted yesterday to move forward with the process. That motion passed because Sen. John McCain (R-AZ) returned after surgery last week for a brain tumor. George Zornick laid out the process. The Senate will have several votes on different bills—with those voting not knowing what is in them. Understanding of the bills is not important for Republicans; their goal is to get anything passed. Any success will continue the secrecy as Senate leaders hide with House leaders to get anything to Dictator Donald Trump (DDT) before his 200th day.

Under consideration are the House health care bill (the AHCA); some version of the Senate health care bill (the BCRA) with changes pushed by Sen. Ted Cruz (R-TX); a straight repeal vote pushed by Sen. Rand Paul (R-KY); and one called a “skinny repeal” bill. The first failure was the Better Care Reconciliation Act with Sen. Ted Cruz’s provision was the first to lose in a vote by 43 to 57. This one needed 60 votes because it didn’t meet the requirements for the reconciliation process. Nine GOP senators opposed the bill. The next bill to fail was the amendment from Sen. Rand Paul (R-KY) similar to the 2015 bill to completely repeal the Affordable Care Act. Paul’s amendment lost by 45-52 as seven GOP senators joined Democrats in opposition.

This chart shows the divergence of GOP senators between the first two options.

The most popular bill among Republicans may be what’s called the “skinny repeal.” Measures of this include repeal of the mandates for individual insurance and requirements for larger employers providing insurance for their workers. It would also end some taxes, including on medical device makers.  The CBO has issued its score that the bill will eradicate insurance for 16 million people and increase premiums by 20 percent. Earlier the CBO concluded that loss of the individual mandate negatively impacts the insurance market. Most Republicans don’t care: they just want to get something passed so that they can meet in secret with the House to have a bill that they can get through Congress. The content doesn’t matter. As VP Mike Pence said, “Inaction is not an option.”

McCain filed amendments today about Medicaid in support for Arizona, one of 31 states that expanded Medicaid under the ACA. He wants the phase out to extend ten years and increase the growth rate for payments to reflect health care inflation. Later this week, senators will endure a “vote-a-rama” with rapid-fire votes on all amendments. Democrats have stopped putting up amendments because no one knows what is in any of the bills. As Sen. Ben Cardin (D-MD) pointed out, how can anyone prepare amendments to legislation without knowing what’s being amended?

One amendment planned by Sen. Steve Daines (R-MT) is for a single-payer plan. He doesn’t want the plan; he just wants to play off the split among Democrats for this type of health care. Although Sen. Bernie Sanders (I-VT) supports “Medicare for All,” he has said that he will not be voting in favor of this amendment because “the Democratic caucus will not participate in the Republicans’ sham process.” He added that “no amendment will get a vote until we see the final legislation and know what bill we are amending.”

Blue Cross/Blue Shield told senators that a repeal of the ACA insurance mandate would be a serious problem if it doesn’t have a replacement that ensures people get and maintain insurance coverage. That puts the giant insurance company against the “skinny repeal.”

Some GOP governors also virulently oppose the “skinny” approach, and their opinion could sway at least one senator toward no. Earlier Rep. Dean Heller (R-NV) had said that he would support a bill that didn’t cut Medicaid although he’s smart enough to worry about cuts in Medicaid after the bill goes to conference. He also said that he will support his GOP governor, Brian Sandoval, who opposes the bill. That could make him the third no, if Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK) stick to their no votes to even proceed. Heller is up for re-election next year, and DDT had pushed his buddies, billionaire casino moguls and GOP donors Sheldon Adleson and Steve Wynn, to twist Heller’s arm. The question is which side Heller picks.

Before he lost his election to a Tea Partier, former House Majority Leader Eric Cantor (R-VA) led the charge to repeal “Obamacare.” He promised voters that Republicans would eliminate the Affordable Care Act if they were elected. Not being in Congress has given Cantor the freedom to tell the truth: he said that the GOP used “that anger working for you,” that they never intended to follow through. About the ACA repeal, Cantor said:

“To give the impression that if Republicans were in control of the House and Senate, that we could do that when Obama was still in office — I never believed it.”

Cantor feels partially responsible for the current mess surrounding the health care debate and the negative part of his party “that says if it’s not everything, then it can’t be conservative.” He prefers working in the private sector because of “the deliberateness and the thoughtfulness.” Too bad that Congress now chooses an opposite path. The fight has turned vicious. Rep. Buddy Carter (R-GA) said somebody needs to go to the Senate and “snatch a knot in their ass,” referring to Murkowski. The folksy statement means to beat up or badly injure. Rep. Blake Farenthold (R-TX) said that he would “settle this Aaron-Burr style” if they were men, referring to Murkowski and Collins (ME) who voted against proceeding with Trumpcare. Vice President Burr mortally wounded Treasury Secretary Alexander Hamilton in a duel.

DDT has been very clear that he has no idea how health care works. He even talked to the NYT about how young people could buy coverage for $12 a year. Before his interview, DDT also said that Trumpcare would offer “better coverage for low-income Americans” than the ACA, a complete fantasy, and that the GOP plan is “more generous than Obamacare.” He promised that “premiums will be down 60 and 70 percent” when they would skyrocket. Sen. Bill Cassidy (R-LA) may be echoing many GOP legislators when he claims that DDT is “about broad principles,” not specifics. All DDT needs to understand, according to Cassidy, is “the principle … that there would be a replace associated with repeal. In one week, DDT tweeted support for a bipartisan repeal and replace plan, failure of Obamacare, and a senate sales pitch for Trumpcare that strips coverage from over 20 million people. DDT’s sole principle is passing a bill, any bill.

The senators accompany DDT in ignorance. Asked last week which bill will be up for a vote, Sen. John Cornyn (R-TX) replied, “I suspect it will be anything senators want to vote on. If a senator wants to offer an amendment that’s the 2015 [Obamacare repeal] bill, they can do that.” And indeed Paul did. In answer to a question about whether senators should know the content of the bill before the vote, Cornyn said, “That’s a luxury we don’t have.”

The CBO scoring for the “repeal and replace” plan indicates that a deductible for a standard insurance plan in 2026 would be $13,000. Under current law, an individual making $56,800 would have a deductible of $5,000, while someone making $26,500 would have an $800 deductible. The GOP plan tries to have lower premiums which equates much high deductibles.

Polls oppose the GOP drive to not provide health care for people. A recent poll shows that 62 percent think that the federal government is responsible for healthcare for all, a number up from 52 percent just three months ago. Only 13 percent want the ACA repealed without a replacement. And 80 percent of people think that Republicans should work with Democrats, something that the GOP has stalwartly refused to do. Patrick Murphy is one example of this majority. He said, “Everybody needs some sort of health insurance. They’re trying to repeal Obamacare but they don’t have anything in place. I can’t remember why I opposed it.”

Everyone agrees that the Affordable Care Act needs fixing. That was a consensus when it became law. The Democrats weakened the plan when they catered to the Republicans to get their support, and the Republicans turned tail and refused to vote for the ideas that they provided. But something that needs fixing should be fixed. A house that needs a new roof doesn’t need to be burned down, but that’s what the GOP wants to do with the ACA. The party that has spent decades saying no can’t figure out how to create something—it just wants to burn everything down.

The GOP is the only major party in any advanced democracy on the planet to oppose health care as a core benefit of citizenship, and people are terrified that Republicans will be successful in achieving their goal.

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