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Republicans Introduce Obamacare Replacement That Leaves Much To Be Desired

congress-healthcare

Late last night, House Republicans finally released their version of a replacement for the Affordable Care Act, and it’s getting a lukewarm reception at best:

WASHINGTON — House Republicans unveiled on Monday their long-awaited plan to repeal and replace the Affordable Care Act, scrapping the mandate for most Americans to have health insurance in favor of a new system of tax credits to induce people to buy insurance on the open market.

The bill sets the stage for a bitter debate over the possible dismantling of the most significant health care law in a half-century. In its place would be a health law that would be far more oriented to the free market and would make far-reaching changes to a vast part of the American economy.

The House Republican bill would roll back the expansion of Medicaid that has provided coverage to more than 10 million people in 31 states, reducing federal payments for many new beneficiaries. It also would effectively scrap the unpopular requirement that people have insurance and eliminate tax penalties for those who go without. The requirement for larger employers to offer coverage to their full-time employees would also be eliminated.

People who let their insurance coverage lapse, however, would face a significant penalty. Insurers could increase their premiums by 30 percent, and in that sense, Republicans would replace a penalty for not having insurance with a new penalty for allowing insurance to lapse.

House Republican leaders said they would keep three popular provisions in the Affordable Care Act: the prohibition on denying coverage to people with pre-existing conditions, the ban on lifetime coverage caps and the rule allowing young people to remain on their parents’ health plans until age 26.

Republicans hope to undo other major parts of President Barack Obama’s signature domestic achievement, including income-based tax credits that help millions of Americans buy insurance, taxes on people with high incomes and the penalty for people who do not have health coverage.

Medicaid recipients’ open-ended entitlement to health care would be replaced by a per-person allotment to the states. And people with pre-existing medical conditions would face new uncertainties in a more deregulated insurance market.

The bill would also cut off federal funds to Planned Parenthood clinics through Medicaid and other government programs for one year.

“Obamacare is a sinking ship, and the legislation introduced today will rescue people from the mistakes of the past,” said Representative Kevin McCarthy of California, the majority leader.

Democrats denounced the effort as a cruel attempt to strip Americans of their health care.

“Republicans will force tens of millions of families to pay more for worse coverage — and push millions of Americans off of health coverage entirely,” said Representative Nancy Pelosi of California, the Democratic leader.

Two House committees — Ways and Means and Energy and Commerce — plan to take up the legislation on Wednesday. House Republicans hope the committees will approve the measure this week, clearing the way for the full House to act on it before a spring break scheduled to begin on April 7. The outlook in the Senate is less clear. Democrats want to preserve the Affordable Care Act, and a handful of Republican senators expressed serious concerns about the House plan as it was being developed.

Under the House Republican plan, the income-based tax credits provided under the Affordable Care Act would be replaced with credits that would rise with age as older people generally require more health care. In a late change, the plan reduces the tax credits for individuals with annual incomes over $75,000 and married couples with incomes over $150,000.

Republicans did not offer any estimate of how much their plan would cost, or how many people would gain or lose insurance. The two House committees plan to vote on the legislation without having estimates of its cost from the Congressional Budget Office, the official scorekeeper on Capitol Hill.

But they did get the support from President Trump that they badly need to win House passage.

“Obamacare has proven to be a disaster with fewer options, inferior care and skyrocketing costs that are crushing small business and families across America,” said the White House press secretary, Sean Spicer. “Today marks an important step toward restoring health care choices and affordability back to the American people.”

Almost immediately, the House proposal faced criticism not just from Democrats, but from other Republicans:

On Monday, four Republican senators — Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska — signed a letter saying a House draft that they had reviewed did not adequately protect people in states like theirs that have expanded Medicaid under the Affordable Care Act.

Three conservative Republicans in the Senate — Mike Lee of Utah, Rand Paul of Kentucky and Ted Cruz of Texas — had already expressed reservations about the House’s approach.

In the House, Republican leaders will have to contend with conservative members who have already been vocal about their misgivings about the legislation being drawn up. “Obamacare 2.0,” Representative Justin Amash, Republican of Michigan, posted on Twitter on Monday.

Representative Mark Meadows, Republican of North Carolina and the chairman of the conservative House Freedom Caucus, also offered a warning on Monday, joining with Mr. Paul to urge that Republican leaders pursue a “clean repeal” of the health care law.

“Conservatives don’t want new taxes, new entitlements and an ‘ObamaCare Lite’ bill,” they wrote on the website of Fox News. “If leadership insists on replacing ObamaCare with ObamaCare-lite, no repeal will pass.”

The move to strip Planned Parenthood of funding and the plan’s provisions to reverse tax increases on the high-income taxpayers will also expose Republicans in more moderate districts to Democratic attacks.

The bill would provide each state with a fixed allotment of federal money for each person on Medicaid, the federal-state program for more than 70 million low-income people. The federal government would pay different amounts for different categories of beneficiaries, including children, older Americans and people with disabilities.

The bill would also repeal subsidies that the government provides under the Affordable Care Act to help low-income people pay deductibles and other out-of-pocket costs for insurance purchased through the public marketplaces. Eliminating these subsidies would cause turmoil in insurance markets, insurers and consumer advocates say.

However, the House Republicans would provide states with $100 billion over nine years, which states could use to help people pay for health care and insurance.

The tax credits proposed by House Republicans would start at $2,000 a year for a person under 30 and would rise to a maximum of $4,000 for a person 60 or older. A family could receive up to $14,000 in credits.

Even with those credits, Democrats say, many people would find insurance unaffordable. But Republicans would allow insurers to sell a leaner, less expensive package of benefits and would allow people to use the tax credits for insurance policies covering only catastrophic costs.

Since the Republican proposal has yet to be scored by the Congressional Budget Office, it’s difficult to say what the ultimate impact it might have on both Federal spending and individuals who have been benefiting from the Affordable Care Act might be. At a glance, though, it appears that this replacement would be woefully insufficient in addressing both the issues that the PPACA was originally intended to address and those issues created by the question of what to do about people who have become dependent on insurance provided under the PPACA. For example, the proposal keeps PPACA provisions such as the ban against denying coverage to people with pre-existing conditions, the provisions that allow parents to continue providing insurance under their own plans for children up to the age of twenty-six, the end of the lifetime cap on coverage, and the expansion of Medicaid. However, it seems highly likely that this will be short-lived at best, especially since Medicaid expansion would be phased out of existence by 2020, meaning that all of the people who have benefited from that portion of the PPACA would be faced with the choice of losing coverage again or trying to find it on the open market. Furthermore, while many of these provisions would be continued under the Republican proposal, it seems clear that costs will significantly increase for the people who have benefited from them and that many of them will be in danger of losing their coverage either due to the cancellation of existing policies or simple inability to pay increased premiums. Additionally, replacing subsidized premiums with tax credits would clearly not benefit poor people who don’t make enough money to benefit from tax credits and would force many of these people to give up coverage entirely if they can’t afford the premiums. Finally, the penalty for not having coverage, which essentially amounts to a 30% surcharge on insurance premiums for anyone who goes two months or more without coverage, seems at first glance to be far harsher than the penalty under the Affordable Care Act and unlikely to be much of an incentive for people who don’t have coverage since it will make the cost of coverage even more prohibitive than it likely already is for them.

The reactions to the proposal seem to be overwhelmingly negative. Democrats, of course, are reacting about as you’d expect from a party that is utterly convinced that a PPACA was a good thing, with much of the criticism focusing on what the bill would allegedly do with regard to the poor. On the right, much of the criticism of the bill comes from conservative critics of the Affordable Care Act. These groups, instead prefer either repeal without any replacement whatsoever, which seems both politically and economically untenable, or a more conservative replacement bill such as the one put forward by Kentucky Senator Rand Paul. and conservative groups such as Americans For Prosperity, FreedomWorks, Heritage Action all coming out against the bill. Given this kind of opposition, the fate of this bill is far from certain.

What is certain, though, is that the proposal itself isn’t really very impressive considering that it effectively took Republicans seven years to come up with what they believe to be a viable alternative to the PPACA. Even if you consider it a good thing that it retains many of the characteristics and provisions of the existing law, the fact that it changes them in ways that seem guaranteed to make insurance more expensive and less available certainly calls into question what exactly it is Republicans think they’re accomplishing here. If you consider the PPACA to be all around a bad thing, on the other hand, the bill obviously doesn’t go far enough in taking away the provisions of the law that were most objectionable to many on the right. If anything, all it really does is change those provisions to make them harder to obtain, more unwieldy, and more expensive, all of which seems to guarantee that insurance and health care costs will continue to rise, that the number of uninsured people will rise to levels not seen since the PPACA went into effect, and finally to bring us back to a pre-PPACA status quo that everyone agrees is simply unacceptable. If this is the best the GOP has to offer, then they may as not have acted at all.

As it stands, Republicans in the House appear to be addressing the anticipated opposition by pushing the bill through as fast as possible. The relevant House Committees are slated to begin markup on the bill tomorrow, but there apparently will be no hearings at all on the matter by any House Committee. Beginning the process this quickly means that they seem likely to try to push for a vote by the full House before the Congressional Budget Office is able to score the bill notwithstanding the long-standing promise that Republicans made when they first took back the House in the 2010 elections that they would follow so-called “regular order” in considering legislation, a process which includes both committee hearings and waiting for the CBO before formally moving forward on anything resembling a final vote. The reason for the rush, no doubt, is to avoid the ability of opposition groups, especially groups on the right, to unite opponents in a meaningful way before a final vote. Even if the proposal manages to pass the House, though, it’s fate in the Senate remains unclear. For one thing, it’s not yet clear that Republicans will be able to use the reconciliation process to bypass the Senate filibuster rule. If it can’t be used, then the bill would effectively be dead on arrival since it will most likely be unable to gain sufficient Democratic support to overcome the sixty vote threshold. For another, even if Republicans can avoid the filibuster, it’s not presently clear that they’ll be able to keep their own caucus together behind the bill. Already, conservative Senators such as Rand Paul of Kentucky and Mike Lee of Utah are signaling their opposition to the House approach and pushing their own, far more conservative, alternative replacement bill. Additionally, more moderate Senators such as Lisa Murkowski and Susan Collins are voicing concerns about the changes the bill makes to the PPACA’s Medicaid provisions and signaling that they too may oppose this plan. Given the how thin the GOP majority is, and the unlikelihood that they’d be able to get any Democratic crossover votes, a loss of as few as three votes would cause the bill to fail. In any case, as Republicans seek to push this bill through rapidly, it’s worth remembering that it took the better part of a year for Democrats to make the changes to the PPACA and garner the support needed to pass the bill and send it to President Obama’s desk. It’s entirely likely that it could take nearly as long for Republicans to accomplish the same task with their bill, assuming their able to get it passed at all.

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About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May, 2010 and also writes at Below The Beltway. Follow Doug on Twitter | Facebook

Comments

  1. Michael says:

    Republicans know exactly what they are accomplishing here. It’s a massive tax cut for the wealthiest Americans wrapped in a health care bill. It repeals $574.5 billion in tax increases on the wealthy.

    Highly-rated. Helpful or Unhelpful: Thumb up 35 Thumb down 1

  2. David M says:

    You know, everyone would probably be better off if the GOP would try and fail to pass a complete repeal with no replace, and then just pass the tax cut.

    Like or Dislike: Thumb up 5 Thumb down 0

  3. Daryl's other brother Darryl says:

    This is a $600B tax cut for the wealthy to paid for by kicking millions of people off the insurance rolls.
    It accomplishes none of the stated objectives.
    It will raise premiums, and leave fewer people insured.
    The plans will go back to being phony scams leaving more people bankrupt…something the fat orange blob in the White House is an expert at.
    I look forward to the CBO report.

    Highly-rated. Helpful or Unhelpful: Thumb up 21 Thumb down 1

  4. Argon says:

    Ultimately, they’re setting the stage for adoption of a single-payer system, right after things go so bad that they get kicked out of office. It’s sad that along the way millions of people will be badly affected but I guess we have to go through the same route Australia did to get full health coverage.

    It’s really time for the rank and file Democrats to get serious about off-year elections.

    Highly-rated. Helpful or Unhelpful: Thumb up 18 Thumb down 0

  5. Liberal Capitalist says:

    Don’t call it an “Obamacare Replacement “.

    It’s not. It’s not a replacement.

    If I break a glass, and replace it, I am looking to make sure that it is same-for-same.

    It is a clear statement that the GOP does not care about fellow Americans.

    If you go to any “conservative” site, the comments there are focused on liberalism being a “disease”. I do not think that word means what they think it means.

    If we call this bill what it is, it’s greed.

    And greed is The Ultimate Addiction

    Hate. Paranoia. Greed.

    Our new American values.

    Like or Dislike: Thumb up 9 Thumb down 0

  6. grumpy realist says:

    Look, let’s just split up the country. The section of it that thinks a government NHS is a communist plot can go over THERE, and those of us who think it’s a jolly good thing can stay HERE.

    My own suggestion for health care is somewhat like that. Create a NHS and use economies of scale and purchasing power to drive down costs for those who sign up. You are automatically on the NHS until you reach 18, after which you can jump off it if you want and are turned loose on the wonders of the Free Market and whatever hoops the unregulated private health insurance sector wants you to jump through. You want to get back on the NHS, you have to be at least as healthy as someone of your age who has stayed on it AND you have to pay in all the default NHS taxes you avoided paying up to now.

    Oh, and we’ll get rid of the hospitals-have-to-accept-everybody. Only those who are on the NHS or can pay. If you want to jump off the NHS you are on your own, period.

    And get rid of Medicare and Medicaid.

    Like or Dislike: Thumb up 8 Thumb down 1

  7. Kylopod says:

    Given the how thin the GOP majority is, and the unlikelihood that they’d be able to get any Democratic crossover votes, a loss of as few as three votes would cause the bill to fail.

    And that’s not even to mention the filibuster….

    Like or Dislike: Thumb up 5 Thumb down 0

  8. David M says:

    I am impressed with how thoroughly awful the bill is.

    Destroys funding source for any future adequate health care replacement? Check
    Significantly worsens Medicare program finances? Check
    Trashes Medicaid? Check
    Wrecks individual insurance market? Check
    Higher premiums for almost everyone? Check
    Lower benefits/higher deductibles for almost everyone? Check
    Totally screws over anyone above age 60? Check
    Idiotic “non-mandate” mandate? Check
    Will cause 10 million or so people to lose insurance coverage? Check
    Creates borderline useless high risk pools? Check

    Highly-rated. Helpful or Unhelpful: Thumb up 20 Thumb down 0

  9. Scott says:

    PPACA provisions such as the ban against denying coverage to people with pre-existing conditions, the provisions that allow parents to continue providing insurance under their own plans for children up to the age of twenty-six, the end of the lifetime cap on coverage

    Yes, everybody wants these goodies, but don’t want to pay for them. Definition of a tea party plan. Notice that no one is yet talking about the repeal of the Ten Essential Elements. Wait til people find out what won’t be covered.

    Bad ideas that didn’t work in the past like high risk pools that create a medical leper colony with enrollment caps, underfunding and a host of other bad features.

    We also get more tax-shelters in the form of HSAs as if 401k, 403b, IRA, Roth IRA, 529 plans are not enough shelters for the well-off.

    Apparently the Medicare funds are ripped off also shortening the status of the fund.

    Anybody know if the Medicare Part D donut hole is opened up again?

    The list will go on.

    More coverage for all people for less cost. That is what Trump promised. Not delivering.

    Like or Dislike: Thumb up 11 Thumb down 0

  10. t says:

    These town halls and meetings with constituents are going to be epic.

    Like or Dislike: Thumb up 10 Thumb down 0

  11. DrDaveT says:

    FauxCare — the name writes itself.

    Like or Dislike: Thumb up 9 Thumb down 0

  12. Scott says:

    @t: They are going to try to ram it through the House and Senate. Any townhalls, if they have them, will be after the fact.

    First hiding the bill, then sneaking it through the legislative process. That is how bad this bill is.

    Like or Dislike: Thumb up 13 Thumb down 0

  13. al-Alameda says:

    Jason Chaffetz, in slightly different words basically said: lower income people are undeserving.

    Speaking this morning on CNN in defense of House Republicans’ Obamacare replacement plan, Utah Republican Jason Chaffetz said that rather than “getting that new iPhone that they just love,” low-income Americans should take they money they would have spent on it and “invest it in their own health care.”

    Let them eat HSA’s and tax credits.

    Like or Dislike: Thumb up 11 Thumb down 0

  14. Argon says:

    @DrDaveT: “FauxCare — the name writes itself”

    FOX care.

    Like or Dislike: Thumb up 3 Thumb down 0

  15. Neil Hudelson says:

    @al-Alameda:

    To be fair to Chaffetz, my last iPhone did cost $8,000.

    Highly-rated. Helpful or Unhelpful: Thumb up 25 Thumb down 0

  16. Tony W says:

    RepubliCare is the right name

    This train wreck of a piece of…legislation….needs to be tied, permanently, to the Republican Party.

    As usual, it’s not that bad for me personally – my ability to contribute to HSA goes up, my taxes probably go down and I’m reasonably healthy so the incremental costs would be trivial.

    Also as usual, liberals think beyond their own narrow interests and look to the good of everyone, particularly those who have no voice.

    Like or Dislike: Thumb up 5 Thumb down 0

  17. Scott says:

    @Tony W:

    As usual, it’s not that bad for me personally

    Same here. I have excellent coverage and care through Tricare. I’m fighting for my children.

    Like or Dislike: Thumb up 7 Thumb down 0

  18. Franklin says:

    @Neil Hudelson: It took me a few seconds before I realized what you did there.

    Like or Dislike: Thumb up 3 Thumb down 0

  19. michael reynolds says:

    I like it.

    I get everything I care about for me: pre-existing conditions, no cap, and I can cover my kids.

    Plus I get a couple hundred bucks.

    So, I buy a new pair of shoes, and working poor Trump voters lose coverage and die. MAGA!

    Highly-rated. Helpful or Unhelpful: Thumb up 17 Thumb down 0

  20. Tyrell says:

    I have presented my ideas on how to fix the current plan. These ideas, I think, would bring in more people and more money. It would give more attractive options and flexibility. I will not put these ideas here unless requested. These steps would help those who can’t afford Obama Care and do not qualify for a subsidy, yet end up paying a tax penalty ! Talk about pouring gas on a wound !
    “Obama Care is going to end up repealing itself” See American Thinker: “Obamacare Self Repeal” (Robert Arvay)
    “Trailer for sale or rent, rooms to let 50 cent; I’m a man of means by no means, king of the road”
    (Roger Miller)

    Like or Dislike: Thumb up 0 Thumb down 14

  21. JohnMcC says:

    @Argon: “…(T)hey’re setting the stage for adoption of a single payer….” I have had the same thought but not with any cheer or joy; there is going to be a lot of pain and suffering between here and there.

    Like or Dislike: Thumb up 5 Thumb down 0

  22. Lit3Bolt says:

    @michael reynolds:

    Your shoes only cost 200 bucks? Plebe.

    Like or Dislike: Thumb up 10 Thumb down 0

  23. michael reynolds says:

    @Lit3Bolt:
    Now, my 17 year old daughter’s shoes. . .

    Like or Dislike: Thumb up 7 Thumb down 0

  24. Liberal Capitalist says:

    @michael reynolds:

    I like it.

    I get everything I care about for me: pre-existing conditions, no cap, and I can cover my kids.

    Plus I get a couple hundred bucks…. So, I buy a new pair of shoes, and working poor Trump voters lose coverage and die. MAGA!

    From a statistical view, you ARE their target audience…

    You just need to develop some selfishness, self-serving motives and a complete distain for others (special bonus points if the distain is for non-white non-Christians, and you can do so in an underhanded, sneering, non-direct way by insinuating “illegals” and “welfare”)

    You’d be in like Flint!

    Like or Dislike: Thumb up 14 Thumb down 0

  25. Dumb Brit says:

    Trumpdoesn’tCare

    Like or Dislike: Thumb up 3 Thumb down 0

  26. Grumpy Realist says:

    That’s why I have my dual-health-care idea. Those who think Teh Free Market automatically produces the best results can put their money where their mouth is, and the rest of us can work to solve collectively a big problem.

    Oh, and the last piece of my plan? All congresscritters and the POTUS have to find their own health care.

    Like or Dislike: Thumb up 2 Thumb down 0

  27. Daryl's other brother Darryl says:

    The American Hosptial Association:

    “We ask Congress to protect our patients, and find ways to maintain coverage for as many Americans as possible…We look forward to continuing to work with the Congress and the Administration on [Affordable Care Act] reform, but we cannot support The American Health Care Act in its current form.”

    Like or Dislike: Thumb up 9 Thumb down 0

  28. Scott says:

    @Grumpy Realist:

    All congresscritters and the POTUS have to find their own health care.

    I’m wondering about that also. The ACA, due to the spiteful Senator Grassley, forced Congress and staffs to buy their healthcare off the Exchanges. Obama bailed them out by having OPM give them taxpayer subsidies. I wonder if they took care of themselves in the repeal bill.

    Like or Dislike: Thumb up 6 Thumb down 0

  29. Terrye Cravens says:

    The American people waited 7 years for this train wreck. What a joke.

    Like or Dislike: Thumb up 5 Thumb down 0

  30. Hal_10000 says:

    Best summary I saw is that it keeps all the popular provisions of ACA without all the unpopular stuff that, you know, pays for it.

    Like or Dislike: Thumb up 4 Thumb down 0

  31. Hal_10000 says:

    @Michael:

    Republicans know exactly what they are accomplishing here. It’s a massive tax cut for the wealthiest Americans wrapped in a health care bill. It repeals $574.5 billion in tax increases on the wealthy.

    It’s kind of astonishing how “OMG! TAX CUTS FOR THE RICH!” shows up in every liberal/progressive/Democrat response to everything. It’s positively Pavlovian.

    Like or Dislike: Thumb up 0 Thumb down 13

  32. David M says:

    @Hal_10000:

    Do you seriously not understand that it is a massive tax cut for the rich? Or are you offended we pointed it out?

    Like or Dislike: Thumb up 11 Thumb down 0

  33. Jen says:

    @Hal_10000: To be fair, the Republicans in Congress *do* seem remarkably adept at putting tax cuts into everything.

    “Tax cuts for the rich!” might be a reflexive comment, but it appears to be an accurate one.

    Illud est quod est.

    Like or Dislike: Thumb up 10 Thumb down 0

  34. Moosebreath says:

    @Hal_10000:

    “It’s kind of astonishing how “OMG! TAX CUTS FOR THE RICH!” shows up in every liberal/progressive/Democrat response to everything. It’s positively Pavlovian.”

    Yes, it is astonishing that people actually look to who gains and who loses when legislation is proposed. It’s also astonishing that every single Republican plan on any domestic issue whatsoever can be boiled down to class warfare on behalf of the upper classes.

    Like or Dislike: Thumb up 14 Thumb down 0

  35. EddieInCA(but not today) says:

    @Hal_10000:

    Hal –

    You’re smarter than this.

    It IS a Tax Cut For The Rich. It it.

    It’s an unworkable plan. It offers several great parts, without any mechanism for which to pay for them.

    Like or Dislike: Thumb up 6 Thumb down 0

  36. Gustopher says:

    The 30% premium increase for people with a gap in coverage gives me a business idea — cheap, shitty “insurance” that pays out nothing, but which costs less than that premium penalty.

    It is Christian Science based — so, no medical care, just some prayers. Should be cheap to operate, and protected due to religious freedom!

    I collect one month, dump the person (or they dump me because they want coverage for something other than someone to pray for them), and now they are back in the health insurance game with a certificate of coverage! Care delayed by one month.

    Like or Dislike: Thumb up 6 Thumb down 0

  37. Just 'nutha ig'nint cracker says:

    @David M: I’d go with your second choice if I were you.

    Democrats denounced the effort as a cruel attempt to strip Americans of their health care.

    Oh non, non, non mes enfants; eopseyo! It’s not only a cruel attempt to strip Americans of their health care; it’s also a scheme to fine them for not keeping their policies after the market prices them out. We have to have an incentive for the poor to carry health insurance. We’ve eliminated subsidy as an incentive, so we need to turn to fines as a disincentive. See?

    Like or Dislike: Thumb up 2 Thumb down 0

  38. Hal_10000 says:

    @David M:

    I understand that if you’re going to dismantle the ACA, that means removing the taxes it imposed. And i understand, that to Democrats, soaking the rich for more taxes is the end-all, be-all of economic policy. If Trump proposed single payer and it cut taxes for the rich, it would be denounced.

    Noting that dismantling the ACA means removing its taxes is not the same as, “Republicans want to kill people to cut taxes”.

    Like or Dislike: Thumb up 2 Thumb down 10

  39. Just 'nutha ig'nint cracker says:

    @Moosebreath: Isn’t that what Warren Buffet was referring to when he said

    Yes, it is about class warfare, and right now, my class is kicking your class’s ass.

    Like or Dislike: Thumb up 7 Thumb down 0

  40. David M says:

    Killing a major revenue stream for Medicare, Medicaid and any other health care is kind of a big deal. And it should be pointed out that it’s for upper class tax cuts, no matter how uncomfortable that truth is for some people.

    Like or Dislike: Thumb up 7 Thumb down 0

  41. Gustopher says:

    I believe it gets rid of the lifetime cap, but not the annual cap. And does not mandate a set of basic coverage.

    So, you can craft a plan designed to drive away anyone as soon as they get sick, by having key gaps in coverage or a low annual cap. Nice.

    Like or Dislike: Thumb up 1 Thumb down 0

  42. Gustopher says:

    @Hal_10000:

    If Trump proposed single payer and it cut taxes for the rich, it would be denounced.

    if Trump proposed single payer that cut taxes (even if only on the rich) and was still able to pay for itself, and provide good benefits, people would embrace it and him.

    He will also have done the impossible.

    This plan is denounced because it is a shitty plan, which is also a big giveaway to the rich. But, mostly because it doesn’t solve the problems, and is massively underfunded. $10B for high risk pools is a sad joke. Replacing subsidies with nonrefundable tax credits is a sad joke. Eliminating minimum coverage is a sad joke.

    Like or Dislike: Thumb up 9 Thumb down 0

  43. David M says:

    @Hal_10000:

    Not true. Without revenue, there isn’t any chance of a decent program.

    And you clearly don’t understand the point of health care reform if you think Democrats wouldn’t trade upper class tax cuts for single payer.

    I’m not sure whether you don’t understand this issue at all, or just aren’t willing to have a good faith discussion.

    Like or Dislike: Thumb up 6 Thumb down 0

  44. Hal_10000 says:

    My last comment was made in haste (I’m packing for return to the US), so let me expand on it now that I have a second.

    I’m well aware of the GOP’s dementia on tax cuts, which they see as an end in an of itself. I have long opposed tax cuts until the budget is balanced (and no tax cuts don’t pay for themselves). My preferred tax reform is a 1986-style reform that increases revenue but reduces the deadweight loss of the system.

    But if you think the opposition to ACA only about cutting taxes, you are mistaken. It makes for a glib talking point — glib talking points being the ultimate in politics these days. But it ignores the big premium increases that have accompanied Obamacare and just how close we’re getting to a death spiral. My own employer just massively raised overhead rates to try to keep up. It ignores the fundamental opposition many conservative have to give-aways and subsidies and the danger they see in dependency. It ignores the danger many see in further regulation of an already heavily-regulated marketplace. And it ignores that this GOP healthcare bill is a piece of garbage mainly because it is trying to balance out too many things. Like everyone else in the healthcare debate, the GOP is trying to pretend there are no tradeoffs.

    My point, however, is that there is an equal and opposite dementia in the Left that favors tax hikes above all else. It’s seen in Vermont and Colorado rejecting single payer once it became clear it could not be financed just with taxes on the rich. It’s seen in Washington where a carbon tax was rejected by the Left because it was made revenue neutral by cutting sales taxes. It showed up in the absolute rage that filled my feed when Obama cut a budget deal with the GOP that didn’t raise taxes on the rich enough. It shows up in every proposal from Democrats keying off raising taxes on the rich to the point where many conservatives believe that raising taxes on the rich is the ONLY point of those policies.

    The GOP position I can at least sympathize with, even if I often disagree with it. It’s their money and they don’t want the government taking it. However, the pathological Dem desire to tax those damned rich people is something I have never understood and never will.

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  45. DrDaveT says:

    @Hal_10000:

    The GOP position I can at least sympathize with, even if I often disagree with it. It’s their money and they don’t want the government taking it. However, the pathological Dem desire to tax those damned rich people is something I have never understood and never will.

    I can see that.

    You really haven’t twigged to the fact that this is not, in fact, about penalizing the rich? That it is about not just wealth inequality, but the TREND in wealth inequality? That all wealth naturally tends to flow to the already wealthy unless active measures are taken to prevent that? And that this is fundamentally unhealthy for society?

    A primary role of government is to ensure — artificially! — that wealth does not flow uphill without limit. That doesn’t have to be ideology; it’s just good management. If Republicans really wanted to encourage long-term economic prosperity, they’d be for it also. This is one of the ways we know that they are not, in fact, interested in long-term economic prosperity, but are instead either (1) personally greedy, or (2) in the throes of a religious conviction that poverty is a stigma of sin.

    Like or Dislike: Thumb up 7 Thumb down 1

  46. David M says:

    @Hal_10000:

    Are there people one left who wanat to raise taxes on the rich? Yes. But how is that fact relevant to this conversation or topic?

    In this case, the GOP is trying to repeal the parts of Obamacare they want to repeal. They are changing the parts they want to change. They are under no obligation to repeal anything, they are doing this of their own volition.

    And so, it’s becoming clear the GOP place a high priority on cutting taxes for the 1%, and are willing to end insurance coverage for millions of people in furtherance of that goal.

    It’s worth reminding you that the premium increases are not out of line or unexpected, and talk of a “death spiral” are indicative of a fundamental misunderstanding of how Obamacare works.

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  47. Hal_10000 says:

    @David M:

    Are there people one left who wanat to raise taxes on the rich? Yes. But how is that fact relevant to this conversation or topic?

    Literally, the first and most popular criticisms of the GOP plan are “it cuts taxes for the rich”.

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  48. Matt says:

    @Hal_10000: Yes if the only part of the criticisms you pay attention to is those related to taxes….

    https://www.youtube.com/watch?v=QPKKQnijnsM

    Here in the real world the concentration of wealth in the hands of the few is causing all kinds of problems. But that’s okay because as long as you have your tax cut you’re fine with it because fck the other 90% of the country.

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  49. David M says:

    @Hal_10000:

    That doesn’t mean it’s wrong. It’s a recognition of how difficult properly funding health care is. The GOP could reform and improve health care, which shouldn’t be difficult if Obamacare is in as bad of shape as they say. It probably would require more funding, so they would have to compromise. The fact they want to cut taxes on the 1% rather than provide health care to millions is basically the entire issue. I’m not sure what else the GOP is actually getting out of this particular repeal attempt.

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  50. michael reynolds says:

    @Hal_10000:

    No, the first criticism is that it’s going to kill people. So that rich people can save a few bucks. Effect + Motive.

    It’s reversing causation to accuse the Left of criticizing the Right for doing precisely what we all knew the Right was going to do. They acted, we reacted.

    Like or Dislike: Thumb up 12 Thumb down 0

  51. rachel says:

    @Just ‘nutha ig’nint cracker:

    Oh non, non, non mes enfants; eopseyo!

    Don’t you mean ‘animnida’?

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  52. MarkedMan says:

    @Gustopher:

    cheap, shitty “insurance” that pays out nothing, but which costs less than that premium penalty.

    Ah, now you understand the Republican fascination with selling insurance across state lines. Some loser Republican state’s insurance commission would allow such a plan, and no decent state could prevent it from being sold.

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  53. Mr. Prosser says:

    @DrDaveT: @Argon: Republicare, Republicare, Republicare.

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  54. Pch101 says:

    Just more evidence that “Republican who understands how markets work” is an oxymoron.

    Like or Dislike: Thumb up 2 Thumb down 0

  55. Monala says:

    @MarkedMan: Gustopher’s plan is somewhat altruistic. By offering short term junk policies, he’d help people avoid the 30% premium hike they’d otherwise face due to a gap in coverage.

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  56. al-Alameda says:

    What many people do not know about ACA, is that with Medicaid expansion, many rural clinics and medical centers that serve a significant low income, often uninsured population, were benefitted greatly by ACA because it (ACA) ensured that there was a stronger revenue flow to cover the fees that sustain these clinics.

    The economics of maintaining medical centers in rural areas is daunting, and when you’re serving low income uninsured people the reliability of the revenue stream from fees is critical to sustaining medical resources in underserved areas. Here in California ACA has made a big difference.

    Not that any of this matters to most Republicans, after all, these low income folks in rural areas need to make a choice between having a $700 iPhone and putting that money into an HSA (or purchasing tax advice on how to utilize tax credits).

    Like or Dislike: Thumb up 4 Thumb down 0

  57. KM says:

    @Hal_10000:

    The GOP position I can at least sympathize with, even if I often disagree with it. It’s their money and they don’t want the government taking it. However, the pathological Dem desire to tax those damned rich people is something I have never understood and never will.

    Because the literal alternative is to tax the poor. Seriously, its basic math: you have 100 people, 1 with $1 million, 10 with $100,000, 20 with $10,000 and the rest with $100. If you needed to raise $50K, who are you going to hit up? You get (pardon the pun) more bang for your buck by having the millionaire pay more with the thousandaires kicking in some then chasing some poor shmuck with a benjamin to his name. The millionaire can lose the whole amount and not feel it but everyone else would see that as a significant chunk of their income. If you are not taxing the rich, you are taxing the rest of America and they notice it in their weekly paychecks.

    There’s also the rather unpleasant but true consideration that just because you have more money then most doesn’t mean you deserve to keep it. In America we like to lie to ourselves and say the rich got that way because they worked hard / were smart about investing or business / make good fiscal choices /etc. The truth is a lot of the rich get that way because they were born on third base and sauntered to a home run but want credit for knocking it out of the park. Why in the world do you deserve to keep your money instead of the guy that makes the fries at McDonald’s? What makes you so damn special that your “hard work” at the office is more fiscally deserving then guy picking your arugula?

    Instead of being grateful you have enough to give that people *can* ask you for more, the rich whine that everyone has their hand out for the money they liberated from others. A concept that gets lost is that there’s really only so much money you need to live, a second limit for what you need to live comfortably and spoiled and then just plain old excess for the hell of it. If it’s not costing you your house, not stressing you out to pay a bill, preventing you from buying what you want or even interfering with your yearly vacay, then frankly STFU. There’s a word for wanting to keep something you don’t really need but others do: greed. Call it what it is.

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  58. mom of 4 says:

    Just out of curiosity…

    So let’s say we get rid of the ACA/Obamacare/Trumpcare/whatever you want to call it…and go back to the pre-2010 days of insurance…because this is what some people want…

    Does anyone really think that their health costs (employer provided or self-funded) will really go down? I get that there is quite a few people who have been hurt by the ACA/Obamacare. Premiums going up 20% (or more…some way more). However, when I look back at our employer provided insurance, the cost to my family and my husband’s firm was skyrocketing even before 2010. There is also quite a few who have been helped by this (through subsidies, non-denial of pre-existing conditions, no caps, etc.).

    Back when health insurance started, it was for catastrophic coverage…accidents, cancer, etc. Insurance companies got wise that if they covered basic healthcare, people stayed healthier and they had to pay out less (generally…or at least that was what was thought). So health insurance became health care insurance. And we Americans got used to that.

    I guess I’m trying to figure out how the current plan (ACA/Obamacare) or the proposed plan (Trump/Ryancare) will ever decrease healthcare costs for anyone…or even scapping the whole thing ala pre-2010. I just don’t see in ANY current plan or proposed plan any lowering of healthcare costs (except my taxes will go down…which only hurts others…ugh).

    And how long with insurance companies continue to offer just “catastrophic” insurance (a plan you could pick with the proposed plan) when keeping people healthy is better for their bottom line?

    I’m not sure there is a viable solution…something that Trump didn’t seem to understand (how the hell not?) when he tweeted that no one knew how complicated health care could be…uh, I’m not the brightest bulb in the planet, but even I knew that one. I would like to see a plan that truly reigns in costs. I haven’t seen it, and not sure I ever will. In that case, I’d rather just stick to the current plan.

    Like or Dislike: Thumb up 7 Thumb down 0

  59. KM says:

    @mom of 4:

    Does anyone really think that their health costs (employer provided or self-funded) will really go down?

    Yes, they really really do. And they are in for a rude surprise.

    But what do you expect when they’ve been lied to for almost a decade and told this was the major cause of all their woes? These are people who believe Donald freaking Trump tells them the truth via 2am tweets – logical thought is not their strength.

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  60. Daryl's other brother Darryl says:

    The AARP is not happy…

    Like or Dislike: Thumb up 1 Thumb down 0

  61. KM says:

    @Daryl’s other brother Darryl :

    The AARP is not happy…

    *gasp* You mean screwing over older voters in favor of the rich might piss off an very important voting block? Especially since they voted for him in the first place and were cool with the poor getting screwed on this deal? Wow, its almost like the GOP DGAF about their constituents anymore…….

    Like or Dislike: Thumb up 4 Thumb down 0

  62. Pch101 says:

    @Hal_10000:

    If you want to provide a $100,000 service to someone who can’t afford it, then how else would you propose to pay for it?

    Again, I find it odd that people who rely upon their political affiliation to claim that they have some unique understanding of markets appear to have zero understanding of markets.

    Perhaps the right has some secret plan to make heart surgery or chemotherapy that costs $59.00 at Sam’s Club, but you’ll have to forgive me if I have my doubts.

    Like or Dislike: Thumb up 8 Thumb down 0

  63. Daryl's other brother Darryl says:

    This is a fantastic explainer of the pickle that Republicans have gotten themselves into by lying about Obamacare for all these years…
    http://www.vox.com/2017/3/8/14843762/ahca-republican-lies-obamacare
    They just should have been clear about their motives…cutting taxes is primary and the well-being of their constituents matters not.

    Like or Dislike: Thumb up 1 Thumb down 0

  64. michael reynolds says:

    @Hal_10000:

    By the way, turns out I get much more than a pair of shoes out ACA repeal. I get $6,750! Wow! Which means basically fwck-all to me but would cover a family. So I get money I don’t much need, and someone dies for lack of medicine. Why exactly is that a good idea?

    Like or Dislike: Thumb up 3 Thumb down 0

  65. al-Alameda says:

    @mom of 4:

    Does anyone really think that their health costs (employer provided or self-funded) will really go down? I get that there is quite a few people who have been hurt by the ACA/Obamacare. Premiums going up 20% (or more…some way more). However, when I look back at our employer provided insurance, the cost to my family and my husband’s firm was skyrocketing even before 2010.

    People who blame big premium increases solely on ACA are looking at anecdotal information. The trend is that the rate of increase in healthcare costs finally slowed during the Obama years.

    From about 1993 until 2010, in my capacity as a finance officer and contracts manager, I received the annual notices of increases in our group plan premium rates. Those annual increases ranged from 9% in the early 1990’s to 12%, then 15%, 18% and finally over 20%. We had to move to higher deductible HSA plans to stop the bleeding.

    Like or Dislike: Thumb up 3 Thumb down 0

  66. Monala says:

    I notice that the parts of Obamacare that this plan would keep are the parts that benefit affluent people. After all, if you’re part of the top 10% but not the top 1%, you (or your kids) could still have a pre-existing condition that insurers might want to deny, or a devastating illness or injury that costs more to cover than some annual or lifetime insurance cap. And since you’re not in that 1%, that could bankrupt you without ACA-type protections. So of course those parts are retained, and so what if poor people get screwed over…

    Like or Dislike: Thumb up 1 Thumb down 0

  67. Monala says:

    @KM: Thank you, thank you, thank you! Well said.

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  68. mom of 4 says:

    @al-Alameda:

    That’s exactly my point. I think people are going to be in for a big surprise when they realize that they health care costs *aren’t* coming down. Insurance companies, even if they get to kick off the sick and elderly, certainly aren’t going to lower your premium. And deductibles will go up. Even for those of us with employer provided health insurance. I think people just didn’t notice how much health insurance was going up until it was pointed out to them…AFTER the ACA was passed. Conveniently forget that it was skyrocketing health care costs that was the whole impetus for the ACA.

    Then again, our esteemed President promised better and cheaper health insurance….and people believed him. He will deliver this. He promised! (sarcasm). But hey, I’m in Michael Reynolds boat…my family will get a bunch of money back…our taxes went up almost $30k after the ACA took effect…er, at least that’s what hubby tells me…I didn’t notice…and won’t notice the money we get back. We are close to retirement and will just sock it away…along with the other tax breaks we will get that the President has promised us…we won’t be stimulating the economy…we plan to travel (outside the US) a lot during our retirement years…more $ for that!

    Like or Dislike: Thumb up 1 Thumb down 0

  69. mom of 4 says:

    Ok…I tried to edit my spelling…I’m kinda a stickler…but not sure if it did, so…believe, not belive…

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  70. DrDaveT says:

    @Pch101:

    Just more evidence that “Republican who understands how markets work” is an oxymoron.

    Not true! There are many Republicans who understand very well how markets work, and are working hard to make sure that as few voters as possible figure it out.

    Like or Dislike: Thumb up 3 Thumb down 0

  71. Mikey says:

    @DrDaveT:

    in the throes of a religious conviction that poverty is a stigma of sin

    That, and also the converse: that wealth is an exaltation of goodness.

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  72. An Interested Party says:

    @KM: This should be permanently tattooed on the eyeballs of anyone who ever whines about how horribly rich people are treated and what a raw deal they allegedly get…the poor dears…

    I’m not sure there is a viable solution…something that Trump didn’t seem to understand (how the hell not?) when he tweeted that no one knew how complicated health care could be…

    Surely you aren’t surprised that there are a lot of things that Trump doesn’t understand…

    Like or Dislike: Thumb up 1 Thumb down 0

  73. Just 'nutha ig'nint cracker says:

    @rachel: Animnida is more formal. Among friends eopseyo was more common, at least in the places where I lived. Both work equally well. My English alphabet spelling may also be throwing you off; if I wrote eobs se yo, would that make more sense?

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  74. Just 'nutha ig'nint cracker says:

    @KM:

    Wow, its almost like the GOP DGAF about their constituents anymore…….

    Wait… When did the GOP give a frock about their constituents–beyond the ones who were members of their country club, I mean?

    Like or Dislike: Thumb up 1 Thumb down 0

  75. Just 'nutha ig'nint cracker says:

    @michael reynolds: Because the $6750 looks better in your wallet than applied to someone else’s health care insurance bill? Just blue skying here, you understand, but that what wealthier people have told me about similar issues in the past–the money looks better (to them) in their wallet than it does in mine.

    So these are actually aesthetic choices, you see.

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  76. al-Alameda says:

    @mom of 4:

    That’s exactly my point. I think people are going to be in for a big surprise when they realize that they health care costs *aren’t* coming down. Insurance companies, even if they get to kick off the sick and elderly, certainly aren’t going to lower your premium.

    You’re right.

    Also, a big problem the Obama Administration had here is that most people get their health insurance through employer offerings, and employers usually pay a significant share of employee coverage, and sometimes of spouse and family coverage.

    Which is to say, most people do not directly pay for their health insurance premiums.

    Therefore, unless their employer was passing on the full cost of these increased premium rates to their employees, they were feeling no negative effect from the annual double-digit percentage increases in the premiums.

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