Saturday, December 17, 2016

Ongoing Obamacare Schadenfreude

Will it morph into Trumpcare Schadenfreude? Priebus: Repeal and then replace coming first

How To Repeal Obamacare: Repeal Obamacare. They campaigned on repealing it, they won, they should do it. Republicans plan on repealing ObamaCare “within weeks” of Trump inauguration. I don't have any confidence in that, but the time to do it is early, as soon as you can line up a reasonable path forward.
According to Senate rules, reconciliation bills cannot be filibustered, which is why Republicans only need 51 votes to succeed. They do, however, require a presidential signature, so they will have to time the bill in order to avoid Barack Obama’s veto pen (and phone). Donald Trump will take the oath of office less than three weeks after the start of the session, so it’s not going to happen until then — and might take a bit longer, since the budget resolution itself will still get debate and editing along the way. The 2017 fiscal year has only been set through the end of April thanks to the use of continuing resolutions, so there still may be a few contentious issues left to hammer out. And be sure to real all of Klein’s lengthy report, which touches on some of the differences between Paul Ryan and Mitch McConnell about what can and cannot go into a reconciliation package.
Trump won’t take a ‘wrecking ball’ to ObamaCare The coverage for preexisting conditions, kids up to 27 etc are too popular. Unfortunately the means to pay for them (the mandate and things like medical device tax) aren't. But is Trump taking aim at Obama’s Medicaid expansion with CMS pick?
Verma has worked with VP-elect Mike Pence to produce a compromise on Medicaid expansion in Indiana, and then did the same in Kentucky and other states run by Republican governors. Verma helped them avoid some of the pitfalls of the expansion when they came under heavy political pressure to join the expansion. Thanks to her work, some governors were able to salvage HSAs and work requirements as part of their packages — although conservatives still howled when these states joined the expansion.

This pick addresses one of the stickier questions for Republicans after repeal: what next? Democrats have already begun to focus their attacks on repeal by accusing the GOP and Trump of leaving low-income Americans out in the cold by rolling back the Medicaid expansion as part of the repeal. Verma has worked on this issue for years, and should be able to work out a transition plan quickly to reduce the impact of repeal on these recipients, and therefore the political liabilities of ObamaCare repeal.
Trying it's best to find something wrong with it, the Washington Post thinks the New push to replace Obamacare reignites old GOP tensions. It's tough when you win, because then you actually have to make choices.
“I’d like to do it tomorrow, but reality is another matter sometimes,” said Sen. Orrin G. Hatch (R-Utah), chairman of the Senate Finance Committee, which will help lead the “repeal and replace” efforts. “We have to live with the real world. And the real world right now is that the Democrats won’t help with anything.”
Obstructionists! But wait, in a bold bid for relevance,  Senate Dems: Say, we may want to help replace ObamaCare too. Pelosi: Republicans won’t repeal Obamacare now that people have found out what’s in it. I do wonder what color the sky is in her world. US taxpayers’ bill for ObamaCare premium hikes: $10 billion extra in 2017.

Did Obamacare Really Insure 20 Million?  Will Obamacare Repeal Really Leave 30 Million without Insurance? No and no. G.O.P. Plans to Replace Health Care Law With ‘Universal Access’
House Republicans, responding to criticism that repealing the Affordable Care Act would leave millions without health insurance, said on Thursday that their goal in replacing President Obama’s health law was to guarantee “universal access” to health care and coverage, not necessarily to ensure that everyone actually has insurance.
. . .
“Our goal here is to make sure that everybody can buy coverage or find coverage if they choose to,” a House leadership aide told journalists on the condition of anonymity at a health care briefing organized by Republican leaders.
NY Times Wonders If It’s OK To Lie To Get Faith Based Insurance, Because Ocare Is Really Expensive And Failing. Would a New Yorker deny gay marriage, the right of boys to go in girls bathrooms, and abstaining from premarital sex to cheat the hillbillies in flyover country to get cheap healthcare? Wait, she's thinking about it.

Death Panels: Obamacare IPAB Repeal Can’t Wait Three Years
For some reason, Republicans want to delay Obamacare repeal for three years. The Manhattan Project detonated the world’s first nuclear bomb in less time, but the U.S. healthcare industry supposedly needs 36 months to go back to how things were six years ago.
. . .
For example, the law’s rationing mechanism — officially called “Independent Payment Advisory Board” or, colloquially, the Obamacare “death panels” — is still in place and threatens to cause major damage to the health care system.

IPAB is designed to take authority from elected officials and place it in the hands of unelected bureaucrats at the Department of Health and Human Services. Its purpose is to shield the rationing decisions from public accountability.

For example, the law makes it illegal for the president to fire any of the panel’s members. And Obamacare actually tries to prohibit any future Congress from repealing IPAB, something that is brazenly unconstitutional but has yet to be adjudicated in court.
. . .
To summarize, Obamacare has set in motion a board of unelected bureaucrats tasked with establishing price controls on autopilot. Are we supposed to just watch the train wreck, while Republicans debate the finer points of health care policy for three years?

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