Friday, March 10, 2017

The Repeal and Replacement of Obamacare Schadenfreude Proceeding Apace

It's going to be Trumpcare Schadenfreude; I can see it already. The Republicans are finally getting ready to do something about Obamacare, and it seems like nobody but Paul Ryan and Donald Trump are happy about it

Why is it such a problem? President Trump Needs To Keep His Promises No Matter How Hard The Haters Squeal. And squeal they will. Be Patient, There are a 'Lot of Things to Unscrew' from Obamacare. But the GOP was against closed-door Obamacare deals before they were for them. Yes, but it's easier to get things done behind closed doors. Jason Chaffetz on new GOP plan: Poorer people may need to choose between that iPhone and investing in health care. No, no! Not that!

Drum please! House GOP Releases Plan to Repeal, Replace Obamacare.
The legislation would provide tax credits to people who don’t get coverage through their job, replacing the subsidies the ACA gave to a narrower set of lower-income people to help them afford insurance policies.
The proposal wouldn’t kill the ACA’s exchanges where people can obtain insurance, but far fewer people are expected to use them because the subsidies that reduce premium costs would no longer exist. Those subsidies are only available now to people who obtain coverage through the state and federal ACA exchanges.
The refundable tax credits have been a thorny issue for Republicans. Conservative Republicans vowed not to support an earlier draft that would have provided the tax credits regardless of income.
Under the House GOP proposal released Monday, the refundable tax credits would be tied to age, with people under 30 eligible for a credit of $2,000 per year, increasing steadily to $4,000 for those over 60. The size of a tax credit would grow with the size of a family, but would be capped at $14,000.
To assuage the concern among conservative lawmakers that the credits would be available to wealthy Americans, the tax credits would start to shrink for individuals making more than $75,000 or households making more than $150,000. For every $1,000 in income over $75,000, the tax credit would be reduced by $100.
What the legislation doesn’t appear to do is create a national market for health insurance, and instead keeps in place our current system of having 50 little state-based insurance fiefdoms — which limits risk pools and, more critically, competition between insurers.

Another complaint against ObamaCare is that it hugely increased the regulatory burden on doctors, clinics, and hospitals, but it’s impossible to tell from this story if the GOP legislation repeals any of that.

Rand Paul calls it “ObamaCare Lite” and says he won’t vote for it.
Second committee advances ObamaCare repeal legislation:
The House Energy and Commerce Committee advanced GOP legislation to repeal and replace ObamaCare, titled the American Health Care Act, on a party-line vote Thursday afternoon, after 27 hours of continuous debate.
Rep. Gohmert: Don't let Robert Byrd's 'KKK rule' stop Obamacare repeal
Speaking on Fox News Wednesday afternoon, U.S. Rep. Louie Gohmert, R-Texas (A, 98%) dismissed concerns that Republicans cannot fully repeal Obamacare with the budget reconciliation process under what Gohmert derogatorily referred to as “the KKK rule,” an arcane part of Senate procedure called the “Byrd rule,” named for the late Sen. Robert Byrd.
McConnell: ObamaCare repeal-replace plan will go right to the floor after House passage
Cato Institute: The House GOP Leadership’s Health Care Bill Is ObamaCare-Lite — Or WorseAbandon ship: Conservative groups turn on House GOP’s ObamaCare billTrumpCare Bill Lays Bare the Schism in the Republican PartyRand smash! Sen Paul takes spineless GOP and RINOcare to task.

The Washington Post is not a fan either: House Republicans release long-awaited plan to replace Obamacare
And four key Republican senators, all from states that opted to expand Medicaid under the ACA, said they would oppose any new plan that would leave millions of Americans uninsured.

“We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states,” Sens. Rob Portman (Ohio), Shelley Moore Capito (W.Va.), Cory Gardner (Colo.) and Lisa Murkowski (Alaska) wrote in a letter to Senate Majority Leader Mitch McConnell (R-Ky.).
. . .
Democrats, meanwhile, have given no indication that they intend to work with Republicans, and top party leaders decried the GOP plan Monday as a betrayal of everyday Americans. “Trumpcare doesn’t replace the Affordable Care Act, it forces millions of Americans to pay more for less care,” said Senate Minority Leader Charles E. Schumer (D-N.Y.).
The non-mandate mandate:  Conservatives on Twitter are also buzzing about this section, which some are reading as a mandate:
That’s not a true mandate in the sense that you’re (apparently) not required by law to have insurance and forced to pay a penalty if you don’t, but if you don’t sign up before 2019 you’re staring at a situation where your plan will be 30 percent more expensive if/when you do eventually decide to buy insurance. They’re trying to deter people from gaming the system when insurers are required to cover treatment for preexisting conditions, which the new GOP bill achieves. If you’re allowed to buy insurance as soon as you get sick, you’re getting all the benefits of the policy without having paid anything into it in advance. In that case, you’ve eliminated risk and turned insurance into a pure welfare program. The provision above would penalize people for that by slapping a 30 percent fee on them if they waited to get covered until they suddenly needed insurance.
In effect, much of the "sugar" in Obamacare has been preserved, but much of the sour (the stuff meant to keep it from ballooning out of control) was preserved. House Republicans Unveil ACA Replacement Plan, Eliminating Obamacare’s Taxes and Mandates.
House Republicans introduced legislation to replace the Affordable Care Act on Monday night. The American Health Care Act attempts to deliver relief to the American people from Obamacare's taxes and regulatory mandates.

Republicans have introduced multiple proposals to replace Obamacare leading up to this point and now the American Health Care Act serves as the replacement that lawmakers, along with President Trump, have chosen to put before the Energy and Commerce and Ways and Means committees this week for mark-up.

The act will keep some of Obamacare's popular provisions, including protecting individuals with preexisting conditions from the denial of coverage or increased costs and allowing young people to stay on their parents' plan until they are 26.
Hence Philip Klein at the Washington Examiner:  Republican Obamacare plan signals that liberalism has already won.
Ultimately, it doesn't do much to foster the development of a free market system. Under GOPcare, individuals would not be able to take insurance with them from job to job, because tax credits would not be available to people who have an offer of job-based insurance. They would not be able to purchase whatever plan they want, because the federal government will still be dictating what has to be in insurance policies, making insurance more expensive then it needs to be. If this bill passes, everybody would have to get their insurance either through government, their employer via tax subsidy, or be left to purchase government-designed health policies using federal subsidies.
House Republican plan would create Obamacare cliff for 2020 presidential election

Two! That's right, two, from the almost invariably sensible Megan McArdle via Wombat-socho's "In The Mailbox: 03.08.17" and and "In The Mailbox: 03.10.17". First, The Republican Plan Is Even Worse Than Obamacare
If Republicans manage to pass this, they will richly deserve it when voters blame them for the resulting havoc it will wreak in the individual market.
Second, Republicans Should Kill Obamacare or Let It Die. The prospect of letting it finish strangling itself in contradictions is pleasing as a lesson to the public on the price of listening to democrats is pretty pleasing. It's also a natural outgrowth of respecting the democratic process, and allowing the democrats to veto it, without going nuclear. Make the democrats continue to pay the price.

PowerLine asks Are the Republicans Blowing it on Obamacare? If you have to ask, they probably are. But in another article Is GOP Health Care a Disaster? No! Well, not yet anyway. House bill is WORSE than leaving Obamacare in place! – Daniel Horowitz tells Mark Levin

But have no fear, Trump is here. Conservatives looking to bargain with Trump, Ryan on Obamacare. Let's make a deal, a really huge, big league deal. Trump says privately second healthcare bill ready as early as next week
The new legislation would differ from the plan presently working its way through the House in that it would not proceed through budget reconciliation and would therefore require cloture in the Senate. Because Republicans intend to pass the healthcare bill introduced this week using budgetary procedures, they will only need a simple majority to shepherd it through the Senate, where the new piece of healthcare legislation would need at least 60 votes to survive.
. . .
That attendee suggested the absence of one of Trump's key healthcare promises — the ability to purchase health insurance plans across state lines — from the current bill is concerning because the provision is unlikely to survive the legislative process if Republicans attempt to stick it in the second bill.
White House Rules Out ‘Wholesale Replacement’ Of Healthcare BillTrump paints ‘beautiful picture’ of new health care plan amid GOP concerns. We can hope, I guess.

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