The Affordable Care Act II - Because Mr. Obama Loves You All

[Magox]

 

I can't help but get this feeling that the next two years are going to be Congress relentlessly poking itself in the eye with a sharp stick.

 

 

House Republicans are a bunch of clowns. They were elected to oppose and now that they have power they don't know how to wield it. They deserve all the ridicule in the world, the irony is that the guys that are most responsible for this are the ones who are politically the safest as they come from districts that are uber conservative and the only way they'll lose their job is if they get out neanderthaled from their right flank during the primaries.

[Magox]

This is a good rundown from Larry Levitt, Kaiser foundation Sr. advisor.

 

Goes over what the HHS can do to undermine or support the markets. Things that I was going over. And also confirms what I had been saying that the ACA is not about to implode, only in certain areas does it face daunting challenges.

 

Politico: So when you were looking at the disagreements that sank the bill, did you think there were any kind of creative workarounds or middle-ground options that you thought people had left unturned?

Levitt: There was this idea of a stability pool—the hundred million dollars in grants to states that would go a long way toward keeping some markets that are now fragile. That hundred-million-dollar pool could go a long way toward stabilizing fragile markets around the country. This was the kind of thing that Republicans in the past called a bailout to insurers, but was a part of their own bills. It’s hard to imagine any congressional action at this point to shore up the ACA, but a grant pool like that could shore things up.

Politico: So what problem would that get around?

Levitt: So, by and large, insurance markets are stable under the ACA, but insurance risk is pooled at the state level, and there are some states where the markets are fragile, where premiums have increased substantially and in some cases, enrollment has started to drop. These markets are still well short of a death spiral, but there could be bigger premium increases to come in these places. And a pool of money that states could use to help cover the cost of a very expensive and sick people could help stabilize those markets. This is what I think people will be watching for in how the Trump administration responds. For example, in Tennessee, which is one of those markets that’s fragile, [the insurance company] Humana recently announced it is pulling out, and it will leave a number of counties in the state with literally no insurers participating. Now, under the Obama administration, there would be a lot of jawboning going on to try to get an insurer to offer coverage there—it’s not clear that will happen under this administration. That happened in Arizona this past year when there was a risk there might be no insurers participating.

Politico: So let’s say the Trump administration pulls out all of its tricks and goes after Obamacare. Do you think it could collapse?

Levitt: The worst case is there are parts of the country where there are no insurers offering coverage, and that could certainly happen, but it’s not going to be the case in the vast majority of the country. I don’t think that in the vast majority of states there’s a risk of collapse. But things could absolutely get worse, with fewer people enrolled and premiums rising fasters.

 

Politico Magazine: What do you think is next? Do you think they will just let Obamacare go, and what will that look like?

Larry Levitt: The Trump administration faces some tough decisions over what to do with the Affordable Care Act. The president has talked in the past about how the law is collapsing, and he has said maybe he’ll just let it collapse. The general consensus is that the law is actually not collapsing, and the Congressional Budget Office recently said that regionally, the insurance market would be stable under the ACA or the alternative the House GOP was considering. But the Trump administration could actively undermine the Affordable Care Act marketplaces or own them and work to improve them, from their perspective, and work to reshape it in a more conservative mold. I think the insurers are going to be watching very closely how the Trump administration approaches this in the next weeks and months.

Politico: You said they could reshape it. What would that look like?

Levitt: The administration has a lot of authority to reshape the law, both on the Medicaid side and the insurance marketplaces. There’s been this big fight over the essential benefits that insurers are required to provide, and the administration has some flexibility in altering those benefits administratively. There’s a lot the administration could do with state waivers, both to Medicaid and under the ACA.

Politico: So with the essential benefits, for instance, they could exempt some things from those?

Levitt: Well, so the statute lays out the 10 benefits that insurers have to provide, but within those broad categories, it’s up to the secretary of HHS to define the details. So HHS could allow insurers to set more limits on those benefits, could give states more leeway in defining them. There’s some limits to the authority: The benefits have to be comparable to a typical employer insurance policy, but you know, there’s still a lot they could do to alter the benefits. So the Pottery Barn rule does apply here: If they break it, they own it. From this point forward, anything that happens to the ACA belongs to the Trump administration.

 

 

It's a good substantive read, you know, things that people aren't interested in.

[TakeYouToTasker]

 

 

House Republicans are a bunch of clowns. They were elected to oppose and now that they have power they don't know how to wield it. They deserve all the ridicule in the world, the irony is that the guys that are most responsible for this are the ones who are politically the safest as they come from districts that are uber conservative and the only way they'll lose their job is if they get out neanderthaled from their right flank during the primaries.

Thats a macro-view revision.

 

Individuals were elected by what is essentially county. They represent their constituents.

 

Republicans are not Democrats. The issues that bind our coalition are not conducive to lock-step

Edited March 25, 2017 by TakeYouToTasker

[IDBillzFan]

 

To be fair, the DNC lost more seats in the Presidential Election (a buffoon), Governors and state houses to the GOP and failed to gain enough seats in congress to obstruct the GOP. So its not like the DNC has a whole lot to brag about.

 

You're trying to explain something to a person who actually repeats the ridiculous trope that the GOP wrote Obamacare.

 

There should be no surprise the only thing he has to write today is "Seven years and this is all you've got?"

 

That's not to say it's not completely true. It's just a handier way to identify those unable to think for themselves.

[Magox]

Thats a macro-view revision.

 

Individuals were elected by what is essentially county. They represent their constituents.

 

Republicans are not Democrats. The issues that bind our coalition are not conducive to lock-step

 

No TyTT, it is what we call reality which is something that you are vaguely familiar with.

[TakeYouToTasker]

 

No TyTT, it is what we call reality which is something that you are vaguely familiar with.

No. Reality is what just slapped you.

 

Reality is what I just described to you.

[Magox]

No. Reality is what just slapped you.

 

Reality is what I just described to you.

 

I don't really take what you say seriously TyTT.

[Joe Miner]

At the end of the day, the GOP has bitched about Obamacare for years, and the now that they have a shot to do something about it, they get all billsy at the goal line and lose.

 

If the Bills were a political party, they'd be the GOP.

[TakeYouToTasker]

 

I don't really take what you say seriously TyTT.

Which is fine, and also the reason people who believe as you do just lost a major political battle.

 

Enjoy that.

[Nanker]

Two large differences in the approach the Dems took eight years ago Vs. the Repubs this time.

The Dems took a full year to craft their backroom abortion.

The Repubs took about a month.

 

The Dems had a filibuster proof majority in Congress and Senate.

The Repubs don't.

[B-Large]

I can't help but get this feeling that the next two years are going to be Congress relentlessly poking itself in the eye with a sharp stick.

I have to think Tax Reform might be every bit as complicated to move on as Healthcare... maybe more so.... tackling that behemoth will be quite the endeavor, let's hope for minimal eye sticking and see what can get done.

[grinreaper]

I have to think Tax Reform might be every bit as complicated to move on as Healthcare... maybe more so.... tackling that behemoth will be quite the endeavor, let's hope for minimal eye sticking and see what can get done.

It may be complicated but the Republican party will be united and there will be some Dems who will cross over.

[Magox]

It may be complicated but the Republican party will be united and there will be some Dems who will cross over.

 

It's not just the votes, by not passing the Republican reconciliation bill, what they did is damage the Tax reform bill. How?

 

Well, you know those Trillion dollars in Obamacare tax cuts they had would have wiped out under their Reconciliation health bill? Well, now those taxes stay in place.

 

How does that affect the Tax reform bill? Those Trillion dollars in Obamacare tax cuts were going to help finance a decent portion of their Tax reform bill.

 

Now they have to figure out where they are going to get those Trillion dollars.

 

The unintended consequences of stupidity.

Edited March 25, 2017 by Magox

[B-Large]

It may be complicated but the Republican party will be united and there will be some Dems who will cross over.

will they be unified, that's a big question. Everybody has a sacred cows, I think It will be very interesting.... I do hope they succeed, though.

[gatorbait]

Major tax reform hasn't been accomplished since the 1980's. You could look at that in two ways: it is incredibly hard to overhaul the tax code, or we are due for reform. I could see him having some success playing around with tax rates, most likely for the wealthy. However, a large tax reform is not going to get done by the Repubs imo. Trump is going to find that nothing about being the president is easy.

[grinreaper]

will they be unified, that's a big question. Everybody has a sacred cows, I think It will be very interesting.... I do hope they succeed, though.

The Freedom Caucus will be behind it and Speaker Ryan and the mainstream republicans will support it along with some democrats. The Senate has too many democrat Senators up for reelection in red states to not help vote tax cuts in. The important provision will have to do with corporate tax rates. Getting them down is key to all the rest of Trump's agenda.

[Magox]

I don't think you guys understand the ramifications of not passing the reconciliation health bill does to Tax reform. It severely limits their hopes to reform the tax system, and most likely all they will be able to do are some cookie cutter style tax cuts.

 

Republicans’ spectacular failure to repeal and replace Obamacare threatens to sabotage another cornerstone of their agenda, tax reform — because of simple math.

The GOP was counting on wiping out nearly $1 trillion in Obamacare taxes to help finance the sweeping tax cuts they’ve got planned for their next legislative act. And now it’s unclear where all that money will come from.

While Obamacare taxes will remain, he said, “We’re going to fix the rest of the tax code.”“This does make tax reform more difficult, but it does not in any way make it impossible,” House Speaker Paul Ryan said at a news conference on Friday. “We will proceed with tax reform.”

But losing the revenue from Obamacare repeal is fueling speculation that Republicans will settle for just tax cuts rather than sweeping reform.

But now Republicans will have to look elsewhere for money to meet their top targets: bringing the corporate tax rate down to 20 percent from 35 percent, cutting the top individual tax rate to 33 percent from 39.6 percent, and generous new writeoffs for business investments.

“We’re going to analyze the complete impacts here. But clearly it makes a big challenge even more challenging," said House Ways and Means Chairman Kevin Brady (R-Texas).

Even if the Republican health care plan had succeeded, tax reform wasn't going to be easy. The House, Senate and businesses are already clashing over key elements of a House GOP plan, notably a provision known as "border adjustability" that would tax imports but not exports.

Ultimately the issue centers on House Republicans’ desire to pass a tax overhaul that would raise the same amount of money as the current tax code. Eliminating taxes tied to the Affordable Care Act would have made reform cheaper by pulling down the budget baseline of how much money was expected to come in to the federal government.

About $43 trillion in revenue is expected from the 2018 federal fiscal year through fiscal 2027, according to projections from the CBO, a sum that includes money raised by ACA taxes.

“That is a huge issue,” a corporate tax adviser and ex-House staffer said on condition of anonymity to protect client sensitivities.

But Republicans may have to trim their sails. Rather than dramatically rewriting the tax code, they might fall back on their bedrock policy of tax cuts, perhaps with a smattering of policy changes and money raisers to offset some of the cost.

 

 

Lawmakers closely aligned with the president are worried about the broader political consequences of failure to repeal the 2010 health law.

“If this goes down, we don’t get tax reform, we don’t get infrastructure,” said Chris Collins (R-N.Y.), the first lawmaker to back Trump’s campaign. “

 

[Pine Barrens Mafia]

It's starting this year, with insurers no longer receiving back end subsidies through reinsurance. It will come to a head when the states lose their federal subsidies.

Ill bet the subsidies are renewed before that happens

[B-Man]

How do Republicans get back on even terms or better? I’d like to them proceed along something like the following lines:

First, later in the year, House Republicans should put together a comprehensive health insurance reform bill. It should include elimination of the individual mandate (so-called Phase I), elimination of offending regulations (Phase II), and additional reforms aimed at freeing up the market and driving down costs (e.g. permitting insurance sales across state lines and tort reform — Phase III).

If such legislation is drafted in consultation with the various Republican blocs in the House, the leadership should be able to pass it. The inclusion of Phase II and Phase III stuff should make the bill sufficiently appealing to the Freedom Caucus.

(By the time the legislation is drafted, the Trump administration may be well on along the path to Phase II regulatory reform. However, such reform should be included in the bill anyway in order to preempt litigation attacking new regs and because a new administration might change the regs again).

When the legislation I’ve described reaches the Senate, Republicans should try to enact it through reconciliation. The Democrats will move to block this and the Senate parliamentarian will back them.

At this point, Republicans should try to enact the legislation through the normal procedure. They will fail due to lack of Democratic support.

But two things will have happened. First, the Republicans will have put forth a serious proposal that it can defend in the court of public opinion. Second, the Republicans will have a reasonable basis for blaming the Democrats for the failure to repeal and replace Obamacare. In fact, they can blame the Dems twice — for not allowing them to proceed through reconciliation and for filibustering the bill.

http://www.powerlineblog.com/archives/2017/03/how-to-reverse-this-weeks-obamacare-defeat.php

[Magox]

 

How do Republicans get back on even terms or better? I’d like to them proceed along something like the following lines:

First, later in the year, House Republicans should put together a comprehensive health insurance reform bill. It should include elimination of the individual mandate (so-called Phase I), elimination of offending regulations (Phase II), and additional reforms aimed at freeing up the market and driving down costs (e.g. permitting insurance sales across state lines and tort reform — Phase III).

If such legislation is drafted in consultation with the various Republican blocs in the House, the leadership should be able to pass it. The inclusion of Phase II and Phase III stuff should make the bill sufficiently appealing to the Freedom Caucus.

(By the time the legislation is drafted, the Trump administration may be well on along the path to Phase II regulatory reform. However, such reform should be included in the bill anyway in order to preempt litigation attacking new regs and because a new administration might change the regs again).

When the legislation I’ve described reaches the Senate, Republicans should try to enact it through reconciliation. The Democrats will move to block this and the Senate parliamentarian will back them.

At this point, Republicans should try to enact the legislation through the normal procedure. They will fail due to lack of Democratic support.

But two things will have happened. First, the Republicans will have put forth a serious proposal that it can defend in the court of public opinion. Second, the Republicans will have a reasonable basis for blaming the Democrats for the failure to repeal and replace Obamacare. In fact, they can blame the Dems twice — for not allowing them to proceed through reconciliation and for filibustering the bill.

http://www.powerlineblog.com/archives/2017/03/how-to-reverse-this-weeks-obamacare-defeat.php

 

 

 

First, later in the year, House Republicans should put together a comprehensive health insurance reform bill. It should include elimination of the individual mandate (so-called Phase I), elimination of offending regulations (Phase II), and additional reforms aimed at freeing up the market and driving down costs (e.g. permitting insurance sales across state lines and tort reform — Phase III).

 

 

 

He doesn't really detail Phase I, but from what I can see, there is very little difference between this proposal and what the ACHA would have done.