The Trump administration now believes that the entire Affordable Care Act should be struck down, a major shift in the federal government’s position and one that could endanger health coverage for millions of Americans with pre-existing conditions.
Throwing out the law would end healthcare coverage for millions of people – getting rid of publicly subsidized health insurance plans sold on exchanges, the expansion of Medicaid, protections for people with pre-existing conditions, and rules letting children stay on their parents’ insurance until the age of 26.
“The Department of Justice has determined that the district court’s judgment should be affirmed,” wrote Joseph Hunt, the assistant attorney general, and other lawyers in the new court filing.
The supreme court ruled in 2012 that the landmark healthcare law is constitutional.
But Texas and other states sued, arguing that Congress’s decision to end a tax penalty for people who don’t have health insurance as part of the 2017 tax overhaul made all of Obamacare invalid. The judge agreed.
Sick people would probably have to pay more under the health bill passed by the House, the Congressional Budget Office reports. Credit Ozier Muhammad/The New York Times
The Senate now has a clearer sense of the 41 million Americans who would lose under the health bill the House sent them by Donald Trump and the Republicans. It also got a startlingly direct message from government analysts about how destabilizing one of the House ideas could be.
The Congressional Budget Office published its assessment of the House health bill on Wednesday, and warned that a last-minute amendment made to win conservative votes would result in deeply dysfunctional markets for about a sixth of the population. In those places, insurance would fail to cover important medical services, and people with pre-existing illnesses could be shut out of coverage, the budget office said.
It found that about half the country would face thinner coverage for people who buy their own insurance, as it would be unlikely to include mental health and addiction treatment services, maternity care or rehabilitation services. Medical deductibles would also increase.
As in the original version of the bill, winners would include people who are young, healthy and earn higher incomes. They would be better off, assuming they didn’t develop serious health problems. The bill makes big cuts to taxes on payroll and investment income for those earning more than $200,000, and provides more subsidies to buy insurance for people earning between about $50,000 and $150,000. On average, premiums for health plans people buy for themselves would decline over the 10-year period, as coverage becomes less generous.
Losers would include poor Americans who use Medicaid, as 14 million fewer people would be in the program after 10 years. Poorer and older Americans who buy their own insurance, particularly those in both categories, would also lose coverage. The cost of insurance for a 64-year-old earning about $27,000 would increase to more than $13,000, from $1,700 under the Affordable Care Act, even for states that pared back insurance rules.
The report was sharply critical of the idea that sicker patients could be protected in a system that allowed insurers to charge them higher premiums. In the minority of states it predicted would pursue broad waivers of Obamacare’s insurance regulations, the office said that sick customers would face far higher prices and many would be priced out of the market altogether.
The bill would save the federal government $119 billion in a decade.
The largest savings would come from cutting Medicaid and reducing tax credits for middle-income insurance buyers.
Projected cumulative change in deficit, in billions
Because Republicans are using a special legislative process to avoid a filibuster in the Senate, the bill had to comply with special rules. They include saving the federal budget at least $2 billion over 10 years.
In the final bill, however, lawmakers added more spending in various areas to get enough votes to pass, including $8 billion over five years to help cover insurance costs for people with pre-existing conditions.
One of the bill’s most expensive items is a provision that would eliminate about $600 billion in taxes imposed under the Affordable Care Act, including taxes on investment income, prescription drugs and indoor tanning.
23 million more Americans will be uninsured in 10 years.
The budget office projected that in 2018, the number of uninsured would increase to 41 million and would continue to grow. In 10 years, it would become closer to what it was before the Affordable Care Act, President Barack Obama’s signature health law, took effect.
Number of uninsured
People with Medicaid coverage would take the largest loss. In a decade, 14 million fewer people would be enrolled in the program.
The C.B.O. estimates that the increase in the number of uninsured would be disproportionately larger among older people with low incomes.
Cost of insurance could rise more than nine-fold for some older people with low incomes.
The House bill included last-minute amendments that let states seek changes to certain insurance regulations.
The C.B.O. estimates that premiums could go down about 10 to 30 percent for people in states that make moderate changes to these regulations. This is largely achieved by offering skimpier plans and pricing out the old and sick from the insurance market.
Senate leaders, aware of the criticism already leveled at the House bill, say they are writing their own bill. This analysis is likely to offer guidance in where they will and won’t want to go.
Read the complete articles in the New York Times here and here.
House Republicans barely managed to pass their Obamacare repeal bill earlier this month, and they now face the possibility of having to vote again on their controversial health measure.
House Speaker Paul Ryan hasn’t yet sent the bill to the Senate because there’s a chance that parts of it may need to be redone, depending on how the Congressional Budget Office estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority.
Republicans had rushed to vote on the health bill so the Senate could get a quick start on it, even before the CBO had finished analyzing a series of last-minute changes. The CBO is expected to release an updated estimate next week.
“Unaware,” said Representative Jeff Denham of California, with noticeable surprise Thursday, when advised that his party leaders still hadn’t sent the bill over to the Senate. Denham was one of the House Republicans who ended up voting for the measure, after earlier in the week opposing it.
“I am on the whip team and we have a lot of conversations, but we have not had that one. So I am going to look into it,” said Denham, a member of the party’s vote-counting team.
In the Senate, the bill must hit separate $1 billion deficit reduction targets in the jurisdiction of the Finance Committee and the chamber’s health committee. Republican aides said failing to meet those numbers would force the House to fix the bill even if the legislation meets the overall cost-savings target.
If Republican leaders hold onto the bill until the CBO report is released, then Ryan and his team could still redo it if necessary. That would require at least one more House vote of some sort.
Ryan told conservative radio host Hugh Hewitt on Friday that he doesn’t think the House will need to vote again on the health law. “We just want to, out of an abundance of caution, wait to send the bill over to the Senate when we get the final score,” Ryan said.
It’s unclear what assumptions the CBO will make about what states will do with that newly created flexibility. If millions of people sign up for much cheaper, minimal insurance, that could trigger billions — and potentially even hundreds of billions — in costs over a decade because of the House bill’s health insurance tax credits.
‘Working together, this unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under Obamacare,’ Paul Ryan said despite health advocates’ criticism of bill. Photograph: J Scott Applewhite/AP
Trumpcare failed to pass but the real problem is that the Republican Party is plagued by partisan infighting. Mr. Trump was able to use the ideological differences between factions in the party to his advantage during the election campaign. Not only did he overthrow the party’s traditional leadership, he united many of the other competing interests in the party.
But the campaign is over now. The factions in Congress are starting to make the President’s life much more difficult. What’s the basis of Republican disunity? Aren’t Republicans, whether elites or voters, all staunch conservatives who oppose the Democrats?
Jon MacKay is an affiliate researcher of the Waterloo Institute for Complexity and Innovation. William Bendix is assistant professor of political science at Keene State College, in New Hampshire. Together they examined how several hundred interest groups have rated congressional Republicans since 2001. They found three distinct factions that were stable over time. Each represented different sets of ideological interests. The party leaders reside in what we call the corporate-establishment faction – a group that advances pro-business policies. The difficulty is that two other Republican factions also compete for power: a lunch-pail faction, whose members focus on working-class issues, and an ethno-radical faction, whose members support a mix of nativist and fiscally regressive policies. You can read their research here…. 2016 08 18 Bendix & MacKay Partisan Republican Infighting
What’s become clear is that any policy decision Donald Trump makes is now likely to produce as many losers as winners within their party’s coalition.
After the health-care defeat, Mr. Trump has said he’ll next turn to tax cuts, dramatically lowering taxes across the board. His plan, estimated to reduce federal revenues by $6-trillion (U.S.) over ten years, will provide much greater tax relief to the affluent than it will to middle- and working-class voters. This makes it, in many respects, a mainstream Republican proposal.
But that’s the problem. Massive revenue cuts need to be offset by large spending cuts, otherwise the national debt will balloon. Mr. Trump wants to boost military spending, cut taxes and slash industry oversight and entitlement programs. That likely suits the corporate establishment and the ethno-radicals of the party, but it will outrage most everyone else – including lunch-pail voters. True, Trump could cut taxes and increase spending without totally blowing up the budget by issuing 100-year bonds. But it’s hard to imagine the ethno-radicals supporting this big-government, big-debt strategy.
Trade protectionism, another pillar of Mr. Trump’s election campaign, is the most important issue for Canada. Although famously inconsistent on many issues, Trump has been unwavering on trade. He has already abandoned the Trans-Pacific Partnership and has said that he wants to reopen NAFTA, impose tariffs on individual firms, and possibly withdraw the U.S. from the World Trade Organization.
These promises are aimed at lunch-pail Republicans, who have seen manufacturing jobs disappear over the last three decades. But this anti-trade agenda is at odds with the corporate establishment of the party – which has, since at least Ronald Reagan, advocated trade liberalization.
Donald Trump listens to a speaker in the East Room of the White House on Friday. Photograph: Mandel Ngan/AFP/Getty Images
Donald Trump is used to running private companies with him as President, and enjoying the Presidential power private companies provide. Now he finds being President of the United States isn’t the same as being President of Trump Organization.
Republicans, who voted more than 60 times to repeal or alter Obamacare over the past few years only to be vetoed by Obama, had got their big chance and blown it. The party’s deep ideological and factional divisions, temporarily papered over amid the euphoria of last November’s surprise win, were back with a vengeance as it struggled to go from opposition to governance.
In Trump’s rambunctious election campaign, the 70-year-old novice promised to repeal and replace the ACA “immediately”. It was a bad choice for an opening offensive. Healthcare reform is to American presidents what the Russian winter was to Napoleon.
Trump has said tax reform is next, and years of Republican planning might allow for that legislation to pass more easily. But his ability to work with Congress is in grave question. His unique selling point, as a dealmaker, has taken a huge hit.
Gwenda Blair, a Trump biographer, said of Trump’s supporters: “They voted for a guy who could fix it, the CEO, on The Apprentice for 10 years, who could make a deal with anybody.”
But the tactics that served Trump so well in business – playing the alpha male, holding one-on-one meetings – did not translate to politics, she said.
“Now he’s up against 535 other people [in the House and Senate], other people who have their own independent power base and are not really interested in rolling over. The model of taking one person in a room and beating up on them doesn’t work with 535.”
But as the health care bill negotiations gathered steam, it was clearly not going to be plain sailing. Last month, Trump admitted: “Now, I have to tell you, it’s an unbelievably complex subject. Nobody knew healthcare could be so complicated.” The bill was, in the eyes of many, rushed and deeply flawed, falling well short of Trump’s campaign pledge to provide insurance for everyone.
Grassroots protests erupted across the country, citizen activists hitting the phones and constituents berating congressmen at town hall events. Groups representing hospitals and medical professionals derided the legislation. The non-partisan Congressional Budget Office estimated that the AHCA would lead to 24 million fewer Americans having health insurance over the next 10 years. The bill achieved the rare feat of uniting the far left and far right in opposition.
Friday’s failure was a fillip for the anti-Trump “resistance” but it was hardly grounds for complacency. The president looks set to press ahead with his agenda on everything from rolling back Obama-era protections on the environment to building a wall on the Mexican border to firing off tweets that alienate allies and embolden enemies.
He may also ensure that his prediction of Obamacare’s explosion becomes a self-fulfilling prophecy. “Move fast and break things” will continue, even it if means breaking his own party.
‘This more egalitarian vision of healthcare freedom may sound utopian, but it is entirely achievable.’ Photograph: Mark Makela/Getty Images
Paul Ryan is promoting Trumpcare as if it were some sort of medical Magna Carta – a brave declaration of healthcare freedom. “We’re not going to make an American do what they don’t want to do. You get it [healthcare] if you want it. That’s freedom” he recently said on Face the Nation. Freedom to die uninsured, that is.
It’s not that House Republicans are proposing some libertarian healthcare promised land wherein open heart surgeries and rounds of chemo are bartered and traded like tubes of toothpaste – far from it. Instead, the bill largely relies on Obamacare’s blueprint, although it mangles its details for the benefit of the rich while stripping coverage from a staggering 24 million people by 2026 (according to Monday’s estimates from the Congressional Budget Office).
Ryan’s healthcare bill would, like the Obamacare, provide subsidies (or tax credits) for the purchase of private insurance policies. Yet these tax credits would be comparatively more regressive and less generous than those in the Affordable Care Act (ACA); many Americans would thus be freed from having affordable premiums.
The Republican bill also discards Obamacare’s cost sharing subsidies for low-income individuals, who would henceforth have the freedom to pay higher copayments and deductibles. Additionally, it prevents tax credits from being used for the purchase of plans that cover abortion, freeing more women from control over their own reproductive systems.
The bill would also punish those with low incomes by squeezing federal funding of Medicaid beginning in 2020, effectively emancipating millions of poor people from the ranks of the insured.
Trumpcare would at the same time cut the ACA’s taxes on the wealthy, which, as the New York Times recently reported, would redistribute upward some $144bn over a decade to millionaires. Now in fairness, this provision would increase freedom for some: freedom, for instance, to buy a second vacation home, or a first yacht.
And finally, what Ryan seems to see as Trumpcare’s greatest emancipatory element – the elimination of the ACA’s unpopular individual mandate – would simply be replaced by a 30% premium penalty, assessed by insurers, for those who spent time uninsured. As Patrick Henry might have put it: give me a continuous coverage premium surcharge as opposed to a tax penalty, or give me death.
Unbelievably, Ryan sees “freedom” in all of this devastation.
For Ryan and those in his ideological camp, freedom in healthcare is basically the freedom of the consumer, who should be free to buy – or not buy – the particular insurance plan that suits his or her needs and tastes. Hence the bewilderment of Representative John Shimkus who recently asked why, exactly, men should be compelled to buy plans that cover maternity care (Trump’s pick to lead the Center for Medicare and Medicaid Services, Seema Verma, has said something similar).
Ryan thus offers a peculiar vision of healthcare freedom. For the medicalliterature tells us – to no one’s surprise – that the uninsured are more likely to die. And as noted, the CBO has now estimated that Trumpcare will increase the ranks of the uninsured by 24 million in a decade from now.
The bill would thus increase our freedom to die of health conditions that are amenable to modern medical care, and thereby liberate tens of thousands of people a year off of the face of the planet.
Donald Trump: pointing the way toward … more of the same for the wealthy, actually. Photograph: Timothy A Clary/AFP/Getty Images
Effects on Health Insurance Coverage
To estimate the budgetary effects, Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) projected how the legislation would change the number of people who obtain federally subsidized health insurance through Medicaid, the nongroup market, and the employment-based market, as well as many other factors.
CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. The increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026.
The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped.
In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
Effects on Premiums
The legislation would tend to increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter, relative to projections under current law. In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.
Starting in 2020, the increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of several factors that would decrease those premiums: grants to states from the Patient and State Stability Fund (which CBO and JCT expect to largely be used by states to limit the costs to insurers of enrollees with very high claims); the elimination of the requirement for insurers to offer plans covering certain percentages of the cost of covered benefits; and a younger mix of enrollees.
By 2026, average premiums for single policyholders in the nongroup market under the legislation would be roughly 10 percent lower than under current law, CBO and JCT estimate.
Although average premiums would increase prior to 2020 and decrease starting in 2020, CBO and JCT estimate that changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules.
Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.
Helping the richest
For many lower-income people, the new tax credits under the legislation would tend to be smaller than the premium tax credits under current law. Conversely, the tax credits under the legislation would tend to be larger than current-law premium tax credits for many people with higher income.
Here’s a roundup of some of the 13 of Trump’s more dubious claims he made at CPAC 2017:
“I saw one story recently where they said, ‘Nine people have confirmed.’ There are no nine people. I don’t believe there was one or two people. Nine people. . . . They make up sources.”
Trump is referring to a Washington Post article that disclosed that then-national security adviser Michael Flynn privately discussed U.S. sanctions against Russia with that country’s ambassador to the United States during the month before Trump took office, contrary to public assertions by Trump officials. The Post report prompted a firestorm that led to Flynn’s firing by Trump, because it turned out that Flynn had misled Vice President Pence and other administration officials about whether he had discussed sanctions.
The article cited information provided by “nine current and former officials, who were in senior positions at multiple agencies at the time of the calls.” (Calls by the Russian ambassador are monitored by intelligence agencies.) No White House official has disputed the accuracy of the article — and indeed, it resulted in Flynn’s departure from the administration.
“The dishonest media did not explain that I called the fake news the enemy of the people. The fake news. They dropped off the word ‘fake.’ And all of a sudden the story became the media is the enemy.”
Trump is making a distinction without a difference. This is the tweet in question:
Trump listed five mainstream media organizations — the New York Times, NBC, ABC, CBS and CNN — as the “FAKE NEWS media” and declared that they are the enemy of the American people. By listing major media organizations as the enemy, Trump was clearly making a statement about the broader news media. (Another article: White House blocks CNN, New York Times from press briefing hours after Trump slams media.) Can you say ‘media control by government’ as it is in China and Russia?
“In the Middle East, we’ve spent, as of four weeks ago, $6 trillion. Think of it.”
Trump is lumping together the wars in Iraq (in the Middle East) and Afghanistan (in South Asia), which together cost about $1.6 trillion from 2001 to 2014. He is also adding in estimates of future spending, such as interest on the debt and veterans care for the next three decades.
“Obamacare covers very few people — and remember, deduct from the number all of the people that had great health care that they loved that was taken away from them. It was taken away from them.”
Trump essentially repeats a false GOP talking point that previously earned Four Pinocchios. The Obama administration calculated that about 20 million people have gained health coverage as a result of the Affordable Care Act, a figure that seems reasonable. Meanwhile, the number of plans that were canceled is far lower, though there appears to be no research that has determined exactly how many people had their policies canceled because the health insurance did not comply with the ACA.
An estimated 2.6 million people received notices of cancellations, but there was such an outcry over reports of cancellations that the Obama administration rushed to issue waivers that would allow people to keep their plans. Forty states accepted the waiver policy — which in most cases remains in effect until December 2017. So a vast majority of the people who might have received notices actually were able to keep their plans, even up until today.
It’s important to remember that the individual insurance market has a lot of ebb and flow, with people moving in and out of it as they change jobs, so the odds are many people who might have been affected by plan terminations would have already switched plans. One study found that in the 2008-to-2011 period, only 42 percent of policyholders in the non-group market retained that coverage after 12 months, with many moving to an employer-provided plan when obtaining a new job.
“ICE came and endorsed me. They never endorsed a presidential candidate before. They might not even be allowed to.”
This is one of Trump’s favorite claims. Federal agencies can’t endorse political candidates. The unions representing Immigration and Customs Enforcement agents and Border Patrol agents did endorse Trump. Both groups said Trump was their first-ever endorsement. But they did not do so unanimously. The National Border Patrol Council endorsement was based on the vote of 11 union leaders, which sparked controversy among union members. Agents in El Paso, in a 14-to-13 vote, narrowly failed to have the local union disavow the endorsement.
Read all 13 of Trump’s dubious claims he made in his CPAC speech. Read it while you can, because if Donald Trump continues his silencing of the free press you may soon only have news as published through the extreme right.
Remember, Donald Trump only likes good news about himself.
House Republican leaders on Thursday presented their rank-and-file members with the outlines of their plan to replace the Affordable Care Act, leaning heavily on tax credits to finance individual insurance purchases and sharply reducing federal payments to the 31 states that have expanded Medicaid eligibility.
What does ‘expanded Medicaid’ mean?
ACA Medicaid Expansion – What is it?
The Affordable Care Act (ACA) called for a nationwide expansion of Medicaid eligibility, set to begin in 2014. Under health care reform law, nearly all U.S. citizens under 65 with family incomes up to 138 percent of the federal poverty level (FPL) ($15,415 for an individual or $26,344 for a family of three in 2012) will now qualify for Medicaid.
Some states opted in to expanded Medicaid, some states did not. An interactive map by state of Medicaid and expanded Medicaid recipients is available here.
As of January 2016, 72.9 million people were enrolled in Medicaid and CHIP. Over two-thirds of enrollees resided in states that have implemented the ACA Medicaid expansion.
Between Summer 2013 and January 2016, there was a net increase of nearly 15.5 million or 27% enrolled in Medicaid and CHIP among the 49 states reporting data for both periods. Most of this growth occurred in year one. Most of this growth was in large states in the West that implemented the Medicaid expansion.
Expansion states experienced significantly greater enrollment growth over the two year period, although there was variation across states. States that implemented the Medicaid expansion experienced over three times greater enrollment growth compared to states where the Medicaid expansion is not in effect (36% vs. 12%). Over the period, growth ranged from a high of 95% in Kentucky to slight decline in Wyoming and Nebraska.
Children account for a greater share of total Medicaid and CHIP enrollment in nearly all states that have not expanded Medicaid compared to states that have expanded. Reflecting higher eligibility levels for children, children accounted for a greater share of total Medicaid and CHIP enrollees in non-expansion states compared to states that have implemented the expansion to adults (68% vs. 44%). Read complete report from Kaiser Family Foundation here.
The federal government now pays more than 90 percent of the costs for newly eligible beneficiaries in states that expanded Medicaid. Under the House Republican plan, the federal share would decline to 50 percent in states like New York, New Jersey, Connecticut and California, resulting in a significant loss of federal revenue.
In a number of states that have expanded Medicaid, Republican governors and Republican members of Congress have made clear that they do not like the idea of a block grant or a per-beneficiary allotment.
The Congressional Budget Office says that 12 million people have insurance because they became eligible for Medicaid under the Affordable Care Act, and it estimates that federal spending for this group will be $70 billion this year. This 12 million figure differs from the 15 million reported by Kaiser Family Foundation. The KFF figure is net amount, the CBO doesn’t state how they arrive at their smaller figure.
The House Republican plan would immediately eliminate tax penalties for people who do not have insurance and employers that do not offer it.
It would also eliminate taxes and fees that help pay for the expansion of coverage under the 2010 health care law. These include fees collected from health insurance companies and manufacturers of brand-name prescription drugs and an excise tax on makers of medical devices.
The Republicans are removing any fees or taxes charged medical related companies which went towards providing funding for at least 12 million Americans. They are also shifting the cost of providing health care away from the federal government and pushing costs onto the states. This means you the lucky taxpayer will have to pony up more cash in the way of taxes or fees or other costs to cover the lost revenue from the federal government.
So if you are middle class, poor, sick or may become ill during the time the Republicans are in office my word of advice to you or your family or your childen is ‘you can’t afford to get sick‘.