The effects of a repeal of ACA

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Mary Baker Eaton, a 64-year-old from Massachusetts and a member of the Facebook group, recently explained to Vox by phone why she appreciates the community and feels protective of the space. “The only ideology that the group has is that we don’t want to die. We’re a bunch of people, and this is life or death for us. This is not Republican, this is not independent, this is not Democrat,” she said.

What we’ve learned from our Facebook community for Obamacare enrollees - Vox

If you like your insurance, you can keep it, Donald Trump version...

This raises one of the central unanswered questions about Donald Trump. We know he wants to repeal Obamacare. But why does he want to repeal it? And how much of a political price is he willing to pay to repeal it?

Congressional Republicans are willing to pay a huge political price to repeal Obamacare, just as congressional Democrats paid a political price for enacting it. They’re willing to pay this price because they think repealing Obamacare is important; for years, they have heard, and said, that Obamacare is socialism, it’s a job killer, it’s a government takeover, it’s endless debt, it’s the ruination of the best health care system in the world, it’s free stuff that will create a dependent underclass permanently loyal to the Democratic Party.

Yes, taking health insurance from tens of millions of people will be unpopular, but it needs to be done. Sacrifices must be made.

With Trump, it’s less clear. Sometimes he seems like a standard-issue Republican here. He says Obamacare is a disaster that he wants repealed, the plan his campaign released is an orthodox conservative repeal plan, and his pick for secretary of health and human services is one of the House’s most ardent Obamacare foes.

But there’s always been a divergence between Trump’s official actions and his off-the-cuff rhetoric. In the past, Trump praised Canada’s single-payer system. In an interview with 60 Minutes, he said he believe that “everybody’s got to be covered” and under Trumpcare, “the government’s gonna pay for it.” And now we have Conway saying, “We don’t want anyone who currently has insurance not to have insurance” — a principle that wipes out every Republican repeal plan, including Trump’s own.

Trump’s “if you like your insurance, you can keep it” moment - Vox

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Good luck, guys..

When Democrats controlled the government in 2009, they could have theoretically passed legislation that opened an existing public insurance system like Medicare or Medicaid to working-age people. But that would have unspooled existing insurance markets, creating significant disruption for consumers and relentless opposition from carriers and other powerful interests.

Democrats instead struck bargains with stakeholders across the health industry, which created political and economic space for a major coverage expansion but left most existing arrangements untouched. They subjected insurers to more regulation, but guaranteed them millions of new customers; they cut reimbursement rates to hospitals, but with the understanding that a spike in insured patients would help them recoup lost revenues. Most of those patients were expected to be poor people who would be added to state Medicaid rolls, in an expansion paid for almost entirely by the federal government. 

Eliminating a program that covers 20 million people will create a backlash on obvious humanitarian grounds, but that’s far from the only challenge Republicans now face. Repealing the Medicaid expansion will confront hospitals with an uncompensated care crisis; repealing private insurance subsidies will collapse the individual marketplaces; repealing the coverage guarantee will allow insurers to again discriminate against sick people.

Delaying these repeal measures with no promise that they will be replaced with an alternative that makes providers and patients whole, will create major disruptions in the health care system anyhow. This is a stickier wicket than many strident Republicans in Washington realized, and the ones who did know were cynical enough to over-promise anyhow.

Republicans Want Revenge for Obamacare and It’s Making Them Do Stupid Things | New Republic

With Republicans convinced they need to repeal Obamacare ASAP but unsure of how they want to replace it, Rep. Marsha Blackburn issued a public plea for help on Tuesday. The Tennessee Republican—and member of President-elect Donald Trump's transition team—asked the Twitter masses to take a poll on whether they like the law. Turns out Blackburn's followers are pretty big fans of the Affordable Care Act, with 84 percent of the 7,968 votes opposing a repeal of Obamacare. 

Online polls are hardly scientific. But the GOP's hopes to make Obamacare magically disappear without having to offer a replacement took a serious hit on Tuesday, when the American Medical Association—the country's largest organization of doctors—wrote a letter to congressional leaders demanding that any tweaks to the health care law ensure that the 20 million people who gained insurance under Obamacare don't lose coverage. That request would be impossible to meet under the various proposals floated by Republican politicians so far.

Republican Congresswoman Discovers Her Followers Love Obamacare | Mother Jones

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The American Medical Association (a powerful doctors association), and the even more powerful hospital lobby have warned Republicans not to repeal Obamacare unless an alternative is enacted in tandem.

When GOP repeal plans are described to them, Trump-supporting Obamacare beneficiaries in key swing states are rightly horrified.

This week, Trump adviser Kellyanne Conway told CNBC, “we don’t want anyone who currently has insurance to not have insurance,” but according to Politico, “Republicans are now realizing how hard it will be to replace the law, and many of them have plainly settled on the fact that they will never be able to craft a plan to insure as many people as Obamacare does.”

A Kaiser Foundation study of these voters, as described in a New York Times op-ed by its president and CEO, Drew Altman, found that “[t]hose with marketplace insurance ... saw Medicaid as a much better deal than their insurance,” and that “Trump voters on Medicaid were much more satisfied with their coverage.” Offering Medicaid to the uninsured would make the system more truly universal than it is today.

Republicans Want Revenge for Obamacare and It’s Making Them Do Stupid Things | New Republic

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One of the country’s largest Christian groups has issued a sternly worded condemnation of President-elect Donald Trump’s cabinet selections and policy agenda, warning that Trump will put America’s most vulnerable citizens at “greater risk” if he does not change. The National Council of Churches (NCC)—which represents 38 denominations and faith communities, or roughly 45 million people—unveiled the statement on Friday afternoon. Co-signed by the Conference of National Black Churches, the Ecumenical Poverty Initiative, and the Samuel DeWitt Proctor Conference, the letter implores the former businessman not to repeal the Affordable Care Act (ACA) or slash funding for Supplemental Nutrition Assistance Program (SNAP) — better known as food stamps — saying such programs protect the poor.

Major Christian group condemns Trump’s cabinet picks, policy agenda

“Repeal and delay” is an incredibly unpopular policy among the American public. According to a poll released Friday by the Kaiser Family Foundation, which has been tracking public opinion on Obamacare for years, 75 percent of Americans wants Congress to either leave the health law in place or wait to repeal it until they have a replacement law ready to go.

The Republican plan to repeal Obamacare may be on the brink of collapse

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High premiums and high deductibles — the things, aside from the individual mandate, that people seem to hate most about the ACA — are natural consequences of high costs. They can be expected to persist after any Republican-driven changes. The main change will be that Republicans take the blame for them. 

Republicans have been able to have it both ways on Obamacare for years. They have attacked the law for being too expensive to taxpayers and requiring insurance that is too comprehensive — and also for the fact that plans sold under the law have high deductibles and limited provider networks.

These complaints are in tension: If you want low deductibles and the most popular doctors, you need higher premiums to cover the cost of all the healthcare the plans will end up paying for. If you want lower premiums, you need plans that are stingier about what they will cover.

GOP options on Obamacare are not good - Business Insider

Cold feet..

Simultaneously, Sen. Rand Paul has been gathering support over the past week to delay any repeal of Obamacare until the GOP has a full replacement bill ready to go. Paul has cited concerns over a possible increase in the deficit caused by a repeal

Republican plan to repeal Obamacare hits roadblocks - Business Insider

A breakaway group of five moderate Senate Republicans pushed Monday to delay a bill repealing Obamacare until March -- potentially enough pressure to force the party’s leadership to comply. The step is the latest sign of some Republicans’ growing uneasiness about their leadership’s plan to repeal the law with no consensus on a replacement as part of an effort to deliver swiftly on one of President-elect Donald Trump’s top campaign promises.

Breakaway Senate Republicans Push to Delay Obamacare Repeal - Bloomberg

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As long as you’re working with private insurance, you run into what I call the iron law of private sector health reform (catchy, right?): You can have any two of good insurance, low premiums and deductibles, or low taxes. But you can’t have all three.

The way to get more coverage than Obamacare currently offers at a lower price is to move toward a single-payer system that negotiates costs with providers. One feature shared by Obamacare and the various conservative alternatives is they try to cut costs primarily by changing the way insurance and medical care are delivered. Other countries — and, to a lesser extent, Medicare and Medicaid in this country — take a more direct route.

They use their size to directly negotiate down prices. If you want to sell a drug in the UK or Canada, you have to come to an agreement with the government on how much it’ll cost. If you want to sell the same drug in the United States, you can charge whatever you want. As you’d expect, drugs in the US cost much more than they do in other developed countries. 

Well, look, this is the irony of this whole debate, is the things that people are most dissatisfied with about Obamacare, about the Affordable Care Act, are things that essentially in other countries are solved by more government control, not less.

And so Republicans are pointing at these things to stir up dissatisfaction, but when it comes to, all right, what’s the solution for it, their answer is less government regulation and letting folks charge even more and doing whatever they want and letting the marketplace work its will.

Obama challenges GOP to offer a “demonstrably better” health plan. It sounds simple. It isn’t. - Vox

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Jeff Jeans, a cancer survivor who owns a small business in Arizona, confronted House Speaker Paul Ryan during a CNN town-hall event on Thursday night over the future of the Affordable Care Act, the healthcare law better known as Obamacare. Jeans said he was a lifelong Republican who worked on the campaigns of Ronald Reagan and George H.W. Bush and that he disliked the ACA when it was passed.

"Just like you, I was opposed to the Affordable Care Act," Jeans told Ryan. "When it was passed, I told my wife we would close our business before I complied with this law."

But then he said the law saved his life. Soon after it passed, he said, he learned he had cancer and was given six weeks to live. He said he was able to get insurance, which allowed him to receive treatment, through the Affordable Care Act.

"Thanks to the Affordable Care Act, I'm standing here today alive," Jeans said. "Being both a small-business person and someone with preexisting conditions, I rely on the Affordable Care Act to be able to purchase my own insurance. Why would you repeal the Affordable Care Act without a replacement?"

As Ryan began his answer, saying the GOP planned to replace the law when repealing it, Jeans interrupted to add a message onto his question.
"Can I say one thing?" Jeans said. "I want to thank President Obama from the bottom of my heart because I would be dead if it weren't for him."

Ryan said Republicans planned to replace Obamacare with high-risk pools, which had been used by states before the ACA was passed, so that Jeans and others could continue to get coverage. Health-policy experts have been wary of this plan because of the low enrollment and prohibitively high costs in previous state-level pools.

Paul Ryan confronted on Obamacare by cancer survivor - Business Insider

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A lot of this hinges on the details of the Republicans' plan. Since Martha receives subsidies to help cover the costs of her plan, a number of the replacement proposals floated by the GOP could affect how much she receives. Additionally, a number of plans would institute high-risk pools, which are separate markets reserved just for people with preexisting conditions. These existed before the ACA and generally had astronomically high costs and limited utilization. The other issue is that any change to the law may be rejected by Democrats. If Republicans want to make any larger changes outside the budget process they would need Democrats on board. If the GOP advances a bill that changes coverage in some way or rolls back parts of the ACA that do not deal with the federal budget, Democrats may block a replacement using the filibuster. Additionally, if even a few Republicans in the Senate don't like the replacement, that could sidetrack the process. If the GOP moves ahead with the repeal while Democrats object to changes to the law, it could make the road that Martha is on even more winding.

Obamacare repeal-replace effects - Business Insider

Congressman Mike Coffman (R-CO) tweeted Friday that he was excited to return home to Colorado this weekend, but things didn’t go very well when he got there. On Saturday, his open meeting to chat with constituents at the Aurora Central Library was overwhelmed by voters particularly concerned about the fate of their health care if the Affordable Care Act (ACA, also known as Obamacare) is repealed — a plan Coffman supports — without a replacement put in place. Rather than meet with most of them or even address them, he left the event via a back door and escaped in a waiting vehicle.

Republican congressman sneaks away from constituents demanding health care answers

Should President-elect Donald Trump and congressional Republicans make good on their pledge to dismantle the Affordable Care Act, the repeal of a handful of tax increases on individuals and businesses and the elimination of a federal tax credit that subsidizes health insurance premiums likely would result in a massive windfall for wealthy households and a financial setback for low and moderate-income people, according to a new study. Indeed, the 400 highest income taxpayers in the country could receive millions of dollars in tax relief next year while middle and lower income Americans would come up empty or in the hole, according to the report by the liberal-leaning Center on Budget and Policy Priorities.

Repealing Obamacare $7 million tax cut for the rich - Business Insider

Despite characterizing themselves as the party of fiscal conservatism, Republicans are planning on pushing through a legislative agenda under President-elect Donald Trump that will cause the deficit to balloon. These include an important method for repealing the Affordable Care Act, namely a budget resolution that will add $9 trillion to the debt by 2026. The actual Affordable Care Act repeal will eliminate more than $1 trillion in revenue that had been acquired through taxes included in the bill in order to maintain a balanced budget.

Finally, Republicans are considering passage of a spending bill in excess of $1 trillion to complete unfinished Cabinet budgets, one that is expected to include allocations for expensive Trump proposals like a wall on the U.S.-Mexican border. “One of the things that we’re focusing on is getting people back to work, is economic growth,” House Speaker Paul Ryan said to reporters on Tuesday. “You can’t ever balance the budget if you don’t get this economy growing.” In 2011, though, Ryan had said, “The country’s biggest challenge, domestically speaking, no doubt about it, is a debt crisis.”

Deficits don’t matter (again)! Paul Ryan promotes Congress’ upcoming spending binge - Salon.com

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A Republican senator on condition of anonymity said the details of the repeal bill remain very uncertain. Originally, Republicans were planning to simply bring back the bill they put on Obama’s desk last year for his veto. But that bill was written knowing it wouldn’t become law, and now some Republicans want to make tweaks to soften the blow of repeal. "Even people who voted for this before are, ‘Wait a minute, wait a minute, we knew that wasn’t going to happen,’" said the senator. "There were no consequences." He said there’s a growing sense among some of his colleagues that they need to have a replacement for Obamacare ready soon "because we’re going to own this."

Republicans: you have to pass our health care plan to find out what’s in it - Vox

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We now know precisely how devastating Obamacare repeal could be.The Congressional Budget Office reports that, without a replacement, repealing the Affordable Care Act will leave 18 million more Americans without health insurance within a year. “Later, after the elimination of the ACA’s expansion of Medicaid eligibility and of subsidies for insurance purchased through the ACA marketplaces, that number would increase to 27 million, and then to 32 million in 2026,” according to the nonpartisan federal agency. 

In addition, the CBO found premiums would increase by 20 to 25 percent within a year: “The increase would reach about 50 percent in the year following the elimination of the Medicaid expansion and the marketplace subsidies, and premiums would about double by 2026.”

We now know precisely how devastating Obamacare repeal could be. | New Republic