The effects of a repeal of ACA

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Not quite surprising, this

Yet there’s one glaring oddity in the pitch Trump’s been making: It doesn’t include anything even remotely resembling an affirmative case for the actual bill House Republicans have to vote on.
When Trump talks health care in public statements and in accounts of his private meetings, he keeps making the following four pretty simple points:

1. Obamacare is a disaster that’s falling apart.
   
2. If Republicans don’t pass the bill, they’ll do badly in the next election.
   
3. Republicans have to pass the bill so they can move on to tax cuts.
   
4. He — President Trump — and the Republican Party need this “win.”
   

There is no case for the American Health Care Act itself there. It’s all either political or a rote condemnation of Obamacare.

President Trump appears unable to make a substantive case for the AHCA - Vox

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The typical family making less than $10,000 will lose $1,420 if the Republican health care plan passes, a cut that amounts to almost one-third of their income. Meanwhile, the average family making $200,000 or more would gain $5,640, according to a new analysis from the Tax Policy Center and the Urban Institute's Health Policy Center:



Urban Institute
The report combines an analysis of the tax provisions of the act — which repeal the taxes the Affordable Care Act imposed largely on rich people, like a 3.8 percent surtax on investment income over $250,000 and a 0.9 percent surtax on wages over that amount — with changes to the ACA’s coverage provisions. That includes massive cuts to Medicaid (more than $880 billion per the Congressional Budget Office) and changes to Obamacare’s tax subsidies; the Republican proposal would make those subsidies smaller for poor people and extend eligibility to people making hundreds of thousands of dollars a year, with phaseout only beginning at $150,000 for dual earners.

If you're a millionaire, the AHCA gives you $50K. If you're poor, it costs you $1,420. - Vox

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One of the key proposals of the American Healthcare Act, the GOP leadership's plan to repeal and replace Obamacare, is a massive spending cut to Medicaid, the government-run health program that provides insurance primarily to pregnant women, single parents, people with disabilities, and seniors with low incomes.

The move has been criticized by both Republicans and Democrats for the effects it could have on people suffering from substance-use disorders, particularly disorders related to heroin and prescription opioids. A study published this week in the journal Medical Care lends further credence to those concerns.

The study found that the Medicaid expansion has led to a massive increase in the number of Medicaid prescriptions for buprenorphine, a medication considered by many experts to be the "gold standard" for overcoming opioid addiction.  Chemically similar to opioids, buprenorphine works by attaching to the same brain receptors as opioids, preventing users from using heroin or other opioids to get high while reducing cravings and withdrawal symptoms.

The most commonly prescribed version is called suboxone and includes naloxone, an anti-overdose drug, to prevent misuse. A study conducted by the National Institute on Drug Abuse, among others, has shown considerable success for suboxone treatment.  Eligibility for Medicaid was expanded under the ACA to include any adult living under 138% of the federal poverty level — an income of $27,821 for a family of three in 2016. Thirty-two states, including the District of Columbia, have chosen to participate, leading to more than 11 million people nationwide gaining coverage.

Obamacare's Medicaid expansion has expanded access to suboxone treatment - Business Insider

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A must read, this article sums up many of those 'coincidences' that happened between the Russians and the Trump campaign.

This is why CNN’s report seems so stunning: It is the first such report suggesting that the FBI may have credible information — say, an account of a meeting where collusion was discussed, to give one wholly hypothetical example — of a possible Trump campaign-Russia plot against Hillary Clinton. To be clear, none of this has been confirmed. All of the sources CNN quotes in the story are anonymous US officials. We don’t know who these people are or whether they have accurate information. The officials, according to CNN, even cautioned that “the information was not conclusive and that the investigation is ongoing.” Here, then, is a brief guide to what we know — and what we still don’t know — to help you catch up to where we are in this whole saga.

What we know about evidence of coordination between Russia and the Trump campaign - Vox

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That’s the fundamental insanity of running headlong toward a floor vote without a score from the CBO. A lot of pixels have been spilled on the basic hypocrisy of the procedural aspects of Trumpcare. But the real issue here is about substance, not process. Making public policy is hard. The CBO is a tool to help make sure members of Congress understand what they are doing. They are not using that tool and, consequently, they are flying blind — voting for a series of interlocking changes that will drastic impact tens of millions of people’s lives with no idea what is going to happen.

Most egregiously of all, at this point the tempo is apparently being dictated by Donald Trump’s personal pique at recalcitrant House members. A president with no interest in the details of public policy is impatient with the idea that House members might care what the content of the bills they pass is, and has decided to make passing this law a test of personal loyalty to him. That’s a ridiculous way to think about legislation in general.

But it’s a particularly egregious way of thinking about this particular bill, since candidate Trump would have thoroughly denounced it. He promised — in the primary, in the general election, and even during the transition — to put forward a plan that covers everyone, lowers deductibles, and protects Medicaid. He then hashed out a bill that doesn’t do any of those things and is now professing to be not just eager to pass a bill that defies all of his campaign commitments, but furious at people who are skeptical of the merits. Meanwhile, even if it does pass, it will have to be substantially revised to have any chance in the Senate.

The Republican health care plan is totally nuts - Vox

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On Wednesday, I wrote about the closing argument President Donald Trump was making to skittish Republican legislators. Vote for the bill, he’s been telling them, or you’ll lose your seat. That night, I received a call from a Democratic senator. He’d read the piece, and it had reminded him of the closing argument President Barack Obama made to skittish Democratic legislators. Vote for the bill, Obama told them, because it’s worth losing your seat. It’s easy to get swept up in the tactical failures and daily horse-trading and nightly Congressional Budget Office estimates, but the real problem Republicans are facing is that they don’t like their own bill.

The Affordable Care Act survived its many, many near-death experiences because, fundamentally, Democrats believed in it, they wanted it to pass, and they thought it important enough to imperil (and ultimately sacrifice) their majority over. The plan Paul Ryan built in secret has few friends. Conservatives think it leaves too much of Obamacare in place. Moderates blanch at the 24 million it will leave uninsured. Wonks shudder at its slipshod, hasty construction. Experts from all three of Washington’s major conservative think tanks — the American Enterprise Institute, the Heritage Foundation, and the Cato Institute — oppose it.

The latest polling shows merely 17 percent of Americans support it. Depending on how you count, Democrats devoted either nine or 13 months to passing health care reform. No one involved in the Republican plan seems willing to wait out a similar siege. Hell, no one involved in the Republican plan seems willing to wait out a carton of milk.

The GOP’s true health care problem - Vox

Donald Trump promised to be a different kind of president. He was a populist fighting on behalf of the “forgotten man,” taking on the GOP establishment, draining the Washington swamp, protecting Medicaid from cuts, vowing to cover everyone with health care and make the government pay for it. He was a pragmatic businessman who was going to make Washington work for you, the little guy, not the ideologues and special interests.

Instead, Trump has become a pitchman for Paul Ryan and his agenda. He’s spent the past week fighting for a health care bill he didn’t campaign on, didn’t draft, doesn’t understand, doesn’t like to talk about, and can’t defend. Rather than forcing the Republican establishment to come around to his principles, he’s come around to theirs — with disastrous results.

Democrats don’t like this bill. Independents don’t like this bill. Conservatives don’t like this bill. Moderates don’t like this bill. All the energy behind the American Health Care Act is coming from inside the GOP congressional establishment — and now from Trump himself. In a sense, this Matt Drudge tweet says it all:

[/url] Follow
MATT DRUDGE 

✔@DRUDGE
The swamp drains you.
3:48 PM - 23 Mar 2017

Sixty days into his presidency, Trump has lashed himself to a Paul Ryan passion project that’s polling at [url=http://www.vox.com/policy-and-politics/2017/3/23/15042748/republican-health-vote-time-delay]56-17 percent against. As political scientist Ryan Enos drolly observed, “in a hyper-partisan political climate, it's actually an accomplishment to write legislation this unpopular.” Nor is Trump emerging unscathed: Polls show his approval rating falling into the 30s — and that’s before he’s taken away health insurance from a single person.

How Paul Ryan played Donald Trump - Vox

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President Donald Trump blamed Democrats on Friday for the failure of the Republican bill to replace to Affordable Care Act and said "the best thing we can do is let Obamacare explode."

Trump blames Democrats for failed healthcare bill - Business Insider

Let this sink in for a moment:

• Mr Fixit "Drain the swamp" dealmaker President proposes a bill that is the exact opposite of his campaign promises ("we will cover everybody, it will be a lot cheaper, premiums will come down, etc. etc.)
  
• He can't get it through his own party
  
• He blames the Democrats (why on earth would they vote for such a cruel law that kicks 24M people off insurance, has just 17% support and almost the whole medical profession against it)?? Especially after the scorched earth tactics of the Republicans versus Obamacare
  
• And now he's saying "the best thing we can do is let Obamacare explode"
  

Heck, yea right. Let it explode, I mean, it doesn't really matter how many casualties that creates, right? This is not the business of the American President to "Keep Americans safe!" 

Per the CBO, Obamacare isn't, in fact imploding but you can bet that they will active try to achieve that anyway, they are already doing that (as you can read in this thread).

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The Congressional Budget Office estimated, for example, that the A.H.C.A. would have caused premiums to rise more than sevenfold in 2026 for 64-year-olds making $26,500.

What Comes Next for Obamacare? The Case for Medicare for All - The New York Times

Mammograms, however, are not part of Essential Health Benefits. They're mandated under a different section of Obamacare that requires insurance plans to cover women's preventative care. While Roberts was referring to the common Republican argument that men should not have to pay for insurance that includes services only women use, more than 2,400 men in the U.S. die every year from breast cancer. Hardline conservatives in the House and Senate argue that gutting the EHB rule would allow companies to sell patients cheap, bare-bones plans to patients that prefer them.

Senator Apologizes After Joke About Losing His Mammograms In GOP Bill

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Must read article by David Frum, who predicted this 8 years or so ago..

A few minutes after the House vote, I wrote a short blog post for the website I edited in those days. The site had been founded early in 2009 to argue for a more modern and more moderate form of Republicanism. The timing could not have been worse. At precisely the moment we were urging the GOP to march in one direction, the great mass of conservatives and Republicans had turned on the double in the other, toward an ever more wild and even paranoid extremism. Those were the days of Glenn Beck’s 5 o’clock Fox News conspiracy rants, of Sarah Palin’s “death panels,” of Orly Taitz and her fellow Birthers, of Tea Party rallies at which men openly brandished assault rifles. 

In that third week in March in 2010, America committed itself for the first time to the principle of universal (or near universal) health-care coverage. That principle has had seven years to work its way into American life and into the public sense of right and wrong. It’s not yet unanimously accepted. But it’s accepted by enough voters—and especially by enough Republican voters—to render impossible the seven-year Republican vision of removing that coverage from those who have gained it under the Affordable Care Act. Paul Ryan still upholds the right of Americans to “choose” to go uninsured if they cannot afford to pay the cost of their insurance on their own. His country no longer agrees.

Whatever else the 2016 election has done, it has emancipated Republicans from one of their own worst self-inflicted blind spots. Health care may not be a human right, but the lack of universal health coverage in a wealthy democracy is a severe, unjustifiable, and unnecessary human wrong. As Americans lift this worry from their fellow citizens, they’ll discover that they have addressed some other important problems too. They’ll find that they have removed one of the most important barriers to entrepreneurship, because people with bright ideas will fear less to quit the jobs through which they get their health care. They’ll find they have improved the troubled lives of the white working class succumbing at earlier ages from preventable deaths of despair. They’ll find that they have equalized the life chances of Americans of different races. They’ll find that they have discouraged workplace discrimination against women, older Americans, the disabled, and other employees with higher expected health-care costs. They’ll find that their people become less alienated from a country that has overcome at last one of the least attractive manifestations of American exceptionalism—and joined the rest of the civilized world in ameliorating and alleviating our common human vulnerability to illness and pain.

Obamacare: The Republican Waterloo - The Atlantic

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The complicating factor here is that there are two separate attempts at using reconciliation: one for health care and another for a tax overhaul. The plan was to use the fiscal 2017 process for health care and the fiscal 2018 process for the tax code. The health-care course has been set, with lawmakers approving a budget resolution in January that contained repeal-and-replace instructions. But Congress hasn’t passed a separate resolution with instructions for a tax rewrite using reconciliation.

So a new resolution could be the Republicans’ ticket to a fresh crack at health care and tax reform. As Ed Lorenzen of the Committee for a Responsible Federal Budget explains, such resolutions are supposed to pass in the spring before a fiscal year begins. That means now, since fiscal 2018 begins Oct. 1. “The window is closing, in that they can’t really even start the process on tax reform until they pass a new budget resolution,” Lorenzen said. Citi analysts wrote in a note on Thursday that Republicans could include their health bill in the fiscal 2018 reconciliation bill, together with tax reform. But they say the strategy is risky given lawmakers’ “limited bandwidth” to address the two issues at the same time.

Here’s how Republicans could get another shot at health care and taxes - MarketWatch