The new Senate bill's major provisions

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Cruz offers a way out of the Senate heathcare mess, but his plan is going to make even more victims

The Cruz plan would allow insurers to offer plans in the individual insurance market that do not adhere to two major regulations imposed under the Affordable Care Act, or Obamacare, as long as they offer one that does. So-called essential health benefits (EHBs) require insurers to cover 10 basic benefits, including maternity care, mental healthcare, and emergency-room trips. Community rating, the other mandate under Obamacare, requires that people of the same age in a given area be charged the same amount for premiums. That helps people with preexisting conditions to not be charged more for care.

Cruz has argued that the virtual repeal of those mandates would allow insurers to offer cheaper plans to people that want them and bring down costs for everyone. But experts say it could mean that plans that feature EHBs and community rating could be priced higher than those without — to the point that they become too expensive for the people that need them. The two tiers of plans, experts say, could allow insurers to box sick people into the more generous plans at a higher cost. "Choice always sounds so good, like with the Cruz amendment," said Larry Levitt, a senior vice president at the Kaiser Family Foundation, a nonpartisan health policy think tank. "But in insurance, it's generally a recipe for instability and discrimination."

Cruz's solution does, however, have backing from President Donald Trump's White House. "We support Sen. Cruz and Sen. Lee's efforts," said Marc Short, the White House director of legislative affairs, on "Fox News Sunday."

Ted Cruz amendment to Senate healthcare bill gains steam - Business Insider

One expensive plan for the sick, a cheaper plan for the healthy. This is a recipe for disaster, as it has an in-build death spiral where more people will chose the cheaper plan, increasing the price difference, which will induce even more people out of the expensive plans, making them more expensive, etc.

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The exception to confirm the rule, but there is a little hope still, a Republican who actually takes into account what their proposed healthcare will do to real people:

Sen. Shelley Moore Capito (R-W.Va.), a fierce opponent of the Senate healthcare bill, reportedly said she will kill the legislation if it comes down to her. “I only see it through the lens of a vulnerable population who needs help, who I care about very deeply,” she said during an interview with Politico that was published Sunday. “So that gives me strength. If I have to be that one person, I will be it.” Capito, who represents a state that President Trump won by large margins, reportedly expressed concern about the bill's impact on Medicaid recipients, especially those afflicted by the opioid crisis. The West Virginia lawmaker also pointed to fears of lost coverage that could occur in her home state, the newspaper reported.

GOP senator: If I have to be that one person to kill healthcare bill, I will | TheHill

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Republicans in the Senate are set to release an update of their healthcare bill as they work to find a way to repeal and replace the Affordable Care Act. One attempt to attract conservative holdouts to the new version of the Better Care Reconciliation Act (BCRA) could be the addition of a Consumer Freedom provision, introduced by Sen. Ted Cruz and supported by fellow Republican Sen. Mike Lee.

But the plan drew backlash Wednesday from an influential group of insurers, who worried potential effects of such a provision on people with preexisting conditions. The amendment would allow insurers to provide plans that do not comply with two major regulations of Obamacare: community rating and essential health benefits. Cruz and Lee have pushed it as a way to bring down premiums and open up choice in the individual market.

But an analysis by the Kaiser Family Foundation, a nonpartisan health policy think tank, said the amendment could cause the cost of plans that complied with those regulations to skyrocket as only those that were sick and needed the more generous coverage would buy them.

Ted Cruz amendment to health care bill could affect preexisting conditions - Business Insider

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Buying off Alaska..

Buried in Senate Republicans’ new health care bill is a provision to throw about $1 billion at states where premiums run 75 percent higher than the national average. Curiously, there’s just one state that meets this seemingly arbitrary designation: Alaska. 

That state also just so happens to be represented by Sen. Lisa Murkowski, a crucial Republican swing vote who has spent months threatening to torpedo the entire Obamacare repeal effort over her concerns about Medicaid cuts. Nobody believes this special fund was created to give Alaska alone a big boost through sheer coincidence. Reporters on the Hill have taken to calling the carve-out to help Alaskans the “Polar Payoff,” the “Kodiak Kickback,” and even the “Juneau Jackpot” — a special gift to the state, inserted by Senate Majority Leader Mitch McConnell to win Murkowski’s vote.

“They really, really, really need Lisa Murkowski to vote for this, and they’re thinking this may help,” said Timothy Jost, a health care expert and a professor emeritus at Washington and Lee University. The big question right now is whether the approximately $1 billion in additional health spending for Alaska will be enough to win over Murkowski to a bill that would gut Medicaid and result in about $1 trillion less health spending for America overall.

The Kodiak Kickback: the quiet payoff for an Alaska senator in the Senate health bill - Vox

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The new amendments are really not improvements, quite the contrary. Even the insurance industry is now speaking out against the new law.

Health insurance companies have largely bit their tongues about the Senate health care plan, but they are turning against it now, warning that a recent revision would send premiums skyrocketing for people with high medical costs.

The insurance industry has been one of the few health care sectors to even tentatively embrace the Senate’s plan, as Vox has documented, but that has changed in the last few days. Their most influential representatives in Washington — America’s Health Insurance Plans and the Blue Cross Blue Shield Association — sent a letter to Senate leaders Friday urging them to remove Sen. Ted Cruz’s amendment from the legislation.

The Cruz amendment, added in the revised Senate plan, would allow health plans to sell insurance on the individual marketplaces that does not comply with Obamacare’s insurance regulations as long as they also sold plans that did comply. Outside experts have warned this would segment the market, with healthy people buying skimpier non-Obamacare coverage and sicker people buying more robust Obamacare plans.

That would then send costs, and in turn premiums, spiraling upward in the Obamacare market, the insurance trade associations warned in their letter. They noted particularly that middle-class families who do not qualify for financial assistance would not be shielded at all from those increasing premiums.

Insurers shred Senate health care bill: “Premiums will skyrocket for preexisting conditions” - Vox

Perhaps the most egregious change this week was the amendment proposed by Sen. Ted Cruz (R-TX), which will allow insurers to offer bare-bones plans as long as they offer at least one plan that fully complies with existing Affordable Care Act regulations on preexisting conditions and comprehensive coverage. On Friday, insurers said the amendment was “unworkable in any form.”

But, somehow, it gets even worse. Not only are the bare-bones plans under the Cruz amendment so cheap that they would cause the cost for comprehensive, ACA-compliant insurance plans to skyrocket, but the Cruz-sponsored plans are so stripped down that they don’t even count as “continuous coverage” in the BCRA.

In other words, if you are a healthy person who purchases the cheap Cruz plan because it’s more financially feasible, but then you become sick and need to upgrade to a better plan, you would be locked out of the insurance marketplace for six full months until you were able to buy a more robust insurance plan..

The Trumpcare provision that could be a death sentence for people who get sick suddenly

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It's already dead meat and the plan B to just repeal Obamacare (really a murderous plan which will shove 32M out of insurance) is dead in the water as well:

Senate Majority Leader Mitch McConnell's backup plan for his healthcare overhaul has already come apart less then 24 hours after he introduced it. Sen. Lisa Murkowski on Tuesday became the third GOP senator to publicly announce an intent to vote against a motion to proceed, a key procedural vote, for a bill that would only repeal the Affordable Care Act, the law better known as Obamacare. "I said in January that we should not repeal without a replacement," Murkowski told reporters on Tuesday. "And just an indefinite hold on this just creates more chaos and confusion." Murkowski joined Sens. Susan Collins of Maine and Shelley Moore Capito of West Virginia in defecting from the repeal-only plan.

"I do not think that it's constructive to repeal a law that is so interwoven within our healthcare system without having a replacement plan in place," Collins said in a statement. "We can't just hope that we will pass a replacement within the next two years. Repealing without a replacement would create great uncertainty for individuals who rely on the ACA and cause further turmoil in the insurance markets."

Republican healthcare plan, Obamacare-repeal-only bill blocked - Business Insider

At least some cooler heads prevail..

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Here is what just repeal Obamacare would do, per new CBO calculation:

According to the CBO, the bill — the Obamacare Repeal Reconciliation Act (ORRA) — would leave 17 million more Americans without healthcare insurance in 2018 compared to the current system. That would ramp up to 27 million more uninsured by 2020 and 32 million more uninsured by 2026.
The numbers were similar to the projections the last time Republicans advanced the legislation in 2015.

Under the ORRA, repeal would not kick in until 2020 but would then go into effect immediately, rather than phasing out Obamacare's provisions. The CBO score does not take into account any replacement that may be passed during that two-year period.

According to the CBO, the impact on premiums would be similarly devastating. "Average premiums in the non-group market (for individual policies purchased through the marketplaces or directly from insurers) would increase by roughly 25% — relative to projections under current law — in 2018," said the report. "The increase would reach about 50% in 2020, and premiums would about double by 2026."

CBO score on GOP Obamacare repeal bill - Business Insider

And the Republicans think this is a good idea...

Actually, it isn't all that surprising, the Obamacare replacement laws they (so far) can't get through Congress are almost as bad.

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According to a new determination by the Senate parliamentarian, some of the most controversial parts of Senate Republicans’ bill to repeal and replace Obamacare violate Senate rules and will thus require 60 votes to pass instead of 51.

The parliamentarian found that key provisions violate the Byrd rule, which prohibits the Senate from including irrelevant matters as part of a reconciliation deal. Republican leadership is pushing the health care bill through as part of the budget reconciliation process in the hopes of passing the bill with a simple majority, thus avoiding filibuster by Democratic legislators.

Parts of the bill that will require 60 votes include defunding Planned Parenthood, a six-month waiting period for purchasing insurance after a lapse in coverage, and restrictions on tax credits for insurance plans that cover abortion. If the bill is not changed before a vote, the 60-vote threshold means it’s unlikely that these parts of the bill will pass, as they would require significant bipartisan support..

Key Trumpcare provisions found to violate Senate rules, throwing Republicans’ plan in jeopardy

Sort of cosmic justice as they're getting caught by their own ideological blinders..

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Lying again in his latest pitch to get Trumpcare through the Senate..

Trump promised the new health care bill would “significantly lower premiums” and “stabilize the insurance market.” He shared horror stories of families who had relied on the Affordable Care Act for coverage but ultimately liquidated a 401(k) retirement account in order to cover their large deductibles. 

The truth, however, is that the Senate bill will not lower premiums for many people. For low-income Americans, in particular, premiums could rise by as much as 700 percent. Nonpartisan analysis from the Congressional Budget Office estimates that the Senate bill would destabilize the individual market. And those plans with large deductibles? They would become more common should the Senate bill become law. 

Trump himself offered no proof for his claims: He was surrounded by supposed “victims of Obamacare,” who had seen their premiums and deductibles rise under the health care law, but he did not explain how any of these families would be better off under the Republican plan.

Trump’s final health care pitch makes promises he can’t keep - Vox

The excellent article explains these issues in a crystal clear way

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These Republicans accused the Democrats to have pushed through Obamacare in the dark of the night. Remember, that was a two year process, with multiple open hearings with experts, commission discussions, etc. etc.. Compared to what the Republicans are trying today, it was a model of transparency..

Sometime on Tuesday, Senate Republicans will vote whether to start debate on a plan to overhaul American health care, without knowing exactly what is in that plan or, by extension, how it will change the lives of millions of Americans. There are few, if any, comparable examples of a bill with such wide-reaching consequences, being voted on so abruptly, with so many critical questions left unanswered less than 24 hours before it is taken up. Senate leaders are bent on holding a vote. But after the plan was drafted in secret, it now needs substantial revisions under the Senate budget rules. And yet the White House and GOP leadership insist on forcing members to vote on Tuesday. It is an unprecedentedly opaque process to try to pass legislation that overhauls an industry worth more than $3 trillion, which would undercut a law that has extended health coverage to more than 20 million middle-class and low-income Americans in the past seven years.

The fate of Obamacare, arguably the most significant domestic policy passed in a generation, hangs in the balance. Medicaid, a pillar of the American safety net since Lyndon B. Johnson’s Great Society, could be fundamentally changed by the Senate bill, with federal spending capped permanently for a program that covers more than 70 million of the most vulnerable people in the country. But as the vote approaches, there is no final text, no Congressional Budget Office score. Senate Republicans at least acknowledge the absurdity, if you ask them — this, coming from a party that spent seven years eviscerating Democrats for passing Obamacare in the quote-unquote dead of night. “I’ll need to know what I’m going to vote on,” Sen. Ron Johnson (R-WI) told reporters Monday. “I’m not real happy with the process. I think you guys are more than aware of that.” Yet Johnson and 49 other Republican senators might very well vote to start the debate Tuesday afternoon, despite not knowing what bill their leaders want to pass or whether the Obamacare repeal-and-replace plan they’ve been crafting for the past two months would even function.

Senate Republicans don't know what's in their health bill or what it would do. They're voting anyway. - Vox

Shame on them, and for the incessant lies and attacks on the CBO they produce.

Again an excellent article producing all the relevant details.