The effects of a repeal of ACA

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Even Warren Buffett getting in on the case..

The health care bill approved by House Republicans this week with the support of President Donald Trump will aid the wealthiest Americans at the expense of everyone else and likely drive up the budget deficit, billionaire Warren Buffett said. “It is a huge tax cut for guys like me,” Buffett said Saturday at the annual meeting of his Berkshire Hathaway Inc. in Omaha, Nebraska. “And when there’s a tax cut, either the deficit goes up or they get the taxes from somebody else.” At the same time, Buffett said health care costs, which in recent decades have risen much more in the U.S. as a percentage of the economy than in other countries, put the nation at a competitive disadvantage.

Buffett Says Republican Health Plan Sure to Help Wealthy - Bloomberg

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Compassionate conservatism in action..

A top White House official tried to defend the American Health Care Act (AHCA)— the GOP’s response to Obamacare — earlier this week by implying that health care systems shouldn’t help someone who “sits at home, eats poorly and gets diabetes.” According to the Washington Examiner, Mick Mulvaney of the Office of Management and Budget delivered the line on Thursday while speaking to the LIGHT Forum at Stanford University. 

Mulvaney was asked whether he agreed with the “Jimmy Kimmel test” — or the idea famously forwarded by the late-night show host that “No parent should ever have to decide if they can afford to save their child’s life.” Kimmel made the quip while delivering an impassioned account of his newborn son’s struggle to survive a congenital heart disease. “That doesn’t mean we should take care of the person who sits at home, eats poorly and gets diabetes,” Mulvaney said. “Is that the same thing as Jimmy Kimmel’s kid? I don’t think that it is.”

Mulvaney was attempting to defend the AHCA, which was narrowly approved by House of Representatives this month without a single Democratic vote. In its current form, the bill would essentially allow insurance companies to price people with pre-existing conditions out of the health insurance marketplace. Meanwhile, so-called “Trumpcare” includes a $880 billion cut to Medicaid, which stands to result in roughly 24 million Americans losing their health insurance because of premium increases.

Mulvaney’s statement was widely panned by progressives as compassionless, but diabetes advocates also noted that it is also inaccurate: The American Diabetes Association was quick to condemn Mulvaney’s remarks, saying they are “extremely disappointed” and describing his statement as “misinformed.”

“Mr. Mulvaney’s comments perpetuate the stigma that one chooses to have diabetes based on his/her lifestyle,” the statement read. “We are also deeply troubled by his assertion that access to health care should be rationed or denied to anyone. All of the scientific evidence indicates that diabetes develops from a diverse set of risk factors, genetics being a primary cause. 

Top Trump official says we shouldn’t take care of someone who ‘eats poorly and gets diabetes’

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Lying Ryan again..

For weeks now, Republicans have claimed that their new bill will protect sicker Americans. "It will be every bit as good on pre-existing conditions as Obamacare," President Trump told Bloomberg earlier this month. House Speaker Paul Ryan has a website up, right now, where he declares "VERIFIED: MacArthur and Upton Amendments Strengthen AHCA, Protect People with Pre-Existing Conditions."
CBO says this isn't true — and is unequivocal on the point. There is this one paragraph in particular that is especially devastating for the Republican plan:

People who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under H.R. 1628 to help reduce premiums. As a result, the nongroup markets in those states would become unstable for people with higher-than-average expected health care costs.

CBO estimates that about one in six Americans would live in states that apply for waivers from key Obamacare provisions, like the requirement to charge sick and healthy people the same prices or cover a set of essential health benefits.

Sick people in those places just would not have a lot of options. The market for them would look a lot like the market they faced before the Affordable Care Act passed: hospitable to the healthy and hostile to the sick. The money the Republican plan puts toward high-risk pools isn't nearly enough to prevent that situation.

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The details of the Senate GOP’s Obamacare replacement plan remain a mystery. But the argument Majority Leader Mitch McConnell is using to push the final product over the finish line isn’t. On Friday, McConnell reportedly “delivered a private warning to his Senate Republicans: If they failed to pass legislation unwinding the Affordable Care Act, Democrats could regain power and establish a single-payer health-care system.”

History may record a certain irony if this is the argument McConnell uses to successfully destroy Obamacare. In recent conversations with Democrats and industry observers, I’ve become convinced that just the opposite is true: If Republicans unwind Obamacare and pass their bill, then Democrats are much likelier to establish a single-payer health care system — or at least the beginnings of one — when they regain power..

Republicans are about to make Medicare-for-all much more likely - Vox

And what's so terrible about a single-payer system? The countries that have it insure everybody and at much lower cost compared to the US. While the latter is also the result of other factors, it will certainly help bringing cost down by reducing stuff like administrative cost, overhead, marketing expenses, outsized executive pay, profit margins and the like. It's also much better to negotiate drug prices down.

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Krugman lambasts them, and rightly so..

The Silence of the Hacks

The actual text of the Senate version of Trumpcare is still a secret, even from almost all the Senators who are expected to vote for it. But that’s actually a secondary issue: never mind the precise details, what’s the organizing idea? What is the bill supposed to do, and how is it supposed to do it?

The answer — which I’ve been suggesting for a while — is that they have no idea, and more broadly, no ideas in general. Now Vox confirms this, by interviewing a series of Republican senators:

With the bill’s text still not released for public view, Vox asked GOP senators to explain their hopes for it. Who will benefit from the legislation? What problems is this bill trying to solve?

The answers, universally, were “Er. Ah. Um.”

Time was when even the worst legislation came with some kind of justification, when you could count on the hacks at Heritage to explain why eating children will encourage entrepreneurship, or something. On the right, these explanations have descended into ever deeper voodoo; the Kansas experiment was based on obvious nonsense, and has turned out even worse than cynics might have suggested. And you might have thought that this was as bad as it can get.

But now we have legislation that will change the lives of millions, and they haven’t even summoned the usual suspects to explain what a great idea it is. If hypocrisy is the tribute vice pays to virtue, Republicans have decided that even that’s too much; they’re going to try to pass legislation that takes from the poor and gives to the rich without even trying to offer a justification.

And they’ll try to do it by dead of night, of course.
This has nothing to do with Trump, who is, as I’ve been saying, an ignorant bystander — yes, he’s betraying every promise he made, but what else is new? It’s about Congressional Republicans.

Which Congressional Republicans? All of them. Remember, three senators who cared even a bit about substance, legislative process, and just plain honesty with the public, could stop this. So far, it doesn’t look as if there are those three senators. This is a level of corruption that’s hard to fathom. Yet it’s the reality of one of our two parties.

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Since the cost of insuring seniors and adults with disabilities already comprises 63 % of Medicaid costs, the ACHA will leave states responsible for a large amount of Medicaid spending. This outcome is very different from the current system, where any increase in state Medicaid spending would be matched at least dollar for dollar and in many case by a higher rate. How will states respond? They could reduce enrollment, limit benefits, or pay providers less. Any one of these responses would be harmful to seniors who receive support from the Medicaid program.

This is how the Republican health-care bill will affect the elderly - MarketWatch

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Republicans do not want the country to know what is in their health care bill. This has become more evident each day, as the Senate plots out a secretive path toward Obamacare repeal — and top White House officials (including the president) consistently lie about what the House bill actually does. There was even a brief moment Tuesday where Senate Republicans flirted with the idea of banning on-camera interviews in congressional hallways, a plan quickly reversed after outcry from the press. “The extreme secrecy is a situation without precedent, at least in creating health care law” writes Julie Rovner, who has covered health care politics since 1986 and is arguably the dean of the DC health care press corps.

It’s become obvious to me, particularly this week, that Republicans plan to move more quickly and less deliberatively than Democrats did in drafting the Affordable Care Act. They intend to do this despite repeatedly and angrily criticizing the Affordable Care Act for being moved too quickly and with too little deliberation.

I’ve covered Obamacare since day one. I’ve never seen lying and obstruction like this. - Vox

He was going to protect Medicare, Medicaid, and Social Security from cuts and replace the Affordable Care Act with a “terrific” new system that would “cover everyone” and offer the lower premiums and deductibles the American people wanted. Pence speaking Tuesday offered reassurance that nothing has changed, promising only “historic flexibility to reform Medicaid in ways that will best serve the most vulnerable in their communities” and thanking the HHS staff for the “leading role in making the best health care system in the world even better.” The only problem is that it’s all lies.

Trump’s health care plan doesn’t protect Medicaid, it loots it to finance hundreds of billions of dollars in tax cuts. The new “flexibility” it gives to states will ensure that the most vulnerable are the most hurt. In addition to slashing the Medicaid rolls by millions, the Trump health care plan will see millions more lose coverage, and the remainder will face higher premiums for plans that cover less. There’s nothing remotely terrific about it, unless you happen to be one of the small number of high-income Americans who can expect to reap a large tax cut paid for by the suffering of millions of newly uninsured people. It’s an enormous con perpetrated on people Trump duped into believing they were in on the scam. And while the Russia situation is certainly a big deal, Trump has at least never made a secret of his admiration of Vladimir Putin — his up-is-down approach to health care deserves to be seen as the biggest Trump scandal of all.

Trump betraying all his health care promises is the biggest Trump scandal of all - Vox

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As Senate Republicans hash out what their healthcare bill should look like, senators are discussing a long "glide path" for the Medicaid expansion — instead of ending it abruptly in 2020, the federal government would phase down its payments to state governments gradually, perhaps through 2027. The idea is that the extra time would help states find the money to pay for more of expanded Medicaid themselves, should they choose to do so. Republican senators from states that have expanded medicaid, like Rob Portman of Ohio and Shelley Capito of West Virginia, have insisted on it. But in practice, this policy choice would set up the next six congressional elections to be fought, in large part, over the issue of Medicaid.

AHCA politics won't end well for Republicans, Trump - Business Insider

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The Senate is softening the AHCA House bill (Trumpcare) somewhat, House hardliners might not swallow it:

The RSC, which the largest bloc of conservatives in Congress, has drafted a letter to Senate Majority Leader Mitch McConnell (R-Ky.) raising “serious concerns” with the direction of the Senate’s healthcare legislation.
The caucus says four elements are critical to keep in the healthcare legislation. They are:

1. Ending the extra federal funds for Medicaid expansion by 2020. The Senate is proposing a more gradual phase-out of this money. Leadership has proposed a three-year transition, beginning in 2020. More moderate senators are pushing for a longer, seven-year phase-out.
   
2. Keeping a waiver that lets states opt out of ObamaCare insurance regulations. The Senate might do away with a provision in the House bill that would allow states to let insurers charge consumers more based on their health status.
   
3. Repealing ObamaCare’s taxes “in the most expeditious manner possible.” The Senate is eying keeping some taxes around for longer.
   
4. Defunding Planned Parenthood for one year and preventing tax credits from going to plans that cover abortion. At least two senators have expressed concerns over defunding Planned Parenthood, and the Senate parliamentarian has warned the tax credit measure may run afoul of reconciliation rules.    
   

RSC warns Senate: Healthcare changes may 'jeopardize' bill | TheHill

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It’s worth asking why Republicans are lying about this, why they can’t give a clear explanation as to what their bill does, why they’re jamming the legislation through a secretive, rushed process that even their own members are criticizing. Because there is a reason. And it is damning.

In 2009, Democrats had an easy answer to what the Affordable Care Act was meant to do: They wanted to cover more people and cut costs. They could give that answer because it was a basically popular position, and because it’s what their bill actually did, or at least tried to do. In 2017, Republicans have a similarly easy answer for their bill: They want to cover fewer people and use the savings to fund tax cuts for the wealthy. That is what their legislation does. But they can’t give that answer because it’s a horribly unpopular position.

Democrats always believed the Affordable Care Act would be popular. They believed that even when polls said it wasn’t popular. They were certain that when Americans understood what was in the law — when they saw it would cover tens of millions of people, and regulate away the worst abuses of the insurance industry, and let children stay on their parents’ plans, and use Medicare to pilot a host of cost-control experiments — they would come around.

This basic belief carried through the more than year-long process behind the bill. It’s why Democrats held dozens of hearings, and released draft after draft of their legislation. It’s why, when the bill was in danger, President Obama invited congressional leadership to the Blair House for a multi-hour televised debate over the bill. He was certain he had the better of the argument, and that if the American people could just hear it, Democrats would win.

By contrast, Republicans have concluded the public will hate their bill if they know what’s in it, and so they are doing everything in their power to keep it a secret and move on from it as fast as possible.

The real reason Republicans can’t answer simple questions about their health care bill - Vox