[Discussion] Health Policies and ACA Reform/Repeal

The existing health thread is for discussion on how changes to current policy will/have personally affected you or those you know. This thread is for more general discussion of the subject.

Politico: Conway: Trump to decide 'this week' whether to let Obamacare implode

President Donald Trump will decide "this week" whether to let Obamacare implode, White House counselor Kellyanne Conway said Sunday.

After the Senate failed to repeal Obamacare last week, the president said he would let law fall apart by ending cost sharing reduction payments, which lower out-of-pocket costs for lower-income people.

On Sunday, Conway said Trump is set to decide whether to actually end the payments.

“He’s going to make that decision this week, and that’s a decision that only he can make,” Conway said on “Fox News Sunday.”

Trump also tweeted that “bailouts” for members of Congress will end very soon. Conway said that if lawmakers had to live under all Obamacare's provisions, they might be more understanding of the problems people face and more willing to repeal it.

Single-payer for all, coming right up.

Though, of course, I see no evidence that Conway isn't lying again. She's better at it than Spicer was but her modus operandi has been to read the tea leaves of Trump's tweets and then come up with something plausible that sounds good on TV and lets her attack liberals. Whether the president actually believes what she says is a distant second.

Though other With House officials are saying similar things:

The Hill: Mulvaney: It's White House policy Senate keeps focus on healthcare

White House budget director Mick Mulvaney said Sunday that it’s official White House policy that nothing else gets a vote in Congress before healthcare.

"Yes," it's official policy that the Senate stay focused on ObamaCare reform before voting on anything else, Mulvaney told Jake Tapper on CNN’s State of the Union.

President Trump’s calls for Republican senators to prioritize passing a bill to repeal and replace ObamaCare are “simply reflecting the mood of the people," he said.

“So in the White House’s view they can’t move on in the Senate; in the people’s view they shouldn’t move on in the Senate,” Mulvaney said.

Uh, yeah, good luck with that one. They've already moved on to the next votes.

Even though the healthcare bill can technically still be revived--the vote was only on the amendments, the house bill itself was returned to the calendar--with McCain out getting treatment McConnell can only muster 51 votes total. For anything. He needs Murkowski and Collins just to get anything else done, let alone healthcare.

Plus, since some other senators are enjoying being similar swing votes on other issues, I suspect that ending the filibuster will not be popular with Republicans, let alone the other side.

Meanwhile:

Politico: Lawsuits could force feds to pay Obamacare insurers: The companies claim the federal government owes them billions from a program meant to stabilize Obamacare marketplaces.

A pending court decision could force the Trump administration to pump billions of dollars into Obamacare insurers, even as the president threatens to let the health care law “implode.”

Health insurers have filed nearly two dozen lawsuits claiming the government owes them payments from a program meant to blunt their losses in the Obamacare marketplaces. That raises the prospect that the Trump administration will have to bankroll a program the GOP has pilloried as an insurer bailout.

Insurers are owed more than $8 billion in payments, and the tab is likely to grow. Insurers say spending restrictions Republicans forced on the “risk corridors” program during the Obama administration, aside from being illegal, are partly to blame for severe turbulence in some Obamacare marketplaces.

The government promised money, insurers are demanding they pony up the promised cash. These aren't even the "bailouts" Trump was ranting about on Twitter.

On the other hand HHS secretary Tom Price claims Trump was joking about firing him. And that he's going to follow the law:
HHS secretary pledges to implement 'law-of-the-land' Obamacare

I'll note that last bit from that article:

“Talk to the families that are making $50,000 dollars a year and have an insurance card through Obamacare but they don't have any care because they can't afford the deductible,” he said. “This is a system that is, that is imploding and has failed the American people. That's where the president's passion comes from.”

Maybe American families would be able to afford it if you would stop jerking around the market with your uncertainty and fund the Medicaid expansions already...

Does Trump even have the legal authority to withhold the cost-sharing payments? He certainly doesn't have any authority to set the Senate's agenda.

I always understood the process as this: Legislature apppropriates money for things, and the Executive spends it. Unless the Legislature passes a law to that effect, the Executive is not required to spend money, and of course passing a law binding the Executive when he or she doesn't wish to be bound requires a veto override.

So, I think it would all come down to how the healthcare bill was worded, and, likely, how the Supreme Court ends up interpreting that wording.

Tomi Lahren, conservative firebrand, bashes Obamacare while benefiting from it (SFGate)

After Lahren launched a slew of attacks against the law, Handler asked her, "Do you have a health care plan or no?"

"Luckily I am 24 so I am still on my parents' . . ." Lahren said.

The irony was not lost on the audience, which immediately erupted in shouts, cheers and laughter. Lahren admitted that she benefited from a major provision of the ACA that allowed young adults to stay on their parents' insurance plans until age 26. Previously, the cutoff was 19, or 22 for full-time students.

Tomi Lahren makes money because she looks like what Republicans think a person should look like and spews hatred and ignorance.

Demosthenes wrote:

Tomi Lahren, conservative firebrand, bashes Obamacare while benefiting from it (SFGate)

After Lahren launched a slew of attacks against the law, Handler asked her, "Do you have a health care plan or no?"

"Luckily I am 24 so I am still on my parents' . . ." Lahren said.

The irony was not lost on the audience, which immediately erupted in shouts, cheers and laughter. Lahren admitted that she benefited from a major provision of the ACA that allowed young adults to stay on their parents' insurance plans until age 26. Previously, the cutoff was 19, or 22 for full-time students.

I'm not especially familiar with this particular situation, but surely somebody can benefit from something while simultaneously believing that thing is a problem. You live in the reality you have, not the reality you wish you had, and you do the best you can with what you've got.

Usually if you're benefiting it, it's not a *problem*. It might have *flaws*, but you at least discuss the bad AND the good, and admit that you're invested in it to your benefit.

Robear wrote:

Usually if you're benefiting it, it's not a *problem*. It might have *flaws*, but you at least discuss the bad AND the good, and admit that you're invested in it to your benefit.

Exactly this, this is the first time Tomi has ever suggested there's anything GOOD happening with Obamacare at all. Every other mention from her has always been with the suggestion that it should be burnt to the ground.

gore wrote:
Demosthenes wrote:

Tomi Lahren, conservative firebrand, bashes Obamacare while benefiting from it (SFGate)

After Lahren launched a slew of attacks against the law, Handler asked her, "Do you have a health care plan or no?"

"Luckily I am 24 so I am still on my parents' . . ." Lahren said.

The irony was not lost on the audience, which immediately erupted in shouts, cheers and laughter. Lahren admitted that she benefited from a major provision of the ACA that allowed young adults to stay on their parents' insurance plans until age 26. Previously, the cutoff was 19, or 22 for full-time students.

I'm not especially familiar with this particular situation, but surely somebody can benefit from something while simultaneously believing that thing is a problem. You live in the reality you have, not the reality you wish you had, and you do the best you can with what you've got.

Generally, I'd agree, but the problem being, for a growing number of conservatives, their usage of the program is great, but anyone else's is a threat to everything freedom related. See Paul Ryan's family getting Social Securities benefits, but now that program is just people mooching off of it and it taxes everyone unfairly so it has to go as much as possible.

Leading to ironies like this where a political figure has nothing but hate for a program that actually did provide benefit to them.

Or like my cousin and her ex-husband where both were on disability due to car crashes that significantly impacted their ability to work who were receiving Medicaid, Food Stamps, and such... but everyone knows those programs are just used by people who don't want to work while they protest downtown (way to be subtle about the racism dude) was a constant refrain from him.

I have a brother-in-law that hurt his back on the job and now receives permanent disability and a range of other support. Now he has time to listen to Hannity and Fox News all day and complain about social safety net that supports others who just didn't plan their lives well enough.

In Tomi Lahren's case, it allows her to be a social media star because otherwise she would have to spend a lot of money nom insurance or get a real job.

1: Tomi Lahren is a flesh-covered sack of bile and poorly thought out talking points, who ruthlessly exploits the rubes of the right-wing mediasphere for profit.

2: I think the mortgage interest tax deduction is a clusterf*ck of a policy that needlessly rewards being lucky enough to afford to buy a home at the expense of those who aren't. I think it should go the way of the dodo for the good of the country. But you're damn-right I'm taking that deduction come April 15th. I'd be an idiot not to. I honestly don't see Lahren staying on her parents' insurance as any different from that. Yes, it's stupid policy, but it is the policy, and I'd be stupid not to work within that policy for my own best ends.

Eh, I'd rather expand the tax break to renters, as not taxing you over money you need too spend on a home makes sense.

Just got this email from Bernie...I agree with him that we need to go on the offensive!

Thanks so much for your ongoing support.

Let me take this opportunity to give you an update as to what's been happening in recent weeks.

As you all know, the disastrous Republican "health care" proposals have, for the moment at least, been defeated. They were defeated because millions of Americans stood up and fought back. They made phone calls and sent emails, letting members of Congress know how they felt. They got their friends involved in the struggle by utilizing social media. They attended town hall meetings. They went to rallies, including some that I attended in Michigan, Maine, Nevada, Arizona, West Virginia, Ohio, Utah, Pennsylvania and Kentucky.

And in poll after poll, an overwhelming majority of the American people were absolutely clear about their opposition to these destructive plans:

No. We will not be throwing 32 million, 23 million, 22 million or 16 million Americans off of health insurance in order to give tax breaks to the rich and large corporations, and to further the right wing extremist ideology of the Koch brothers.

No. We will not be cutting Medicaid by $800 billion, raising premiums for older workers, defunding Planned Parenthood and making it almost impossible for people with pre-existing conditions to get affordable insurance.

Needless to say, while we have won at least a temporary victory by defeating horrific Republican proposals, that is not good enough. We need to go on the offensive, not simply remain in a defensive posture.

The status quo is not satisfactory. Too many Americans continue to have no health insurance. Too many are paying premiums, deductibles and co-payments that are much too high. Too many cannot afford the outrageously high cost of prescription drugs they need. Too many cannot gain access to high quality primary health care or dental care, even when they have insurance. Our goal is not complicated, and it is not radical. It is to have the United States join every other industrialized country on earth in guaranteeing health care for all. Health care must not be considered as a privilege or a commodity. It is a human right to which every man, woman and child is entitled.

Our goal is to create a rational, cost-effective health care system. Today in the United States, we are spending almost $10,000 a year per person on health care. This is absurd and unsustainable. We must not continue a system which is, by far, the most expensive, wasteful and bureaucratic in the world.

Our goal is to put health care dollars into disease prevention and the provision of health care, not insurance company profits, not outrageous salaries for health industry CEOs, not advertising, not billing, not lobbying or campaign contributions.

Our goal is to move this country to a Medicare-for-all, single-payer system.

Let me be clear. This will be an enormously difficult and prolonged struggle, and one which will require the efforts of tens of millions of Americans in every state in this country. It will, in fact, require a political revolution in which the American people participate in the political process in a way that we have not seen in the recent history of our democracy.

In order to pass a Medicare-for-all, single payer system we will be taking on the most powerful special interests in the country: Wall Street, the insurance companies, the drug companies, the corporate media, the Republican Party and the establishment wing of the Democratic Party. In opposition to our efforts there will be a never-ending barrage of TV ads, editorials, political attacks and lies.

If we are going to be successful in this struggle, we have got to be smart – very smart. Not only do we need strong legislation (which I will be offering shortly and an outline of which I will be sending to you), but we need an unprecedented organizing and educational campaign.

How do we counter the lies and distortions against Medicare-for-all that is sure to come? How do we make certain that all of us – men and women, gay and straight, black, white, Latino, Asian-American, Native American -– are in this struggle together? How do we bring young and healthy people to stand alongside the elderly, the sick and the poor?

The battle that we are undertaking is enormous and unprecedented in the modern history of our country. Please send us your ideas as to how we can best go forward. Please give us your vision of what a humane and rational health care system looks like. Please share your experiences with the current system. Please help us map out an effective political strategy.

We are in this together. We need everyone's ideas.

Thanks again for your support and all that you are doing.

In solidarity,

Bernie

Gremlin wrote:
OG_slinger wrote:

I don't know what gets to me more. The fact that tweet shows he doesn't have a clue how Congress really works or that he thinks calling Republican Senators quitters will suddenly make them do what he wants.

I guess he'll ratchet up the pressure in tomorrow morning's Twitter rant and double dog dare Republicans to repeal Obamacare.

Guess who today's winner is?

Answer: Not the American people!

So it sounds like he wants them to abolish the filibuster completely. Good luck with that. Not to mention he couldn't even get the 51 votes needed for a simple majority.

Quintin_Stone wrote:
Gremlin wrote:
OG_slinger wrote:

I don't know what gets to me more. The fact that tweet shows he doesn't have a clue how Congress really works or that he thinks calling Republican Senators quitters will suddenly make them do what he wants.

I guess he'll ratchet up the pressure in tomorrow morning's Twitter rant and double dog dare Republicans to repeal Obamacare.

Guess who today's winner is?

Answer: Not the American people!

So it sounds like he wants them to abolish the filibuster completely. Good luck with that. Not to mention he couldn't even get the 51 votes needed for a simple majority.

In his defense, math, like the electoral college, is stacked against republicans.

He thinks that the only reason they had to go for skinny repeal was because the filibuster kept them from doing more sweeping reforms, and if they could have done bigger reforms, they would have passed a. Because he's dumb.

This is the kind of thing that worries the hell out of me. Either through intention or incompetence, the administration is going to destroy the mundane processes and infrastructure that actually get people signed up for the ACA, then claim to have no idea why enrollment numbers are down, and yell about how that's evidence the whole program needs to be torn down. Most of this will be invisible to the majority, so they'll accept this explanation.

And now the GOP is suggesting that McCain's brain tumor impacted his vote on healthcare

The GOP continues to reach new levels of despicability

I for one think it's reasonable to want to ensure that our elected officials have a healthy brain capacity. Let's start scheduling some tests, obviously in anything like this it's good for morale if the boss goes first, so we'll get Trump in later today.

Yonder wrote:

I for one think it's reasonable to want to ensure that our elected officials have a healthy brain capacity. Let's start scheduling some tests, obviously in anything like this it's good for morale if the boss goes first, so we'll get Trump in later today.

Oh, Please. This out from Trump TV, "He has the best brain! He got the best scores! Bigly!"

Trump is back to attacking McConnell again. This time at 4 am.

"Can you believe that Mitch McConnell, who has screamed Repeal & Replace for 7 years, couldn't get it done. Must Repeal & Replace ObamaCare!"

Can you believe that someone who screamed for years that Obama wasn't American couldn't prove it and it turned out he was lying the whole time?

The Trump Administration Has Many Options to Undermine Obamacare

The CBO scored what would happen if Trump terminated cost-sharing reduction (CSR) payments.

The TL;DR version is that terminating CSRs wouldn't kill the ACA and the federal government would end up paying $194 billion MORE because stopping CSR payments would cause premiums to rise by 20-25% and would cause the tax credits that individuals get under the law to also increase.

So instead of paying insurance companies directly, Trump would have consumers pay insurance companies more and then have those same consumers get more tax credits back from the government. Far from punishing insurance companies, Trump terminating CSR payments would literally be giving them nearly $200 billion in additional revenues over the next ten years.

Of course it would.

Are we a dystopia yet?

So, I'm waiting at the pharmacy today for a reimbursement...

Wait. Let me back up... After my insurance provider denied payment for a monthly scrip, I paid full price so that I wouldn't have to do without....

No, wait. Let me back up some more... I switched jobs recently. A routine part of this is enrolling in benefits. After reviewing our options, we decided that my wife's employment offered a better plan and we went with them. As part of enrollment, the new provider somehow cocked up my information and identified me as covered by Medicare as a primary provider and refused to process the claim from the pharmacy. I paid full price in good faith and sent my receipts in for a manual reimbursement. The provider worked their arcane adjustment wizardry and literally sent me a check for $1.51, far less than what I paid to the pharmacy. I then returned to the pharmacy only to be informed that they could not process a refund since I had filed a manual claim and their ability to reprocess was blocked by the provider. Further complicating matters, the insurance provider subs out prescription coverage adding an additional decision maker to an already complex process. As of today, I still don't have my ducats.

While I was waiting in line, I was thinking of family and friends that have told similar stories (before and after the ACA) and was also reminded of the fact that I was lucky enough to: float an interest free loan to an insurance provider and a drug company by proxy, have the time and transportation to make repeated fruitless trips to the pharmacy, have the time and resources to spend on the phone with customer service drones with no actual power and perverse professional incentives to get me off the phone unpaid. All of this was due to their f*ckup. There are entirely too many people in this country that do not have the time or ability to jump through these common hoops when accessing health care. And this minor scrap is nothing compared to the threat of a lawsuit or medical bankruptcy.

The mercantilist structure of health care in this country (with all it's barriers to entry, cronyism and market distortions) needs to end. With no better option on offer and agreeing with the premise that a government's role is to address the needs of its people that the market refuses to, I fully support Single Payer.

/rant

A liberal is a conservative who just got mugged by economic reality...

Robear wrote:

A liberal is a conservative who just got mugged by economic reality... :-)

And was intelligent enough to recognize root causes, rather than blame their economic reality on immigrants or whatever.

I wasn't analyzing, just humorously restating a saying popular in my youth.

Trump slashes advertising and outreach budget for ACA enrollment period.

- Advertising 90% down to $10 million nationwide.
- In-person outreach budget cut by 41%
- “We haven’t done a specific study related to the public awareness of the program,” the third HHS official said. “I think most Americans are aware of the program at this point in time.”