Quote:Senate GOP Obamacare replacement would lead to 22 million more uninsured in 2026, CBO estimates

• The nonpartisan Congressional Budget Office estimates that 22 million more people would be uninsured in 2026 under the Senate's Obamacare replacement bill.
• Average premiums are expected to fall in 2026 after initially rising.
• The CBO's estimate of the plan's effect on the number of uninsured Americans could influence whether Republican senators support it.
• Senate leaders are aiming to quickly gather the votes needed to pass the plan.
  

CBO releases score of Senate health-care draft  4 Hours Ago | 01:44
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The Senate's Obamacare replacement bill would lead to 22 million more Americans uninsured in 2026, while average premiums are expected to fall after climbing at first, according to [url=https://www.cbo.gov/publication/52849]a Monday report from the nonpartisan Congressional Budget Office.

The CBO's estimate of the plan's effect on the number of uninsured Americans could influence whether Republican senators support it, as GOP leaders walk a thin line in trying to win the votes needed to pass their plan. The estimated growth in the number of uninsured Americans is slightly lower under the Senate plan than the bill that passed the House last month, which the CBO said would lead to 23 million fewer covered in 2026.

Average premiums for single individuals would rise by 20 percent and 10 percent in 2018 and 2019, respectively, relative to current law, according to the CBO. By 2026, average premiums in most of the country are expected to be about 20 percent lower under the plan than they would be under current law.

Senate Republicans last week released a draft of their secretive Obamacare replacement bill, called the "Better Care Reconciliation Act of 2017." The plan would repeal Obamacare taxes, restructure subsidies to insurance customers that are based on their incomes and phase out Medicaid's expansion program. It contains some key differences from the version the House passed last month.

Shortly before the CBO released the score, Senate Republicans unveiled a revised version that appears aimed to deter younger, healthier people from dropping insurance. The updated bill would impose a six-month waiting period on individuals who buy insurance but let their coverage lapse for more than 63 days in the prior year.

That provision, an apparent response to Obamacare's individual mandate, would start in 2019. It would "slightly increase" the number of people with insurance in the 2018 to 2026 period, the CBO said.

Before the CBO released the score for the Senate plan, five GOP senators said they will not back it in its current form. Republicans, who control 52 seats in the Senate, can only lose two votes to pass the plan. They face difficulties in winning over skeptical senators, as tweaks to appease conservatives could alienate moderates, or vice versa.

Here are some of the key conclusions from the CBO report:

• An estimated 15 million more people would be uninsured next year than under current law, "primarily because the penalty for not having insurance would be eliminated."
• Lower spending on Medicaid than under current law and "substantially smaller average subsidies" in the individual market would lead to more Americans being uninsured in the following years. Enrollment in Medicaid is expected to fall by about 16 percent by 2026, the CBO estimated.
• The Senate plan would lead to an estimated $321 billion in deficit reduction from 2017 to 2026. Most of those savings would come from a drop in spending on Medicaid, which the CBO expects will fall 26 percent by 2026, relative to current law. That deficit reduction is higher than the estimated $119 billion saved by the House plan.
• While average premiums are expected to fall, out-of-pocket costs could rise for many Americans "because nongroup insurance would pay for a smaller average share of benefits under this legislation."
• States can also waive Obamacare's essential health benefits requirement, which covers things like mental health and substance abuse treatment. About half of Americans would live in states modifying EHBs, and could "experience substantial increases in supplemental premiums or out-of-pocket spending on health care, or would choose to forgo the services."
• Nongroup insurance markets "would continue to be stable in most of the country," according to the CBO. Premium tax credits would "provide insulation from changes in premiums through 2021 and in later years," according to the report.
  

Gathering votes

Senate Majority Leader Mitch McConnell aims for a vote this week, but it is not clear if he can rally the support needed to do so.

"Americans need relief from the failed Obamacare law," McConnell said in a statement issued after the CBO report was released. "The Senate will soon take action on a bill that the Congressional Budget Office just confirmed will reduce the growth in premiums under Obamacare, reduce taxes on the middle class, and reduce the deficit. The American people need better care now, and this legislation includes the necessary tools to provide it."

But the White House issued a statement questioning the report's findings, saying that "the CBO has consistently proven it cannot accurately predict how health-care legislation will impact insurance coverage."

As of right now, it is difficult to gauge how much support the bill has.

Four conservative senators — Rand Paul of Kentucky, Ted Cruz of Texas, Mike Lee of Utah and Ron Johnson of Wisconsin — argue the Senate proposal does not go far enough to dismantle the Affordable Care Act.

Moderate Republican Susan Collins of Maine said Monday night she would vote "no" on the motion to proceed with the bill. In a tweet, Collins said she wants to work with Republicans and Democrats to "fix the flaws" in Obamacare, but the "Senate bill won't do it."

Paul also said Monday he would oppose a motion to proceed without changes.

Also on the GOP's so-called moderate wing, Sen. Dean Heller of Nevada has opposed the bill as written, slamming its rollback of Medicaid expansion. Heller is up for re-election next year in Nevada, a state where Medicaid expansion provided coverage to about 210,000 people, according to its Republican Gov. Brian Sandoval.

After the CBO report's release, Sen. Bill Cassidy, (R-La.), told CNN that he had not seen the CBO report but that, as described by the network, it made him "more concerned." He added that he remains "uncommitted."

House Republicans barely managed to muster enough votes with a series of last-minute amendments before the chamber passed its highly criticized Obamacare replacement plan last month. That chamber, too, faced opposition from both conservative and moderate pockets.

Democrats slam plan 

As expected, Senate Democrats and independents immediately bashed the Republican plan. Senate Minority Leader Chuck Schumer of New York criticized the waiting period provision, saying that it "would pour salt in that wound, locking American families out of health insurance for even longer."

Democratic National Committee Chairman Tom Perez called it a "disaster for women, older Americans and people with pre-existing conditions."

Here's how much support the GOP plan has. #morningjoe pic.twitter.com/E5pxYaL3M4

— Morning Joe (@Morning_Joe) June 29, 2017

Quote:Nevermind that the Republican Party currently controls the White House, the Senate, and the House of Representatives. And nevermind that Republican candidate Donald Trump stole the White House from Hillary Clinton by illegally conspiring with the Russian government to rig the election. Today the GOP demanded that Hillary step up and fix their health care mess – and she promptly gave them a response that shut them up.


The surreal exchange began when the Republican Party’s official @GOP account on Twitter posted a brief video of Hillary Clinton saying “We’ve got to fix what’s broken” with American health care. The GOP added: “Where’s your plan, Hillary Clinton?” (link). Shortly thereafter, Hillary fired back at the GOP: “Right here. Includes radical provisions like how not to kick 23 mil ppl off their coverage. Feel free to run w/it.” (link). She included a link to her own campaign website, where she had long ago laid out a comprehensive and realistic plan to improve upon the existing tenets of Obamacare (link).


But that didn’t stop the Republican Party from posting other tweets aimed at everyone from Bill Clinton to Elizabeth Warren to Bernie Sanders to Democratic Senator Joe Manchin, each time demanding that these individuals also provide a plan to fix health care. But none of those people are in the majority party, meaning none of them have the power to implement the various health care reform ideas they’ve put forth.

Meanwhile the Republican Party continues to cling to the the shards of the disastrous AHCA, which has become derisively known as Trumpcare, as it would kick twenty-three million Americans off health insurance. The GOP has never had a valid plan for health care, and it spent the past several years flat out lying when it insisted it had a secret plan that was better than Obamacare. Now that the lie is being fully exposed, the GOP is asking the Democrats to fix it. If you’re a regular reader, feel free to support Palmer Report

Quote:Why Republicans Exempted Their Own Insurance From Obamacare Rollback
The unusual nature of staff and member health benefits


Senate budget rules are giving opponents of the rollback of the 2010 health care law an easy way to attack Republicans for hypocrisy.
The Senate GOP may not really want to immunize their own member and staff health plans from their health care policy changes, but because they are seeking to bring their bill to the floor under the expedited budget reconciliation process, they have little choice.

Sen. Ted Cruz has already unveiled a fix to nullify the exemption, but that bill would take 60 votes to overcome any filibuster attempts.

“While this exemption was included in the Senate health care bill out of procedural necessity, we must still be diligent in ensuring that Members of Congress are treated just like other Americans under this law,” the Texas Republican said in a statement. “This is an issue of fundamental fairness. Lawmakers are not above the laws that they pass and I believe that it is crucial that Members of Congress abide by the same laws that their own constituents follow.”

The exemption has already prompted a web ad from the group Save My Care, which has been working against efforts to repeal and replace the health care law that took effect under President Barack Obama.

“Senators did make the bill better for one group of Americans ... themselves,” the ad says, citing a Thursday report from Vox.
It is substantively accurate to say there is a carve-out in the Senate measure, but as with much of what happens when the Senate uses the budget reconciliation process, the reasons are complicated.

As part of the implementation of the 2010 health care law, members of Congress and many staffers both on Capitol hill and in state-based offices shifted from getting health insurance benefits through the Federal Employee Health Benefits Program to the small-business exchange in Washington, D.C.

Matters related to the local government in D.C. fall within the jurisdiction of the Homeland Security and Governmental Affairs Committee, and internal operations of the Capitol are the responsibility of the Rules and Administration Committee.
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Aides previously confirmed that since neither panel received reconciliation instructions in the fiscal 2017 budget resolution that was adopted earlier this year so Republicans could pass health care legislation with just 50 votes and a tie-breaker by Vice President Mike Pence.

A bill or amendment could lose its privileged status and be subject to needing 60 votes to overcoming procedural hurdles if staff and lawmaker health benefits were not exempted.

Under a decision by the Office of Personnel Management during the Obama administration, employer contributions were allowed to be used in the D.C. SHOP.

That led to a recurring saga in the Senate involving an amendment crafted by then Sen. David Vitter. The Louisiana Republican sought to end the employer benefit. OPM under President Donald Trump has not reversed course on the availability of the benefits

Quote:Insurers Oppose Cruz Amendment to Republican Health-Care Bill
Provision would allow insurers to sell plans that aren’t compliant with Affordable Care Act




Sen. Ted Cruz (R., Texas) said the amendment is essential to his support of the Republican health-care bill.  PHOTO: BILL CLARK/ZUMA PRESS

Insurers are ramping up their opposition to a new amendment in the Senate Republican health bill that would allow them to sell plans that don’t meet Affordable Care Act requirements, an effort that could add to the challenges faced by GOP leaders trying to shepherd the legislation.

The provision, backed by Texas Sen. Ted Cruz, would authorize insurers to sell coverage that wouldn’t meet ACA standards on the condition that they also sell at least some plans that did. While this setup could offer healthy people less expensive policies, insurers and actuaries say it would likely prove dysfunctional over time, pushing up rates and reducing offerings for people buying the compliant plans.
In a letter sent Friday night to the Senate Republican and Democratic leadership, the two major associations representing health insurers, which don’t typically send such missives jointly, said the amendment “is simply unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums and lead to widespread terminations of coverage for people currently enrolled in the individual market.”

The fate of the bill is on a knife-edge. Two Republican Senators have already said they oppose it, and Senate Majority Leader Mitch McConnell (R., Ky.) cannot afford to lose any more Republicans to get the 50-vote majority the legislation needs to pass. Vice President Mike Pence would break any tie. No Democrats are expected to support the GOP bill.

The letter from America’s Health Insurance Plans and the Blue Cross Blue Shield Association may alarm moderate Republican senators who have pledged to protect coverage for people with pre-existing medical conditions. But on the other side, the provision’s inclusion has been vital in winning over Sen. Cruz, and it is supported by other conservatives, though some feel it doesn’t go far enough to wall off the healthier market from the sicker consumers’ costs.

In an interview, Sen. Cruz said the provision is essential to his support of the bill. He said his amendment “takes nothing away” and would help millions of people by allowing them to buy lower-cost coverage, including with pretax dollars from health savings accounts, which in turn would boost insurance pools overall.



The noncompliant plans sold under the Cruz amendment could be more limited than today’s ACA coverage, lacking benefits such as maternity care, and could feature higher out-of-pocket costs and potentially annual or lifetime limits on coverage, said  Larry Levitt, a senior vice president at the Kaiser Family Foundation.

Also, insurers could refuse to sell these noncompliant plans to unhealthy people, or they could charge enrollees higher premiums based on their health conditions, according to Mr. Levitt.

The upshot, experts say: The noncompliant plans would likely be far less expensive and would draw healthy enrollees away from the compliant plans. That could leave the compliant plans with a sicker customer pool that generates higher medical costs on average, pushing up premiums.

“There are certainly winners and losers with this program,” said Kurt Wrobel, a fellow of the Society of Actuaries and chief actuary at Geisinger Health Plan. “Individuals that were healthier and not getting a subsidy in some respects would be better off, those with pre-existing conditions would be made worse off.”

In their letter, the insurance associations said that if the amendment becomes law, “premiums will skyrocket for people with pre-existing conditions.” The provision “will lead to far fewer, if any, coverage options for consumers who purchase their plan in the individual market.
As a result, millions of more individuals will become uninsured,” the associations said.

The bill contains some mechanisms designed to avoid this outcome. It adds billions of dollars in stabilization funds that could help hold down premiums for those buying ACA-compliant plans. Also, to access federal premium assistance under the Senate bill, consumers would need to purchase the compliant coverage, which could keep lower-income, healthy people in the mix.

The insurers’ letter said the funding is “insufficient and additional funding will not make the provision workable for consumers or taxpayers.”

Defenders of the Cruz amendment have noted that it does keep the compliant and noncompliant plans in the same risk pool, meaning that their pricing is supposed to be linked.

However, the amendment disables an important mechanism for ensuring that link is meaningful, insurers say. Under the ACA, a program called “risk adjustment” forces insurers that enroll a lot of healthy people to pay out money to competitors with sicker, costlier enrollees. That program won’t include the new noncompliant plans offered under the Cruz amendment.

“All the language that says there is a single risk pool is meaningless,” said Raj Bal,  an insurance-industry consultant. “You’ll have two pools.”

Actuaries and insurers say insurance companies would have an incentive to cherry pick—to offer a few expensive, unappealing plans that complied with ACA rules, aiming to attract few enrollees, and to focus instead on the skinny plans that could draw healthy people, which are likely to be more profitable.

“It’s difficult when you’ve got two sets of rules, and you’ve got an uneven playing field where you can’t compete against that cherry picking,” said Justine Handelman, a senior vice president at the Blue Cross insurer group. Some insurers “may be forced to pull out of the market.…You could see widespread terminations.”

(07-15-2017, 02:59 PM)Belsnickel Wrote: Yeah, pretty much everyone is against the health care bill the Senate is kicking around, except the lawmakers pushing for it.

Quote:[color=rgba(0, 0, 0, 0.8)]Health care bill on brink of collapse as third Republican senator lashes out at McConnell

[color=rgba(0, 0, 0, 0.44)]If they lose one more vote, the Senate health care bill is dead.[/color]


[color=rgba(0, 0, 0, 0.6)]Sen. Ron Johnson, R-Wis. walks on Capitol Hill in Washington Thursday, July 13, 2017. Senate Majority Leader Mitch McConnell of Ky. plans to rolls out the GOP’s revised health care bill, pushing toward a showdown vote next week with opposition within the Republican ranks. CREDIT: AP Photo/Pablo Martinez Monsivais[/color]
All 48 Democrats and two Republicans — Senators Rand Paul (KY) and Susan Collins (ME) — firmly oppose the Senate bill to repeal Obamacare. That means if Majority Leader Mitch McConnell and the Republicans lose one more vote, the bill will fail.

Before McConnell can even schedule a vote on the bill itself, he needs to round up 50 votes for a technical measure called a “motion to proceed.”

One positive sign for McConnell was that Ron Johnson (R-WI), who opposed a motion to proceed on an earlier version of the bill, announced he would support the motion to proceed this time.

Things have changed.

In an interview with his local Fox affiliate, WLUK, Johnson said he had changed his mind and declared that the motion to proceed was now “in jeopardy.” (Collins and Paul will also vote against the motion to proceed.)

Johnson said he was upset by reports that McConnell told moderate members of the Republican caucus “don’t worry about some of the Medicaid reforms” because “they are scheduled so far in the future they will never take effect.”


Johnson was referring to this report in the Washington Post on Thursday:
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Quote:Here’s what McConnell has told several hesitant senators (including Portman and Sen. Shelley Moore Capito (R-W.Va.): The bill’s deepest Medicaid cuts are far into the future, and they’ll never go into effect anyway.

Quote:“He’s trying to sell the pragmatists like Portman, like Capito on ‘the CPI-U will never happen,’” a GOP lobbyist and former Hill staffer told me.

“CPI-U” is a measure of inflation that grows slower than medical inflation. Beginning in 2025, the Senate bill would limit Medicaid growth at the “CPI-U” level. In this way, the bill would not only repeal Obamacare’s expansion of Medicaid but cut it relative to the law prior to Obamacare’s passage. Over time, federal money would cover less and less of each state’s costs, which likely force states to cover even fewer people.

This reduction in spending that is favored by conservatives like Johnson but worries moderates in states with large Medicaid populations like Capito, who represents West Virginia.

In any event, Johnson is not pleased with McConnell’s tactics.

Also complicating matters for McConnell is news that John McCain “underwent surgery to remove a blood clot above his left eye.” The surgery was reportedly successful but McCain will be resting in Arizona for the next week to recover. That means that McConnell, even if he keeps Johnson’s vote, will definitely not have 50 votes until McCain returns.

McCain has been critical of the legislation but was not expected to oppose the motion to proceed.

UPDATE (10:22PM): McConnell has formally delayed the health care vote, which was planned for next week, citing McCain’s recovery.

BREAKING FROM @SenateMajLdr MCCONNELL pic.twitter.com/zkpBTLM6dt

— Seung Min Kim (@seungminkim) July 16, 2017

(06-19-2017, 04:54 PM)Belsnickel Wrote: I think that's what has a lot of people irritated about this. For 6 years we have heard nothing but repeal, or repeal and replace. They haven't just had a couple of weeks, the GOP has had 6 years to come up with a unifying policy alternative for their party. Instead, they are acting like the dog that caught the car.

(07-16-2017, 12:36 AM)StLucieBengal Wrote: If there is anything other than full repeal. I don't care.


Now if they want to also throw in the removal of regulations then I could live with that as well.

(07-16-2017, 12:45 AM)Vlad Wrote: That's exactly right. All they could offer is lip service believing there wasn't a chance in hell Trump was gonna win.

Sen. Patrick J. Toomey offered a simple, remarkable explanation this week for why Republicans have struggled so mightily to find a way to repeal the Affordable Care Act.

“Look, I didn’t expect Donald Trump to win. I think most of my colleagues didn’t, so we didn’t expect to be in this situation,” the Pennsylvania Republican said Wednesday night during a meeting with voters hosted by four network affiliates across his state.

https://www.washingtonpost.com/powerpost/one-reason-the-gop-health-bill-is-such-a-mess-they-didnt-think-trump-would-win/2017/07/06/bed6a8e0-624a-11e7-8adc-fea80e32bf47_story.html?utm_term=.402b1f5afc40

(07-16-2017, 01:22 AM)oncemoreuntothejimbreech Wrote: So he didn't expect Trump or any other Republican to win the presidency 6 years ago before Obama was even re-elected? That's not an excuse for the lack of a plan to replace what they hoped to repeal and replace.

He must have hired the same writers that work for Trump, Jr. penning his excuses.

(07-16-2017, 12:45 AM)Vlad Wrote: That's exactly right. All they could offer is lip service believing there wasn't a chance in hell Trump was gonna win.

Sen. Patrick J. Toomey offered a simple, remarkable explanation this week for why Republicans have struggled so mightily to find a way to repeal the Affordable Care Act.

“Look, I didn’t expect Donald Trump to win. I think most of my colleagues didn’t, so we didn’t expect to be in this situation,” the Pennsylvania Republican said Wednesday night during a meeting with voters hosted by four network affiliates across his state.

https://www.washingtonpost.com/powerpost/one-reason-the-gop-health-bill-is-such-a-mess-they-didnt-think-trump-would-win/2017/07/06/bed6a8e0-624a-11e7-8adc-fea80e32bf47_story.html?utm_term=.402b1f5afc40

Remember that big victory celebration in the Rose Garden. That kegger with a beaming @SpeakerRyan? Well, here's Ryan now. pic.twitter.com/GCr2hsPnUm

— Scott Stern (@ScottAStern) July 18, 2017

My statement on an upcoming vote to repeal #Obamacare pic.twitter.com/RdyDiUJfMD

— Leader McConnell (@SenateMajLdr) July 18, 2017

(07-18-2017, 09:46 AM)Belsnickel Wrote: We've now officially moved from "repeal and replace" to "repeal and go **** yourself."