Magox

He doesn't really detail Phase I, but from what I can see, there is very little difference between this proposal and what the ACHA would have done.

The author of that first article Andrea Ruth is either really delusional or just another conservative huckster. The Republicans voted on many repeal bills, even one that was very similar to the ACHA in which Meadows co sponsored along with Tom Price. It was one thing for Republicans to beat their chest and scream "REPEAL OBAMACARE" and then take a meaningless inconsequential vote back in 2015 and it is another to then govern and then vote on something that could end up having a real impact on people's lives. I know I'm repeating myself over and over, but it has to be said because these hucksters can't possibly be this stupid. A vote on the bill was not voting on a final product. It would have had to have gone back to the Senate, they would have debated it for months, giving ample time for Freedom Caucus to huddle up with Cotton, Cruz, Lee and Paul and they would have had plenty of say in how they would have wanted to craft legislation in the Senate. And even if passed the Senate it still would have gone back to Conference where leadership of Senate and House would have come to an agreement on a proposal to bring back to their members and then it would have had to go back to the house for yet another vote. People are stupid, seriously. And good for Ted Poe. These groups like the Freedom caucus should be marginalized, they only have an interest in purity not in governance. Their proposals typically aren't proposals that have any shot at becoming law. All they know how to do is oppose, they are not a constructive force when it comes to governing.

Sure, I agree with that, but that isn't really what I'm trying to get at. I'm just trying to figure out what a possible deal could look like. It's pretty clear to me that trying to get everything done in a purely partisan basis is not only unwise but nearly impossible. There are too many divisions within the GOP and not enough room for margin for that to happen. They need to try to get bipartisan consensus to pass things, plus the odds that a future Democratic party undoing such things become much less because it was done on a bipartisan basis. Things that are very important to people such as healthcare, if done on a partisan way is destined to be undone or at the very least dramatically changed.

Current state of affair really sucks right now, Trump is seen as a wholly unacceptable partner to work with from the perspective of the Democratic party. The Democrats are about as red hot as the Republicans were in 2010. Their base is in no mood to hand Trump a victory, just like Republicans were with Obama., just that it is even worse now than then., which was pretty !@#$ing bad. There really needs to be a one on one outreach to lots of Democrats in the house and Senate and talk with them, and see if there really is a compromise to be had. Also, if Trump is truly willing to work with Democrats than he needs to say publicly that he is willing to work with Democrats and spell out some of the popular things that Republicans are proposing and compromises that they are willing to make. Schumer and Pelosi have both stated that they are willing to work with Republicans, I think that they are full of ****, but he can call their bluff in a very public manner. There is a compromise to be had that can appease reasonable people from both sides of the aisle. You can definitely introduce some market based reforms and keep the main tenants of Obamacare in place, such as financial assistance and covering people with Pre existing conditions. I don't think they should do that now, they need to try to get him a tax reform bill to pass, I don't think it will be as comprehensive as they had hoped because of this first bill failing, which took out nearly a Trillion dollars worth of cuts in that bill that would have helped fund the tax reform. The Freedom Caucus and a few others really screwed up the agenda for 2017 and now Trump and leadership will have to see how they can navigate around the carnage of the failed bill.

Mulvaney, current white house budget director, one of the founders of the Freedom Caucus, who I happen to believe is a very bright man, sounds off: That's the confounding thing about it all, all this vote did was advance the ball on over to the Senate. It would have been debated for months and guys like Cruz, Lee and Paul would have had ample opportunity to huddle together with the Freedom Caucus to try to make reasonable and realistic adjustments to the bill but rather than just let it die. Now as a result of their decisions, there is a very real possibility that one of three things will most likely happen. A) Trump and leadership cuts many of them out and looks to go the bipartisan route, which means the end product would be significantly less what they would have gotten if they had gone this route or B) The Freedom Caucus realizes that they overplayed their hands and are willing to negotiate in good faith and make concessions that they weren't willing to do so to begin with. or C) Obamacare stays with a few reforms to improve it. Either way, The Freedom Caucus will end up getting a much worse bill than what they could have gotten. There is no bill that can pass the house and Senate that the DC Conservative class of Heritage, Club for Growth and Freedom Caucus were pushing for. I found this to be interesting.

Glad to see that, it appears others such as grinreaper and a few others are open to this as well. The problem is there needs to be enough political cover for those that are willing to buck the the base of either party that are willing to compromise.

WIth Trump's tweet this morning and now Priebus saying this I'm hopeful. This would indicate that they would look to cut out the purists and most intransigent of forces from both sides of the aisle. The way it should be.

Shots fired:

As much as I would love to see a strong movement towards fiscal responsibility combined with moderate approach to healthcare and safety nets, that isn't where the passion lies. If you look at the overall numbers where many of the country reside, its pretty much what I described. However all the media and radio hucksters, social media passion and political activists are all aligned with the furthest end of the right and left wings of each party, which is probably somewhere between 25-35% of the country. They are the loudest voices and the ones that vote most often, specially during the midterms. It's going to take strong leadership and someone who isn't beholden to either extreme faction of their irrespective base to achieve this. Someone who is able to identify those positive forces in politics that are willing to do what is best for the country as opposed to their narrow ideology and political base. Someone who will always try to achieve things on a bipartisan basis and when confronted with intransigent unreasonable voices to not be afraid to call them out and marginalize them for being corrosive forces in our Democracy. That's the hope I have, but I don't see it happening anytime soon.

Yes, Ryan would have to be on board. Ryan is a free market guy but unlike some of his colleagues he's a realist and understands the legislative body better than almost anyone. Unfortunately, he's not a good salesman and he really underestimated the outcome of his proposal. Having said that, I would imagine before Trump would look to do this, Ryan would basically outline what he'd be willing to give up and what they would like to include in a compromise. I think a good compromise would look like the following, not sure Ryan would accept this, but this would what I would try to do. Democrats would get to keep: 1) Medicaid expansion with slight reforms 2) Taxes on the "rich" over $500,000 a year income 3) Some of the minimum essential benefits, such as Preventative care, mental health, no life time and annual limits. 4) Planned parenthood Democrats would have to give up: 1) Repeal of taxes of those over $250,000- $500,000 a year 2) Individual Mandate 3) Employer mandate 4) Taxes on Medical devices Republicans would look to add: 1) Rather than mandate coverage for Pre existing medical conditions from the carriers, create Federally subsidized Risk pools. By the way, I think this would be a fantastic idea. 5% of the sickest of the population makes up over 50% of the entire healthcare costs. Think about that for a second. Imagine for a minute that you are able to place a good portion of those 5% into a separate risk pool, what do you think that would do to insurance premiums for the rest of the 95% of the population? I think they could actually create a medical reimbursement rate sort of program for this subsidized pool like they do with Medicare, where the providers who accept it understand that they will charge at medicare reimbursement rates which is much lower. I think this is something that should be heavily funded. It would be great for the American public because lots of money would be saved on the behalf of the consumer, which means more money would be available to go back into the economy. 2) Tort reform 3) Competing across state lines 4) pilot programs where people can choose the option of the cost share reduction subsidy or a fixed amount of funds that would go directly into an HSA. HSA's should be something that they really try to promote. The problem in the past is not a lot of people can save money to put into the HSA. So if you give the public a choice to choose a plan with either the Cost share reduction that is currently in the ACA, (which for those of you who aren't familiar with it, basically the cost share reduction is something that is income based, and if you quality the plan will have its deductibles, max-out-of-pockets and copays reduced) And a choice to where they can place those allocated funds into an HSA and give them the choice to spend those dollars, I think that would be very interesting and help reduce medical costs. 5) reform of how subsidies or advanced tax credits are distributed. 6) pilot programs to promote price transparency from Medical providers This would reduce taxes, lower premiums, take away the two big mandates which would give more freedom to individual consumers and help out employers and still provide expanded coverage at probably at an even higher amount than where we are today. But of course, this won't happen.

They being Ryan and team should have included their members more into the discussion beforehand, I think they would have been able to get a few more people to go along with their plan. Krauthammer brought up an interesting point the other day, basically he said they should have just loaded everything that the GOP wanted into the reconciliation bill, making it easier for the house to vote for it, knowing that once it got to the Senate side that the Senate parliamentarian would have struck down a number of the provisions that aren't allowed through budget reconciliation, but at least leadership could have essentially said "we tried to get these things through" and we delivered it up for a vote. Then the grown ups in the Senate would have had to work out the details. In any case, I will go back to my original thoughts before they tried doing this which is when it comes to healthcare, they should try to do this on a bipartisan basis. When you do this from a hard partisan line, these sort of things are destined to fail. You'll have constant opposition to the bill and when Democrats get back in control they'll do the same thing and repeal that bill and next time it will be single payer. Which to be honest with you, unfortunately I think that is where we are inevitably headed. Unless, they can do something that incorporates more free market reforms with financial assistance to lower to middle income folks and people with pre existing conditions. I'm hoping that Trump tries to strike a deal with those that are truly interested in advancing bipartisan healthcare reform. The key is to identify those from both sides of the aisle who are willing to negotiate in good faith and understand the concept of rational compromise. There is a good bill to be had that includes ideas from both sides, I just hope they try to tackle that before the window of opportunity closes.

I don't think you guys understand the ramifications of not passing the reconciliation health bill does to Tax reform. It severely limits their hopes to reform the tax system, and most likely all they will be able to do are some cookie cutter style tax cuts.

Yes it does, but Tim Alberta is not a lefty, he works for the National Review and is well-connected. Publicly I'm sure he will try to not go after the Freedom Caucus because that constituent of voters who probably represent about 20% of the GOP is not one who he will want to upset for re election purposes. But privately, I'm sure he's fuming.

It's not just the votes, by not passing the Republican reconciliation bill, what they did is damage the Tax reform bill. How? Well, you know those Trillion dollars in Obamacare tax cuts they had would have wiped out under their Reconciliation health bill? Well, now those taxes stay in place. How does that affect the Tax reform bill? Those Trillion dollars in Obamacare tax cuts were going to help finance a decent portion of their Tax reform bill. Now they have to figure out where they are going to get those Trillion dollars. The unintended consequences of stupidity.

I couldn't agree with you more, as I've stated on numerous occasions, the idea of just sitting back and waiting for the ACA to implode is a fool's errand. I mean, sure there are things that Trump and HHS along with congress could do to sabotage and gut the law to force a collapse, but if they were to go this route then the GOP would completely own it. Not only would they own it, but it would be a pretty ****ty thing to do by using people and their constituents as pawns in their political game. Plus the media, hospital organizations, AARP, Insurers, hell you name it, every one would call them out for their cynical and cruel approach. If they let the law exist as is, then there will be no collapse of the ACA in the foreseeable future. As I've tried explaining, the markets are very localized and the vast majority of the markets under the ACA are not in the present at any danger of a death spiral. Don't get me wrong, they have lots of issues and many markets that aren't in danger are still seeing hefty increases, but the point is that if you think that you can just wait until it collapses before you do something, you'll be waiting quite a long time. I posted an article from Larry Levitt who is sr advisor to Kaiser and he substantively points out pretty much what I've been saying about the regionalized risk pools and that in the overwhelming areas that ACA individual plans are available, there is no immediate risk of a collapse. Here are a few others who point to the same: When you look at what metrics determine a "death spiral", there are three main areas that you point to. A) Rising premiums - Well, this isn't so clear cut. Yes, premiums are rising and they rose a lot last year, 24% throughout the country in the ACA individual market exchanges. But, that isn't truly what people paid. 83% of those who purchased plans in the ACA received a subsidy, and overall the average consumer through the exchanges paid a nominally higher premium. We can have the philosophical debate as to whether or not the government should provide subsidies, but that isn't what the discussion is about. We are posing the question, is the ACA in a "death spiral", and based off of what people are paying, the answer to the Rising premium portion is no. B) Deteriorating risk pools - In order to be in a "death spiral", you have to have a growing number of older sicker people signing up and less younger people. That's essentially at the heart of it all. According to US centers of Medicare and Medicaid, people between the ages of 18-34 which is the lowest risk category, the share of people who signed up in this demographic is expected to be the same at 26% from the previous year. In a Death Spiral the number moves down in a substantive manner. 26% isn't great, but it's stable. C) Shrinking enrollment - If you have a "death spiral", that would mean you have to have fewer people signing up, because.... well......That is the end result of an implosion of a market. According to this years open enrollment figures, there was a decline of about 3%. That's not good, but that isn't indicative of an imminent collapse. This isn't to say that things are working well. Again, that isn't the argument. The argument being made by many is that we can just wait for it to collapse and then fix it. I suppose it all depends on how you define "collapse". If you mean wait for a few markets that offer no options and no market availability and the press coverage is so bad that you wait to have Democrats come to you, well, I suppose that could happen. But if you are waiting for the Obamacare markets to collapse in the sense that some have defined it to where you have large regions and many states throughout the country to experience this "death spiral", well that simply isn't going to happen any time soon. I've been a huge critic of the law and I have pointed out all its deficiencies countless times , and I believe the law needs a major revamping but what I won't do is spread falsehoods or ignorant talking points.

The main problem with healthcare prices aren't because of the insurers but rather the underlying price of medical care. Price transparency would go a long way in helping drive down rates. You literally can get an MRI in one location for $500 and go to another medical provider a few miles down the road for $2000. That's why HSA's would be a good idea, if you could allow people to have more control of where their hard dollars would go, that would encourage more consumers to shop around for services rather than just going to whatever network provider is accepted by the insurer.

I don't really take what you say seriously TyTT.

No TyTT, it is what we call reality which is something that you are vaguely familiar with.

This is a good rundown from Larry Levitt, Kaiser foundation Sr. advisor. Goes over what the HHS can do to undermine or support the markets. Things that I was going over. And also confirms what I had been saying that the ACA is not about to implode, only in certain areas does it face daunting challenges. It's a good substantive read, you know, things that people aren't interested in.

House Republicans are a bunch of clowns. They were elected to oppose and now that they have power they don't know how to wield it. They deserve all the ridicule in the world, the irony is that the guys that are most responsible for this are the ones who are politically the safest as they come from districts that are uber conservative and the only way they'll lose their job is if they get out neanderthaled from their right flank during the primaries.

John Boehner knew what was up months ago. I'm sure he's off somewhere laughing and shaking his head knowing that striking a deal that could pass congress and become law is not something that the Republican conference is capable of doing.

Sad!

Well, that is a stretch. It still will Obama's law and yes the media would try to spin it that way along with Democrats but that would be a tough sell. But aside from your partisan sniping, that is an interesting question. Will he and Price try to help gut it from within via HHS undoing of specific regulations or will he do the right thing and try to stabilize the market as much as possible until some sort of resolution comes about. One thing is for sure, the insurance industry, hospitals and doctor associations will all be lobbying for him to attempt to stabilize it. I'm not sure which way they'll go. Right now, I don't believe Trump even knows which way he'd go. I'm think he'll try to roll the right wing and strike a deal with Democrats. But probably not until 2018.

He did. I'd love for that to happen, unfortunately I don't see that happening any time soon. The Mainstream media and radio hucksters have a firm grip on their political bases.

I wouldn't be surprised to see Trump now try to strike a deal with Democrats. And at this stage, it is clear to me that the Republicans are not a party that is fit to lead. I would completely support the idea of Trump now reaching out to Democrats and just making a few reforms to the bill as opposed to repealing large portions of it. Now rather than having 75% of what a "conservative" bill would have, now you'd be lucky to get 35% of "conservative" reforms. Under a deal with Democrats, I think it would look like the following: A) Medicaid would stay as is B) Subsidies would stay with some modifications C) Most of the Essential benefits would stay, probably not all. D) Most of the taxes would stay, specially on the "rich", Republicans would in exchange get A) some level of Tort reform B) maybe a repeal of the excise and medical devices C) maybe competing across state lines D) Allowance of carriers to create higher deductible plans The moderate republicans would be all for this and the more conservative Republicans would be up in arms. But if you strike a deal with Democrats, there would be no filibuster and all they'd need is 51 votes and you'd probably get a lot of Democrats to push it through the finish line.