Tomorrow's Vote in the House (vote postponed)

[Benjamin Franklin]

What's sad is everyone is focusing on the political implications with virtually no discussion of the substance.

See London atracks thread.

 

It's become a pox. The Republicans stumbled ass backwards into what might be a good thing. Trump says he wants to see the ACA fail and then get back to discussing points but just maybe this recent Rep embarrassment on the vote and the near miss of ACA repeal for the Dems will get a few like minded people to the table across the aisle and start a discussion.

 

Care for dependents, pre-existing conditions, the concept of shopping for care...the ACA is NOT the total disaster top to bottom that it is sometimes painted.

 

Then fix/repeal some other parts. How much control do states get and what happens if states fail to provide? Need a good realistic answer to this because it will surely happen.

 

Really tough questions that will take two parties working together to hammer out. Otherwise the Reps will pass something and in 4/8 years, the Dems will repeal and replace and we will be back on this stupidity rodeo.

[Magox]

See London atracks thread.

 

It's become a pox. The Republicans stumbled ass backwards into what might be a good thing. Trump says he wants to see the ACA fail and then get back to discussing points but just maybe this recent Rep embarrassment on the vote and the near miss of ACA repeal for the Dems will get a few like minded people to the table across the aisle and start a discussion.

 

Care for dependents, pre-existing conditions, the concept of shopping for care...the ACA is NOT the total disaster top to bottom that it is sometimes painted.

 

Then fix/repeal some other parts. How much control do states get and what happens if states fail to provide? Need a good realistic answer to this because it will surely happen.

 

Really tough questions that will take two parties working together to hammer out. Otherwise the Reps will pass something and in 4/8 years, the Dems will repeal and replace and we will be back on this stupidity rodeo.

 

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:

 

Obamacare in a death spiral? It’s been a mantra of Republicans, who say the law is collapsing and they are riding to the rescue.

But the Congressional Budget Office, in a little-noticed part of its report last week, said that is not the case. In fact, the CBO analysts said, Obamacare’s exchanges are likely to “be stable in most areas” under the existing law.

 

 

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.

[Tiberius]

Thanks Mags, very nice insight!

[HappyDays]

http://www.politico.com/magazine/story/2017/03/obamacare-vote-paul-ryan-health-care-ahca-replacement-failure-trump-214947

 

The Art of the Deal, ladies and gentlemen.

[ExiledInIllinois]

 

Trump vows insurance for everybody in Obamacare replacement plan

 

By Robert Costa and Amy Goldstein January 15 Washington Post

 

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obamas signature health-care law with the goal of insurance for everybody, while also vowing to force drug companies to negotiate directly with the government on prices in Medicare and Medicaid.

 

 

Trump said his plan for replacing most aspects of Obamas health-care law is all but finished. Although he was coy about its details lower numbers, much lower deductibles he said he is ready to unveil it alongside Ryan and Senate Majority Leader Mitch McConnell (R-Ky.).

 

https://www.washingtonpost.com/politics/trump-vows-insurance-for-everybody-in-obamacare-replacement-plan/2017/01/15/5f2b1e18-db5d-11e6-ad42-f3375f271c9c_story.html

"Nevermind, on to other things!"

 

Signed,

 

President Donald "ADD" Trump

[gatorbait]

http://www.politico.com/magazine/story/2017/03/obamacare-vote-paul-ryan-health-care-ahca-replacement-failure-trump-214947

 

The Art of the Deal, ladies and gentlemen.

Politico leans heavy to the left, but that was a good read. "Forget about the little ****" I guess is part of his deal-making prowess. Hey Donald, the little **** is what kept everyone from agreeing, you orange genius.

[ExiledInIllinois]

http://www.politico.com/magazine/story/2017/03/obamacare-vote-paul-ryan-health-care-ahca-replacement-failure-trump-214947

 

The Art of the Deal, ladies and gentlemen.

The Art of the Deal is more like Art of Noise... Of course, Diversion One

 

Politico leans heavy to the left, but that was a good read. "Forget about the little ****" I guess is part of his deal-making prowess. Hey Donald, the little **** is what kept everyone from agreeing, you orange genius.

What do you expect from somebody with no gov't experience?

[/dev/null]

What do you expect from somebody with no gov't experience?

A lower Freecell score

[Magox]

Politico leans heavy to the left, but that was a good read. "Forget about the little ****" I guess is part of his deal-making prowess. Hey Donald, the little **** is what kept everyone from agreeing, you orange genius.

 

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.

[ExiledInIllinois]

A lower Freecell score

Or an over-zealous IT guy that doesn't know his place!

 

;-P

Edited March 25, 2017 by ExiledInIllinois

[Meathead]

he could go nuclear and work with the dems to fulfill his promise of retribution in a seriously aggressive donian manner

 

nah forget it. that probably a wet dream

[TakeYouToTasker]

 

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.

Again, this speaks to the sheer stupidity of trying to pass legislation that offers nothing to 20% of your party.

[snafu]

Again, this speaks to the sheer stupidity of trying to pass legislation that offers nothing to 20% of your party.

20% of the GOP < 10% of the country's interest. Last I checked, democracy was a majority/minority thing when it comes to interests and votes. The "sheer stupidity" is trying to cater to everyone on both sides. That's why you get this clown show. Lack of leadership is the root of the problem. That and lack of patience to craft something right before shoving it under everyone's nose.

[Benjamin Franklin]

Again, this speaks to the sheer stupidity of trying to pass legislation that offers nothing to 20% of your party.

And that 50% of the country opposed (both for ACA and ACHA).

[Magox]

20% of the GOP < 10% of the country's interest. Last I checked, democracy was a majority/minority thing when it comes to interests and votes. The "sheer stupidity" is trying to cater to everyone on both sides. That's why you get this clown show. Lack of leadership is the root of the problem. That and lack of patience to craft something right before shoving it under everyone's nose.

 

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.

[Tiberius]

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.

 

If Trump tried to work with Dems wouldn't the House rules give speaker Ryan a veto on anything brought to a vote in the House? Trump would have to really lobby to get House leadership to allow the process to go forward. Or am I mistaken about how the House works?

[DC Tom]

If Trump tried to work with Dems wouldn't the House rules give speaker Ryan a veto on anything brought to a vote in the House? Trump would have to really lobby to get House leadership to allow the process to go forward. Or am I mistaken about how the House works?

 

I'm just quoting you to show all the people that have you blocked that you really are capable of not being a complete tool.

 

Although really, knowing that you're a complete tool by choice is just going to encourage them to keep you blocked.

[ExiledInIllinois]

 

I'm just quoting you to show all the people that have you blocked that you really are capable of not being a complete tool.

 

Although really, knowing that you're a complete tool by choice is just going to encourage them to keep you blocked.

You really should leave people alone in their echo-chamber, safe place.

[DC Tom]

You really should leave people alone in their echo-chamber, safe place.

 

Nah. I like &#33;@#&#036;ing with gatorman.

[Magox]

If Trump tried to work with Dems wouldn't the House rules give speaker Ryan a veto on anything brought to a vote in the House? Trump would have to really lobby to get House leadership to allow the process to go forward. Or am I mistaken about how the House works?

 

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.

Edited March 26, 2017 by Magox