House Republicans release ObamaCare replacement bill

[Breccia]

7) The 4-year continuation of the Medicaid Expansion and the new tax credits are paid for by preserving most of the taxes levied in the ACA. We'd get less efficiency at the same price. Yay.

Are you sure? I was under the impression most of the taxes were removed, except one that was pushed back to 2025.

[Mormolyce]

The main reason the Republicans want to "repeal and replace" Obamacare is to remove the ACA's association with Obama. They could replace it with the same damn thing but you couldn't call it Obamacare anymore. First and foremost it's about deleting the Obama legacy. Health care is secondary to their agenda.

They could just change the name. After all, they invented the name.

[Breccia]

Supposedly, this will hit a couple of important committees in a couple days. How long does it take the CBO to do a writeup on something like this?

[Mormolyce]

3) Ends community rating; basically, the ACA only let insurers charge extra on policies held by older people by 3 to 1. TrumpCare ends that, so older policy holders will be charged a lot more. Someone close to Medicare eligibility (60-64) would see their premiums go up by a few grand a year, and a 27 year old would see their premiums fall by comparatively little. The big bucks for insurers are always going to be the older and more desperate.

I'm sure this will go down well with the Republican base of old white guys, once the rubber meets the road.

[Slybak]

Are you sure? I was under the impression most of the taxes were removed, except one that was pushed back to 2025.

Every other tax is preserved just for a shorter period. The first one to go, of course, is the 0.9% Medicare surcharge on individuals making more than $200,000 a year. That's repealed as the fundraising for the 2018 Congressional midterm elections starts to kick into high gear.

[Surfd]

Thing is, for the vast majority of people the 30% surcharge is absolutely worth it as long as they get covered when they get ill.
The reason for this is that as soon as you get ill (and have to visit a hospital for example) you will most likely already be paying 1k+ at minimum. This means that smart young people, with a low chance of illness, are far better of just not getting insurance until they need it. The only risk of this is acute care (ie breaking a leg or something or having to go to the ER) since that can't be planned, but that is a risk many will want to take since the chances of that happening are relatively small and acute costs are generally lower/potentially payable out of pocket. The aforementioned makes it that healthy people arn't paying into the insurance pool, which will either cut into the insurance companies margins (like they will let that happen) or premiums will inevitably go up.

And this is exactly the WRONG mindset one should have when it comes to a properly functioning healthcare system (IE: single payer like we have in Canada for example).

The problem you Americans have is that you have been brainwashed into thinking that paying for healthcare should be done for an "immediate" return. The "Healthy Young People shouldn't pay for healthcare because they likely wont need it" idea. Or the idea of "Health insurance, under the assumption that you only need to be paying for it to cover the unexpected event of an accident or something.

The entire concept of "Health Insurance" is ass backwards. You should be paying for "Health Care". And the Healthy Young People should not be treating it as something to avoid because they don't need it now. They should be treating it as a down payment, as an investment for the future because they will need it then. And trust me, unless you are the goddamned Wolverine, when you are 60+ and nature starts catching up with you, you are going to be glad that the next generation of Healthy Young people are contributing to the Healthcare that keeps your aging ass healthy and alive.

[Slybak]

Supposedly, this will hit a couple of important committees in a couple days. How long does it take the CBO to do a writeup on something like this?

Longer than 8 days. The first committee votes are next Wednesday.

But that's probably not the issue. A CBO score not only estimates cost, but impact. Christopher Jacobs at The Federalist (a.k.a. Breitbart for people with a bigger vocabulary than a fourth grader, so no FAKE NEWS LEFT WING BIAS) had conversations with people close to the inner workings of the bill's development and they told him that the scoring effort was quashed after the initial estimates of the CBO told them that the bill wouldn't cover many more people than just repealing the ACA outright (i.e. an end result of 15-20 million people lose their coverage).

If that's the case, then I seriously doubt this bill will receive any formal CBO scoring at all before its voted on.

[Edge-]

Supposedly, this will hit a couple of important committees in a couple days. How long does it take the CBO to do a writeup on something like this?

Won't matter either way. Republicans will ignore the CBO report if it's not to their benefit, and do everything possible to undermine its projections.

And it's not like Ryan can whip the Freedom Caucus in-line on this. There's already plenty of resistance to this within his own party, much less any hope of swinging Democrats to vote for it.

[Mormolyce]

Given Trump is still repeating the claim that the unemployment rate is 40 percent, I can't imagine a CBO figure would make him bat an eye. Even if 15-20 million people actually do lose their health care, he'll no doubt deny it actually happened.

[Blur4stuff]

Some of the things Trump/republicans have done so far are magic tricks. They can pretend they are doing something useful whether they actually are or not. Examples would be the travel ban or trans bathroom nonsense.

This is different. Even republicans will know that if they pass something like this it will completely fuck over their own voters. Those voters will feel it. It can't be propaganda'd away. It doesn't matter what FOX or Breitbart say because in the end the voter won't get coverage or will get jacked by insane costs.

They will directly harm the people that vote for them and their voters will know it. Can't be blamed on dems or Obama or Clinton's emails. It's suicide for the republican party.

[Slybak]

And it's not like Ryan can whip the Freedom Caucus in-line on this. There's already plenty of resistance to this within his own party, much less any hope of swinging Democrats to vote for it.

And Ryan can't do anything about resistance in the Senate. Four Republican Senators are on record as committed to voting against repealing the Medicaid Expansion, and reaffirmed that commitment in a joint letter to Mitch McConnell this afternoon. If they go the 50-vote-reconciliation route to pass this, which they'll have to because no Democrat in their right mind would vote for it, then they'll likely need all four of them to vote yes.

[PosPosPos]

Easy to argue when you can just point at someone and yell 'TIS THEIR FAULT!'

So according to your (abject lack of) logic if someone stabs you and you point him out to the police it's just playing the blame game?

[Underverse]

and the rich are winning and winning big.

Well that's what Trump promised when he said 'we're going to win big'.

[Ishan]

/points and laughs at Murica

[Surfd]

Someone on another forum I am on posted a nice summary of some of the fun bits based on his reading through of the bill:

Some high points:
* If you (literally) win the lottery, you're pretty much instantly ineligible for Medicaid forever, and the state can claw back an unlimited amount of past Medicaid spending.
* States are "encouraged" to be very aggressive about kicking people out of Medicaid (and suing the hell out of them with massive civil penalties) if their income fluctuates. This is euphemistically called "increased frequency of eligibility redetermination".
* No money can be spent for anything abortion-related, regardless of what else a medical provider may do (i.e., takes out Planned Parenthood but doesn't name it explicitly).
* Kids covered under CHIP will no longer be counted when computing how much money a state's block grant should be.
* If a state has expenditures that are higher than "expected" based on averages, the state is punished with less money.
* States lose the ability to allow a higher level of equity in one's home when determining eligibility for Medicare nursing homes. If you live in a state with high property values, you'll have to sell your house to be eligible for Medicaid. This is the "Fuck California" provision.
* If your health insurance lapses (no more mandates), your rates are required to go up by at least 30% for a year to punish you when you try to buy insurance later.
* States that didn't expand Medicaid coverage get bonus money to "make up for it". There are dollar limits that look to be designed to guarantee that higher-population (blue) states cannot get this free money. And if a state tried to make up for not expanding Medicaid through additional aid, they can never get the free money. This is the "rewarded for fucking over the poor" provision.
* It eliminates the "metal" levels of health insurance (i.e., requirements that benefits paid out are actuarially equivalent to certain percentages). This can be subtitled "unlimited profits for insurers", and uses the lie euphemism of "Increasing Coverage Options".
* Premiums for older people will jump by 166%, as the cap on the cost of coverage for the oldest subscribers is changed from a 3:1 ratio to a 5:1 ratio. This is known as "ensuring older people cannot afford coverage".
* Part of the block grants are intended for states to set up high-risk coverage pools, because those failed the last time they were tried (pre-ACA).

Fun thing to note regarding that first point: Apparently it not only applies to lottery winnings, but it also counts for civil judgments, and alimony. So, get rear-ended and settle for more than $80K, or get divorced and receive more than that amount in support, you're disqualified from Medicaid for life.

[Hooked]

I would prefer Rand Pauls version of repeal completely and replace with something different entirely. Once they get their foot in the door with a new tax they can raise it at anytime and they will. I wouldn't mind being taxed for the greater good if the democrats weren't already taxing the shit out of me for their wasteful spending on literally everything.

[Wyrt]

Someone on another forum I am on posted a nice summary of some of the fun bits based on his reading through of the bill:

Fun thing to note regarding that first point: Apparently it not only applies to lottery winnings, but it also counts for civil judgments, and alimony. So, get rear-ended and settle for more than $80K, or get divorced and receive more than that amount in support, you're disqualified from Medicaid for life.

Of course they have a provision in there specifically to fuck California(and New York).

Which is all the more fun since the House Majority Leader is from California. Good job fucking over the people you're supposed to represent.

[belleflop]

What is this? 8 years of republican opposition and we get....this? This is an embarrassment of all republicans and all Americans. We can do better than whatever this "replacement" thing is..

Here is your one any only metric republicans. Anything less than "Better health care coverage (NOT ACCESS) and cheaper coverage for ALL" is unacceptable. Get back to the drawing boards Republicans, this one is a dud.

[Deleted]

Soooo, when democrats get power back, what do they plan to do? Reintroduce Obamacare or make yet another bill for healthcare?

[Breccia]

The Washington Post, Jan 17th

Trump vows ‘insurance for everybody’ in Obamacare replacement plan

President-elect Donald Trump said in a weekend interview that he is nearing completion of a plan to replace President Obama’s 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 declined to reveal specifics in the telephone interview late Saturday with The Washington Post, but any proposals from the incoming president would almost certainly dominate the Republican effort to overhaul federal health policy as he prepares to work with his party’s congressional majorities.

Trump’s plan is likely to face questions from the right, after years of GOP opposition to further expansion of government involvement in the health-care system, and from those on the left, who see his ideas as disruptive to changes brought by the Affordable Care Act that have extended coverage to tens of millions of Americans.

In addition to his replacement plan for the ACA, also known as Obamacare, Trump said he will target pharmaceutical companies over drug prices.

“They’re politically protected, but not anymore,” he said of pharmaceutical companies.

The objectives of broadening access to insurance and lowering health-care costs have always been in conflict, and it remains unclear how the plan that the incoming administration is designing — or ones that will emerge on Capitol Hill — would address that tension.

In general, congressional GOP plans to replace Obamacare have tended to try to constrain costs by reducing government requirements, such as the medical services that must be provided under health plans sold through the law’s marketplaces and through states’ Medicaid programs. House Speaker Paul D. Ryan (R-Wis.) and other Republicans have been talking lately about providing “universal access” to health insurance, instead of universal insurance coverage.

Trump said his plan for replacing most aspects of Obama’s 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.).

“It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump said. He noted that he is waiting for his nominee for secretary of health and human services, Rep. Tom Price (R-Ga.), to be confirmed. That decision rests with the Senate Finance Committee, which hasn’t scheduled a hearing.

Trump’s declaration that his replacement plan is ready comes after many Republicans — moderates and conservatives — expressed anxiety last week about the party’s lack of a formal proposal as they held votes on repealing the law. Once his plan is made public, Trump said, he is confident that it could get enough votes to pass in both chambers. He declined to discuss how he would court wary Democrats.

As he has developed a replacement package, Trump said he has paid attention to critics who say that repealing Obamacare would put coverage at risk for more than 20 million Americans covered under the law’s insurance exchanges and Medicaid expansion.

“We’re going to have insurance for everybody,” Trump said. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.” People covered under the law “can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.”

Republican leaders have said that they will not strand people who gained insurance under the ACA without coverage. But it remains unclear from either Trump’s comments in the interview or recent remarks by GOP leaders on Capitol Hill how they intend to accomplish that.

For conservative Republicans dubious about his pledge to ensure coverage for millions, Trump pointed to several interviews he gave during the campaign in which he promised to “not have people dying on the street.”

“It’s not going to be their plan,” he said of people covered under the current law. “It’ll be another plan. But they’ll be beautifully covered. I don’t want single-payer. What I do want is to be able to take care of people,” he said Saturday.

Trump did not say how his program overlaps with the comprehensive plan authored by House Republicans. Earlier this year, Price suggested that a Trump presidency would advance the House GOP’s health-care agenda.

When asked in the interview whether he intends to cut benefits for Medicare as part of his plan, Trump said “no,” a position that was reiterated Sunday on ABC by Reince Priebus, Trump’s incoming chief of staff. He did not elaborate on that view or how it would affect his proposal. He expressed that view throughout the campaign.

Moving ahead, Trump said that lowering drug prices is central to reducing health-care costs nationally — and that he will make it a priority as he uses his bully pulpit to shape policy. When asked how exactly he would force drug manufacturers to comply, Trump said that part of his approach would be public pressure “just like on the airplane,” a nod to his tweets about Lockheed Martin’s F-35 fighter jet, which Trump said was too costly.

Trump waved away the suggestion that such activity could lead to market volatility on Wall Street. “Stock drops and America goes up,” he said. “I don’t care. I want to do it right or not at all.” He added that drug companies “should produce” more products in the United States.

The question of whether the government should start negotiating how much it pays drugmakers for older Americans on Medicare has long been a partisan dispute, ever since the 2003 law that created Medicare drug benefits prohibited such negotiations.

Trump’s goal is uncertain, however, with respect to Medicaid, the insurance for low-income Americans run jointly by the federal government and states. Under what is known as a Medicaid “best price” rule, pharmaceutical companies already are required to sell drugs to Medicaid as the lowest price they negotiate with any other buyer.

So, in order:
1) Did Trump even write this thing? He hasn't even endorsed it.
2) Is this "insurance for everybody" in the bill or not? Because it looks like removal of the individual mandate, plus a penalty for getting back in, to me.
3) Where in this bill are the much lower numbers, the much lower deductibles?
4) Was this the result of something that was down to the final strokes on Jan 17th? Because I'm pretty sure a leaked early draft from mid February didn't have a lot of this stuff in it.
5) How is this "much better" health care, with or without the qualifier "much less expensive"? In what way is the quality of care improved?
6) Isn't the stock market the report card by which Trump will be judged?