Analysis Shows Surprising News about the Cruz Amendment

As the latest GOP attempt to replace Obamacare with – well, anything – crumbles to dust, new analysis from the Department of Health and Human Services shows surprising news about Ted Cruz’ amendment to the bill. It turns out that the Cruz Amendment, which would allow insurers to offer any plan as long as they offer one Obamacare-compliant plan would lower premiums and increase enrollment, according to the HHS report.

The Washington Examiner reports:

According to HHS, those likely to sign up for Obamacare-compliant Silver plans, presumably those who are considered high risk, would pay on average $380 per month in 2024, down from $845 per month projected under current law.

Consumers who purchase plans outside of the Obamacare mandates would save even more money by 2024 and would pay $240 per month on average.

However, the HHS analysis is based on the assumption that non-Obamacare compliant plans would carry a $12,000 annual deductible.

Enrollment in the individual market would climb, according to HHS.

New language added to the Cruz Amendment places all individuals into a single pool rather than the original plan that would divide higher risk people and those of lower risk into separate pools.

Cruz’s office asked HHS to analyze both the single risk pool plan and the plan with dual risk pools. Cruz believed GOP leaders would more likely use the single risk pool plan but wanted to “give conservatives the opportunity to continue to fight for an even stronger version of Consumer Freedom.” a Cruz source said.

Now Cruz wants to convince lawmakers on both ends of the party’s political spectrum that the plan saves money and helps enrollment.

Politico spent more time attempting to poke holes in the analysis than reporting on the HHS findings, making a claim that the data and assumptions are flawed.

But its conclusions on the Cruz proposal’s effect on premiums are derived by comparing the costs for a 47-year-old under Obamacare to those for a 40-year-old under a scenario that tacks Cruz’s amendment onto Obamacare — an apples-to-oranges comparison that also doesn’t take any of the effects of the Senate GOP’s own health care bill into account.

But what Politico doesn’t take into account is the fact that Obamacare is more flawed and wildly unpopular. Reporter Adam Cancryn is waiting for Congressional Budget Office analysis, presumably so he can write an article with a headline screaming how many people the CBO says will be uninsured under an Obamacare replacement.

The truth of the matter is that, flawed analysis or not, anything else is better than Obamacare, and the GOP should give a plan that includes the Cruz Amendment a shot – because it doesn’t look like they’re going to do anything more drastic to Obamacare.

McConnell Watches Support for His Obamacare Repeal Vote Slip Away

Senate Majority Leader Mitch McConnell (R-KY) has vowed to move forward with his plan to vote on repealing Obamacare, even though it looks like support for this vote among his GOP colleagues is slipping away.

The erosion of support began with three female senators: Lisa Murkowski (R-AK), Susan Collins (R-ME), and Shelley Moore Capito (R-WV), who have all said they would not consider repealing Obamacare without a replacement ready to go. (To paraphrase an Atlanta radio host I heard yesterday, it’s funny how the GOP opposition to conservative ideas always seems to start with Murkowski and Collins.)

“I said in January we should not repeal without a replacement and just an indefinite hold on this just creates more chaos and confusion,” Murkowski told reporters.

And…

“I do not support the new plan,” Sen. Susan Collins, R-Maine, told reporters. “A better approach would be…to begin hearings focused on the problems in the ACA, and let’s try to get bipartisan support to fix those egregious flaws.”

Other moderate senators have been shaky about a repeal plan because of the cuts to Medicaid that would go along with it. At the same time, conservatives have called for a repeal of Obamacare for a long time, and most of them have been willing to allow time for a replacement to be developed.

McConnell called for a clean repeal bill with a timeline to devise a replacement after his initial bill replacing Obamacare with a watered-down version failed to gain traction earlier in the week.

President Trump has placed the blame for Congress’ failure to come up with a suitable plan on Democrats “and a few Republicans,” while Vice President Pence declared that “inaction is not an option.”

McConnell, for his part, remains resolved. As he said from the Senate floor:

We will now try a different way to bring the people relief from Obamacare. I think we owe them at least that much. In the coming days, the Senate will take up a vote on a repeal of Obamacare combined with a stable two-year transition period as we work toward patient-centered healthcare.

For years we’ve heard the GOP promise to repeal and replace Obamacare. Time and time again, Republicans have kicked the can a little further down the path. When they won the House, they needed the Senate. When they won the Senate, they needed the White House. Now they have all three. How much longer will it take for them to keep their repeated promise?

Rand Paul Shames GOP, ‘Keep Obamacare’ While Dems Want to Fix It

Sen. Rand Paul said that the Senate Obamacare bill “does not repeal Obamacare. Not even close.” He blasted the GOP for caving in on campaign promises to tear out Obamacare “root and branch!”

Writing in a Breitbart Op-Ed, the Kentucky senator shamed his fellow Republicans for “promising repeal and instead affirming, keeping, and, in some cases, expanding Obamacare.”

“What a shame,” he concluded.

I won’t link to Breitbart, them being the home and haven of all things in Trump heaven and earth, with Trumpian angels ascending and descending golden ladders of rose-colored journalism. But conveniently, Paul published his op-ed on his senate website.

The Senate Obamacare-lite bill does what the Democrats forgot to do – appropriate billions for Obamacare’s cost-sharing reductions, aka subsidies. Really? Republicans are going to fund Obamacare subsidies that the Democrats forgot to fund?

It is a shame.

Seemingly in response to Paul’s attack on his own party (a well-deserved attack that hopefully will wake some up to the importance of getting this done), Democrats have unveiled their own plan to “fix Obamacare.”

This was written up in Vox, which I reluctantly link to.

Ten House Democrats (tellingly, not including Nancy Pelosi) have floated a plan that includes crating a permanent reinsurance fund to offset costs of “especially expensive patients.”

This program would be expected to reduce premiums, as insurance plans would know they’d get federal help for their highest bills. The Democrats’ proposal would make this a permanent program with $15 billion in annual funding. The idea has found at least some favor with Republicans: This week, the Trump administration gave Alaska the funding it would need to create a state-level version of the program.

It’s got some other bones like a Medicare buy-in for older Americans instead of enrolling in Obamacare plans, and “fixing” some of the rural areas that have no options. That would allow Democrats to reinstate enforcement of the mandate to purchase health insurance.

Remember, that mandate is still in effect, even though Trump’s administration has vowed not to enforce it.

“Some Democrats are fearful to talk about what is wrong with [Obamacare] for fear we’ll be seen as abandoning it,” says Rep. Peter Welch (D-VT), a relatively progressive Democrat who supports Medicare-for-all. But he says now is a moment to talk about fixing Obamacare, and not single-payer. “There is the practical reality that we’ve got a Republican president and a Republican Congress,” he says. “That’s not the opportune moment for Medicare-for-all. We’ve got to defend what we have.”

It’s important for Republicans to do something and not punt this opportunity away.

Trump is sitting around, “waiting” for a bill to “come to my desk.”

“I am sitting in the Oval Office with a pen in hand, waiting for our senators to give it to me,” Trump said in [a Wednesday CBN] interview. “For years, they’ve been talking about repeal-replace, repeal-replace. I think they passed it 61 times … now we have a President that’s waiting to sign it. I have pen in hand so now it means something.”

He will literally sign just about anything placed in front of him that says “Health Care” in the title and can put his name on it. If Republicans won’t supply the document, Democrats would be glad to.

Republicans and Conservatives are at Odds Over Taxes in Obamacare Replacement Bill

In 2010, 2012, 2014, and 2016, the American people elected Republicans to Congress with a clear mandate: repeal and replace Obamacare. Yet somehow the GOP has managed to do little more than propose watered-down versions of the health care legislation that citizens so desperately want replaced.

As the Senate hammers out their version of Obamacare replacement, there’s one sticking point that is making the negotiations more difficult – taxes.

Specifically, senators are divided over the inclusion of Obamacare’s 3.8 percent net investment income tax. Conservatives want the tax repealed, while more moderate Republicans are fine with keeping the tax as a way to help fund health care for those with lower incomes.

Some in the Senate emphasize the importance of keeping the tax embedded in the new legislation:

“We [want to] address the issue of ensuring lower-income citizens are in a position to buy plans that are actually provide them appropriate healthcare,” Sen. Bob Corker (R-Tenn.) told reporters last week.

While other members of Congress understand a need to keep the tax in place whether they like it or not.

“Our official position is we want to repeal all the taxes. That being said, we understand the logistics of having to have enough revenue,” House Freedom Caucus Chairman Mark Meadows (R-N.C.) said. “And so I’m not at this point closing that off to negotiations because I think it would be premature to do that.”

Sen. Ron Johnson (R-Wis.) told his constituents in a telephone town hall last week that he’s “personally not opposed” to keeping ObamaCare taxes to pay for health benefits.

On the other end of the spectrum are taxpayer advocacy groups who are adamantly opposed to the tax remaining in any GOP replacement.

“Cutting the capital gains tax gets you growth,” said Americans for Tax Reform President Grover Norquist. He called keeping the investment tax an “economically illiterate bad idea.”

Taxpayers Protection Alliance President David Williams said that failing to repeal the investment tax would cause investors to delay selling assets and would “discourage more entry into the stock market.”

So many questions remain. Can the GOP create a replacement that will keep taxes low while still allowing the poor to have more options? Will they proceed with or without the tax in place? Will they scrap Obamacare altogether and create something new? Is a free market solution possible at this point?

But the biggest question of all that is yet to be answered is this one: will the Republicans keep the promises they’ve made to the voters time and time again to repeal and replace Barack Obama’s signature domestic accomplishment?

White House Signals Cruz-Lee May Save Healthcare Proposal This Summer

The best path for getting Obamacare repealed may lie with Sens. Ted Cruz and Mike Lee, two conservative leaders whose plan gained key White House backing Sunday.

President Trump’s director of legislative affairs, Marc Short, appeared on Fox News Sunday, offering an olive branch to potentially remove Obamacare’s protections for pre-existing conditions. “We hope it’s part of the process of bringing everybody together,” Short said, alluding to Cruz’s “Consumer Choice” proposal.

“We support Senator Cruz and Senator Lee’s efforts,” Short said. “This is similar to efforts that transpired in the House, and we think it’s perfectly appropriate, his amendment.”

Short dismissed a grandstanding call for compromise from Democrat Minority Leader Chuck Schumer. Democrats would love for the GOP to pass their own version of Obamacare, left essentially untouched. They’d love to see a replacement plan with no repeal versus a repeal with a later replacement.

Although Trump has at various times indicated he would work with Democrats, his latest messaging is that the new health care plan would pass without a single Democrat vote.

“The president’s absolutely right,” Short said. “They have been obstructionists.”

Ten senators want to work through August to deal with the GOP’s health care reconciliation bill, and place it on President Trump’s desk. Sens. Perdue, Daines, Ernst, Kennedy, Lankford, Lee, Rounds, Strange, Sullivan and Tillis proposed shortening or cancelling the traditional August recess.

If the Senate gets serious about repealing Obamacare this summer, the effort may hinge on Cruz and Lee. If their plan fails to gain enough votes, then the president’s suggestion (finally) that the Senate simply repeal and replace later could be the fallback position.

Either way, this is a good, solid signal from a White House that tends to step on its own messaging with the cadence of an Army platoon on the march.

NH Gov. Sununu Takes Down BCRA, and He’s Absolutely Right

Watch Gov. Chris Sununu take down the Better Care Reconciliation Act (BCRA) for dumping the enormous problem of opioid addiction back on to states.

“That downshifting of cost to a state like ours is unfair,” Sununu said. “And more importantly, it’s impractical. There’s really no practical way to implement the plan as-is.”

Obamacare did much to create the opioid crisis, hobbling states like New Hampshire and Maine, along with many rust belt states that put Trump into the White House. Trump talks a good game about helping these people, but has done little in the way of leadership on drug issues.

It might sound like Sununu is siding with liberals like Sen. Susan Collins, but his opposition isn’t based on the federal government not doing enough. It’s based on a principle as old as our nation: taxation without representation. What else do you call an unfunded mandate?

In the 1760’s, Britain taxed its colonies to pay for the French and Indian War, that nearly bankrupted London. It was a war about which the colonists themselves were mostly ambivalent, except those who stood to gain from royal land grants. Similarly, today, Obamacare’s prescription plans and Medicaid caused this huge spike in addiction. Democrats think the solution is more addiction and more money.

But Sununu realizes that the government can’t simply dump Medicaid on the states without dealing with the enormous health and societal issues related to addiction. That’s an unfunded mandate, and it’s as wrong as the Stamp Tax was.

Seth Leibsohn and Sean Noble, co-directors of American for Responsible Drug Policy, wrote in the Daily Signal:

Finally, if we plan to get serious about the opioid crisis, we must devote at least half as much—if not more—attention to prevention as we do to treatment and recovery.

Treatment and recovery—while important—are last ditch efforts, after-the-fact solutions, addressing the issues too late. We need to focus on stopping these problems before they start, especially knowing how high the rates of relapse are.

We know that prevention programs have worked in the past, whether they pertain to forest fires or drunk driving or, for that matter, the massive reduction in drug use we witnessed in the late 1980s and early 1990s.

Such a prevention program for the opioid crisis must start with leadership from the White House in leading these conversations and highlighting the devastation of substance abuse initiation.

If the Senate is simply going to punt the problem back to states, it’s not going to get better. And the Democrats’ (and Sen. Collins, proto-Democrat) solution of simply keeping more Obamacare love around won’t fix it either.

Let’s see the White House and the Senate take some leadership here, or BCRA may be dead.

BREAKING: Media Reports McConnell Will Delay Healthcare Vote

According to reports by CNN and Fox News, Senate Majority Leader Mitch McConnell will delay a vote on the Senate’s healthcare reconciliation plan until after the July 4 recess.

Several conservatives, including Sens. Mike Lee, Ron Johnson and Rand Paul, along with liberal Democrat-with-an-R Susan Collins oppose the bill, albeit for different reasons.

The bill needs some work, notably on two issues. One is allowing states more flexibility to deal with Medicaid and free market solutions, including waiting periods for pre-existing conditions; and the other is dealing with funding Planned Parenthood.

CNN reported that McConnell and Vice President Mike Pence decided at a “power lunch” to delay the voting until these issues could be worked out, and more senators could be brought on board to support the bill.

CBO Says 22 Million More Uninsured, But They’ll Pass BCRA Anyway

When a Democrat was in power in the White House, Republicans could safely craft a healthcare bill like 2015’s AHCRA, in the now-hopeless hope that the King v. Burwell went against Obamacare. Now that Trump is president, the best they can do is keep Obamacare, and add some nice 22-inch chrome wheels to give it bling.

The CBO report on the Senate version of the bill says 22 million (versus the House’s 23 million) fewer Americans would have health insurance by 2026.

Next year, 15 million more people would be uninsured compared with current law, the budget office said.

What is that 22 million number, though?

 

The entire raison d’être for Obamacare was that everyone in America should have health insurance to obtain health care. But America has private health care, not a public system like England. Even Democrats in 2010 couldn’t say they’re going to nationalize one-sixth of the U.S. economy. So they punted and forced everyone to buy something. It failed.

Unfortunately, the healthcare debate isn’t being driven by actual policy, it’s being driven by election politics. This whole thing about a “three-part plan” to repeal and replace Obamacare is pie-in-the-sky fantasizing, as Ted Cruz warned.

And now the GOP plan, both in the House and in the Senate (the Better Care Reconciliation Act of 2017– “BCRA”), keeps the core reason for Obamacare–universal insurance–as its goal, but moves further away from realizing that misguided goal than the original 2010 plan.

The problem is that universal health care and universal health insurance are not the same goal. They are not even close. And Medicaid is not the answer to either problem. America values personal freedom, and part of that is the freedom not to buy insurance, so Republicans are on the right track by removing the individual mandate.

But they’re not considering who the so-called “uninsured” are. Vox interviewed Forbes’ in-house healthcare blogger, Avik Roy. Roy pointed out that of the 23 million fewer with health insurance by 2026 in the House bill, 78 percent of them will be uninsured by choice, according to the CBO. Of those, 5 million will be eligible for Medicaid.

If Medicaid is so important, so life-changing, why is that so many people either have to be fined to sign up for it, or even if it’s handed to them, don’t take it? That is something I think the policy debate has not adequately.

In his Forbes article, Roy criticized Speaker Paul Ryan’s plan for its flat tax credits, which he called a “fatal flaw.” But he found a silver lining in Section 202 of the bill, which has a “transitional” bridge between the original ACA and the new plan, beginning in 2020.

He praised the Senate plan for keeping the “bridge” as a permanent fixture.

But the BCRA has the same problems as Obamacare, in that it doesn’t address health care, it addresses health insurance. And it does so by passing the buck for Medicaid from the federal government back to the states.

The reason that Medicaid’s health outcomes are so poor is because the outdated 1965 Medicaid law places a laundry list of constraints on states’ ability to manage their Medicaid programs. As a result, the main tool states have to keep Medicaid costs under control is to pay doctors and hospitals less and less each year for the same care. Hence, many doctors don’t take Medicaid, and Medicaid enrollees struggle to gain access to care.

Roy applauds the fact that states will have more options to craft Medicaid programs of their own to fit their populations, to open up private insurance markets through “Section 1332” waivers (which were part of Obamacare beginning in 2017 anyway), and to give states a $100 billion (over 10 years) in grants to “shore up” their markets.

Great, but we’re still talking about regulating health insurance, with its enrollment periods and waiting periods and myriad forms and decisions. The Senate bill doesn’t restore a waiting period for sick individuals to prevent them from buying fire insurance after the building burns, so to speak. That is a deal killer for keeping premiums low.

And low premiums is the only desirable outcome of a federal health care plan focused on insurance. Stripping all the trimmings of Obamacare, which transformed the health insurance market in a foundational way, is not going to be possible with such a small Republican majority in the Senate.

So it won’t be policy that shapes the final bill. It will be politics, specifically election politics. Of the 34 seats up for election in 2018, 25 are Democrats. A number of those are going to be competitive elections (such as Heidi Heitkamp in North Dakota, or Joe Donnelly in Indiana). But Republicans also face some tight races: even Jeff Flake and Ted Cruz could face some strong opponents.

If Obamacare is to be repealed and replaced piecemeal, it will happen after 2018. For it to even have a snowball’s chance after 2018, Republicans have to gain several seats in the Senate, and keep their majority in the House. If Republicans don’t pass something on healthcare, they won’t do well in 2018.

Therefore, the Republicans will pass something, and very probably they’ll pass the BCRA. Senate Majority Leader Mitch McConnell will push it with all his might. And he’ll have plenty of help.

The Senate will pass BCRA, the House will come back from recess to finish the job, and before summer is done, President Trump will sign it amid much back-slapping and crowing. And not much will change in 2018 except the campaign ads.