Posted on 03/09/2017 7:28:42 AM PST by SeekAndFind
Peter Nelson, my colleague at Center of the American Experiment, is one of the country’s leading experts on health care policy. On the Center’s web site, he urges conservatives to take a deep breath and understand the constraints that Congressional Republicans are working under.
In particular, a full repeal of Obamacare must get through the Senate, which means it must get 60 votes. There are only 52 Republican senators. Therefore, the first bill that has been unveiled is intended to be passed under the reconciliation process, which requires only a bare majority. Only Obamacare provisions that have a budgetary impact can be repealed in the reconciliation bill. Other measures will have to follow afterward. Peter writes:
Critics do have reason to complain and demand change, but the current response recklessly sets up the expectation of a full repeal among those in the conservative base, an expectation that Congress cannot meet. Upon failing to meet this expectation, the base may become needlessly demoralized and distrustful.
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Republicans can repeal a substantial portion of Obamacare with a simple majority through the budget reconciliation process, but this process only allows Republicans to repeal those portions with a budgetary impact.Repealing just items with a budgetary impact leaves in place the insurance regulations that are presently driving up health care costs and spinning many state insurance markets into death spirals. Specifically, the reconciliation process can’t repeal Obamacare’s essential health benefit requirements that force people to buy very generous and, therefore, very expensive health plans. Most troublesome, reconciliation cannot repeal insurance regulations that force insurers to sell coverage to everybody, regardless of whether they responsibly maintained coverage. This allows people to wait until they are sick before gaining coverage.
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A key problem is that repealing the individual mandate without repealing the requirement on insurers to guarantee coverage increases the incentive to wait to buy coverage until you need it. That’s why the House plan imposes a 30 percent penalty on people who buy coverage who failed to maintain continuous coverage. This penalty has been panned by critics, but anyone who studies health insurance markets will tell you something like this is necessary, so long as Obamacare regulations remain in place.
The good news is that the reform process is beginning, not ending. GOP leaders say there are two more bills yet to come, and we have a Republican president whose administration can reverse those portions of the Obamacare disaster that came into being through regulations. Which is many of them.
[A]nother point too often lost in the debate is the role the Trump administration will play in complementing Congress’s work. Though certain regulations cannot be immediately repealed, the Trump administration can modify regulations through the rule-making process. For instance, the Department of Health and Human Services (DHHS) can authorize a much more affordable set of essential health benefits. DHHS has already proposed important changes to stabilize individual insurance markets.
Peter thinks that the Medicaid provisions in the current bill represent a very important set of reforms, and will address that aspect of the legislation soon. In the meantime, conservatives shouldn’t be depressed over what we have seen so far:
Much of the rest of the bill is open for reasonable debate among conservatives—such as those refundable tax credits to buy health insurance—and critics are certainly entitled to their strong opinions and encouraged to share them.
But it’s dangerous if, to foment a public outcry to force changes to the bill, critics instill within the conservative base a sense that full repeal is possible if not for those weak-kneed Republicans elected to Congress. If conservative leaders set unattainable expectations, they will create a perception of failure in Congress that will deflate the conservative base.
Read the whole thing at the link.
The vitriol with which people spout factually false information on this site can be a bit off-putting at times.
Those are details that can be fixed in a Senate version or in a conference committee.
The GOP couldn’t do anything about DeathCare because they didn’t have control of Congress. So we voted them the House.
Then, they couldn’t do anything because they couldn’t get a repeal past the House. So we voted them the Senate.
Then they couldn’t do anything because the the President would veto any repeal. So we voted them a Republican President.
What’s the excuse now?
Facts are a difficult thing to overcome.
Oh, it will also take away what brakes we had on the 10s of millions of illegals in the US being able to sweep up massive Obamacare use and subsidies as well.
Oh, also, simply add it to the massive new entitlements that Ivanka wants for childcare for those making up to $500K, as well as the guaranteed, paid family leave and the Trump administration will have already become this most expensive entitlement-bloat admin in history. Ivanka’s big giveaway is supposedly slated to be part of any tax “reform”, so the goal is to get all of this massive, budget-busting entitlement expansion done in the first year of the Trump presidency.
Then on top of that, Obama is already threatening to campaign against those freedom caucus fighters that we have in Congress.
This isn’t a Trump presidency, this is shaping up as a Ryan/Pence/Priebus debacle of a presidency. The same sort of excess and stupidity that made W such a disaster as a president and handed the presidency right on back over to the leftists.
RE: simply add it to the massive new entitlements that Ivanka wants for childcare for those making up to $500K,
Ivanka is not congress, they can always IGNORE her.
Those aren’t details, those are fundamental to the bill. And the House is more conservative than the Senate—no reason to expect McConnell to slow the RINO idiocy of Ryan.
1) Send to Trump the same repeal that you sent to Obama
2) Create “standard” and “color coded” policies as defined by HHS. For example, RED would be high deductible + HSA type account. GREEN would be low deductible, high premium EPO/PPO account. Add an A/B/C distinguishing the allowance of pre existing conditions indicator. GREEN/A would indicate no preexisting conditions. GREEN/B would indicate some limit on preexisting and GREEN/C would indicate that preexisting conditions were allowed.
Allow companies who comply with the standards verified by HHS, to sell insurance into the national market place.
3) Allow all businesses to deduct the cost of both HSAs as well as insurance for all employees - 101% for less than 40 hour workers and 102% for full time workers
4) Allow individuals to tax deduct premiums, co-pays and out of pocket expenses from their individual taxes.
5) Wait 4 years before making any other adjustments and let the market heal itself from the Dem interference
those specific numbers? those are details.
They can, but it doesn’t change a whit that Trump’s admin is already pushing for the biggest expansion of entitlements, in areas that the federal government has no business being involved at all, in history.
No, the whole thing is a disaster to start, and likely to get worse.
The only thing honest and decent is for Congress to simply repeal now—and combine the promised tax cuts in the same reconciliation bill—then deal with whatever they can’t help themselves from meddling in down the line.
RE: The vitriol with which people spout factually false information on this site can be a bit off-putting at times.
The problem I often have with posters at FR is they post one liners which DO NOT address the points raised in an article.
Many are simply trying to come up with clever one liners, and that’s all. For instance, I once posted an article from the National Review which was actually favorable and supportive of Trump.
I got several posts on that thread that can be summarized in one short post : “National Review sucks”. THAT’s IT.
I do appreciate those who try to respond to the issues raised and to refute the points presented by the authors.
How’s ACA passed Senate votes?
Google “Deem and pass”
I think my idea in Post #11 is better. Get the HHS the hell out of health insurance, period.
The only function of "public health care" on a national level is to protect the public from infectious diseases that can spread across large swaths of the population. That's it.
The last thing we need is an arrangement where the U.S. Secretary of Health will invariably become a paid whore of the insurance industry.
Am I the only one who remembers the “deem and pass” strategy?
So support this now because they will really, really fix it in the future? Right, and the horse might talk, too.
Here is how Obamacare passed, as I understood it.
Obamacare was signed into law in March 2010. The Dems just lost a huge election the November before. If you recall, Nancy Pelosi’s Democratic majority in the House of Representatives was unable to pass their version of a healthcare law.
The Senate at that time had 60 Democrats, just enough to pass Obamacare. However after the bill passed the Senate, Democrat Senator Ted Kennedy died.
In his place, Massachusetts elected Republican Scott Brown. That meant that if the House made any changes to the bill the Senate wouldn’t have the necessary number of votes to pass the amended bill (because they knew no Republicans would vote for Obamacare).
So Senate Leader Harry Reid cut a deal with Pelosi: the House would pass the Senate bill without any changes if the Senate agreed to pass a separate bill by the House that made changes to the Senate version of Obamacare.
This second bill was called the Reconciliation Act of 2010. So the House passed PPACA, the Senate bill, as well as their Reconciliation Act. At this point PPACA was ready for the President to sign, but the Senate still needed to pass the Reconciliation Act from the House.
The Senate only had 59 votes to pass the Reconciliation Act since Republican Scott Brown replaced Democrat Ted Kennedy.
Therefore in order to pass the Act Senate Democrats decided to change the rules. They declared that they could use the “Reconciliation Rule (this is a different “reconciliation” than the House bill).
This rule was only supposed to be used for budget item approvals so that such items could be passed with only 51 votes in the Senate, not the usual 60.
Reconciliation was never intended to be used for legislation of the magnitude of Obamacare. But that didn’t stop them.
So both of the “Acts” were able to pass both houses of Congress and sent to President Obama for his signature without a single Republican vote in favor of the legislation. The American system of governance was shafted.
So, in essence, if I read it right, many posters here want the GOP to use the same chicanery the Democrats did. If they did a bad thing, the GOP should also do something similar.
This train wreck may not even get 50 votes in the Senate.
Here's a real problem to fix:
The bill doesn't remove the individual mandate. It revises the penalty to $0. This change is on page 83/84. It amends the Internal Revenue code 5000A and leaves the requirement for insurance in place. It remains in place because the federal penalty has been replaced with an insurance fine.Here's another real problem to fix:
However, this bill would make the situation even worse than Obamacare. Although Obamacare didn’t require photo ID and fingerprints to verify identity, it did harness the Department of Homeland Security’s Systematic Alien Verification for Entitlements (SAVE) database. Thus, officials were at least able to check immigration status against Social Security numbers. The problem with this bill is that because it tweaks Obamacare and creates a new massive entitlement system through the budget reconciliation process, it cannot have the statutory effect of mandating HHS and IRS work with Citizenship and Immigration Services to use the SAVE database because that issue is outside the jurisdiction of the reporting committees. And no subject matter from other committees can be included in reconciliation.Thus, to pass Obamacare 2.0 instead of plain repeal via budget reconciliation, Republicans must use weaker verification language.
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