Greetings friends and readers, I decided to wait and post my last two pieces together, so that way you could understand my train of thought on the issue of the recent attempt to repeal Obamacare.
Obamacare Ideas: What a Leaked Draft from Congress Looks Like
On Friday, February 24th, a discussion draft of the House Republican’s bill to repeal and replace Obamacare, or the Affordable Care Act, went public. The 106-page draft looks very similar to a GOP Leadership outline that got leaked on February 16th. No longer are the GOP thinking of doing a repeal and delay, where they repeal the funding streams of Obamacare and then fight with Democrats for replacements. Instead, they are going through a reconciliation process.
The reconciliation process is a budget bill that is only debated for 20 hours, thereby making it filibuster proof because of the limited time. While the reconciliation process was historically put in place to give Congress a chance to better manage the country’s fiscal position, so it could better reduce a deficit or produce a greater surplus in spending, the process also allows changes to the budget in revenue and spending amounts. These do NOT have to actually increase a surplus from the budget or reduce a deficit. It allows for large-scale manipulations of a law, without generating the potential conflict a normal bill would. This is something the Congress is considering because the Republicans lack a filibuster-proof majority in the Senate (60 Senators).
Having read through the draft, here are some initial thoughts. Of the ideas being floated, the first is the creation of a new program that allows Americans to use the subsidies already in place for them to purchase any healthcare plan legally available in their state. To facilitate a market that might have cheaper insurance, states would hold the right to decide what an “essential health benefit” is defined as and give flexibility for companies to charge prices on an age ratio of 5:1, meaning the youngest customer could pay 1/5 of what the oldest customer pays, and that ratio is not established. A state could decide to widen this gap even more if they desired.
The biggest thing to note is that the tax credits being used to place people into Medicare or provide cheaper insurance would no longer be based on income, but would instead be a flat tax credit. This part is particularly painful for any person currently enrolled in Medicare or in the income-assisted plan because the tax credit proposed is considerably lower than the means-tested one that is currently given out. At the current premium cost, the tax credit would not be able to provide the lowest-income families with health insurance.
One feature that is different in what has been frequently talked about in replacement is the “State Innovation Grants and Stability Program.” Rather than “high-risk pools” which just gave money piles for states to keep high-risk patients alive, this system is about getting money to the state for the following, as the discussion draft produced by Politico shows:
“1) Provide Financial Assistance to high-risk individuals who do not have access to health insurance coverage offered through an employer.
2) Provide incentives to appropriate entities to enter into arrangements with the State to help stabilize premiums for health insurance coverage in the individual and small group market.
3) Reduce the cost for providing health insurance coverage in the individual and small group market for individuals that have or are projected to have a high rate of utilizing health services.
4) Promoting participation in the State health insurance market and increasing health insurance options through that market
5) Promoting access to preventive services, dental care services, vision care services, or any combination of such services.
6) Providing payments, directly or indirectly, to health care providers for these provisions
7) Provide assistance to reduce out-of-pocket costs, such as copayments, coinsurance, premiums, and deductibles for individuals enrolled.”
To see the Politico document referenced, go to http://www.politico.com/f/?id=0000015a-70de-d2c6-a7db-78ff707e0000
Later on there are provisions to cover the costs of those already enrolled in the exchanges and provide states with the funding and grant money to make sure those who have insurance from the healthcare exchange do not lose it.
There are some major flaws with this plan. The lack of an income-adjusted tax credit means that poorer families take the worst damage. However, this does offer a tax credit to middle-class homes. While the Employer and Individual mandates are eliminated, no provision exists on how the uninsured are handled. There is also an elimination of a Small Business Tax Credit for businesses that gave employer insurance. Also the Cadillac Tax on Employer-provided Health Insurance is gone.
If this is really a draft of the Republican proposal for fixing and replacing ACA, expect a long fight. The Provisions, while some are interesting, generally go in the wrong direction; not just of Democrat support, but also the President’s support. It will be interesting to see if this any significant provision from this draft survives Congressional discussion.
This was from two weeks ago. This was my take on the “then-leaked” preview of what House Republicans would attempt to push through the Congress. But then the House Republicans didn’t change the preview. They didn’t take the initial criticism into perspective and we watched as Paul Ryan became nearly Public Enemy No. 1.
Policy versus Principle: Why Conservatives are at odd with Republicans
In recent years, the divide between ideological Conservatism and the Republican Party has grown, with the election of Donald Trump putting this on display. The current situation with the Republicans’ handling of Obamacare has emphasized how the Republican Party has yet to integrate and accept Conservatism. The Party is often willing to take Conservative ideas on tax reform, and cut spending on entitlements for the individual; the Party has for a while shown a particular hostility to social values, be they black-and-white issues like homosexuality and abortion, or social policies like healthcare and corporate welfare.
This is the case and point for the recent spat between Senators Mike Lee (R-Utah), Ted Cruz (R-Texas), and Rand Paul (R-Kentucky) and Congressional leadership. The three Senators have begun publicly calling out Senate Majority Mitch McConnell (R-Kentucky) and Speaker of the House Paul Ryan (R-Wisconsin). First, Republican leadership has kept under wraps their current plan to repeal and replace Obamacare. They claim this is essential for the sake of arguing their opinion of the plan. Just as the Affordable Care Act was prevented from scrutiny, a plan that cannot be thoroughly evaluated is a plan that should not be trusted. It creates a reminiscent image of what happened to the American people not that long ago, when Nancy Pelosi said, “But we have to pass the bill, so you can find out what is in it, away from the fog of controversy.”
Because of this suspicious behavior by the Congressional Republican Leadership, Rand Paul has begun calling the repeal and replace secret plan “Obamacare Lite”. This is because there is a replacement for the cadillac tax, an individual mandate to insurance companies rather than the federal government, and a permanent entitlement plan in the bill. Some conservatives have pointed out that the provisions would lead to an expansion of corporate welfare and “subsidies to others who could, indeed, be millionaires.” These provisions have been argued by Conservatives as bad for the bill. Hence, why Congressional leadership has kept the plan secret from rogue Conservative politicians.
“I think everybody knows I want to see the bill and that I think they’ve had a PR disaster by putting it under lock and key and trying to keep it out of the view of legislators and the public,” Senator Paul said. He followed this up by pointing out the Congressional leadership is acting as if this is a “take it or leave it” situation, where if you don’t approve of what the leadership is doing, it doesn’t matter. The biggest problem is that leadership wants to put repeal and replace in one super bill and Conservatives feel that the two should be separate, so arguments can occur and compromise form over the replacement.
But while this would be the pragmatic and useful act for the American people, and guarantee that the Americans get the best deal possible, it is not the most politically satisfying. By passing one big plan, that feels wholly unsatisfying to many parties, Congressional Republican leadership can claim a political victory and act as if they need not do more work on healthcare.
Meanwhile, political activists on the Right have started mobilizing a “You Promised” campaign against House and Senate Republicans for failing so far to offer a repeal and/or replacement bill. One such organization, Americans for Prosperity, is owned by the Koch brothers, who many will remember are Right-wing Libertarians who fund both politicians, businesses, and campaigns. But their support for an effort against the politicians that they have helped or aided is interesting. It would seem that somehow in the course of a few months, Congressional Leadership not only has created friction between it and the White House, but also between it and dissidents in Congress, and finally between it and the donors and voters at home.
House and Senate leadership needs to get it’s act together. The under-cover-of-darkness approach to passing and writing legislation is non-republican, it is undemocratic. It seems not only condescending by Congressional Leadership, but it reflects this continuous attitude of non-cooperation and an uncompromising attitude by the leadership. They are expressing this attitude, not only to the opposition (Liberals and Democrats) but now to their fellow Republicans and to the voters. Last week, a leak of the plan occurred and the leadership refused to talk about it at all. Now they claim it is close to being presented and zero scrutiny has occurred.
This is the kind of situation that I expect Paul Ryan to say, “But we have to pass the bill, so you can find out what is in it.” To that I say, “No Deal.” The American people should not just take what Congress gives them, they should demand the best Congress can give them.
Once the posts are online at the Leader Opinion page, I will post the links to them at the top of this post.