Trump's Full Court Press on healthcare

[Zarathud]

The process is transparent to Putin.

The Big Lie has become contagious.

[Isgrimnur]

Patience Gone, Koch-Backed Groups Will Pressure G.O.P. on Health Repeal

Saying their patience is at an end, conservative activist groups backed by the billionaire Koch brothers and other powerful interests on the right are mobilizing to pressure Republicans to fulfill their promise to swiftly repeal the Affordable Care Act.

Their message is blunt and unforgiving, with the goal of reawakening some of the most extensive conservative grass-roots networks in the country. It is a reminder that even as Republicans control both the White House and Congress for the first time in a decade, the party’s activist wing remains restless and will not go along passively for the sake of party unity.

With angry constituents storming town hall-style meetings across the country and demanding that Congress not repeal the law, these new campaigns are a sign of a growing concern on the right that lawmakers might buckle to the pressure.
...
The new mantra could be summed up as repeal, replace or revolt. Beyond the Koch network, other well-financed conservative groups like the Club for Growth and FreedomWorks are also increasing the pressure. All together, the new campaigns will involve advertising, rallies, phone calls to the Capitol switchboard and efforts to confront lawmakers in their offices with documentation of their own words about the need for repeal.

The Koch groups are calling their campaign “You Promised,” and are prepared to spend heavily, they said.

[stessier]

I'd be joining in the popcorn if this wasn't such an important issue they were playing with.

[Smoove_B]

The fact that they ever thought they could "swiftly repeal" anything related to insurance goes to show how clueless they all really are.

[Isgrimnur]

I'd be joining in the popcorn if this wasn't such an important issue they were playing with.

The popcorn is more about them continuing the party in-fighting than the idea that they can successfully strong-arm every member into marching to their drum.

[El Guapo]

I'd be joining in the popcorn if this wasn't such an important issue they were playing with.

The popcorn is more about them continuing the party in-fighting than the idea that they can successfully strong-arm every member into marching to their drum.

They might be able to. The House long ago descended into madness, so I have no real doubt that the House will pass whatever draconian repeal bill Ryan puts in front of them. Trump would almost certainly sign it. So, that means that the health care of tens of millions of people is depending upon whether three GOP senators are willing to vote no on the eventual repeal bill.

Given how GOP senators have acted under the Trump regime so far, this seems like a 50/50 proposition to me.

[Fitzy]

I assume I'm missing something, but this Washington Post article seems to be applying the Republicans are going to replace the ACA's "subsidies" with "refundable income based tax credits". Plus modest tweaks. So what the hell was all about?

The issue of tax credits being paid at the end of the year could hurt. Though people could readjust their withholding to cover it. I think.

It will be interesting to see what they are actually proposing and how different it really is.

[El Guapo]

I assume I'm missing something, but this Washington Post article seems to be applying the Republicans are going to replace the ACA's "subsidies" with "refundable income based tax credits". Plus modest tweaks. So what the hell was all about?

The issue of tax credits being paid at the end of the year could hurt. Though people could readjust their withholding to cover it. I think.

It will be interesting to see what they are actually proposing and how different it really is.

A key difference is that the tax credits most likely won't come anywhere near the level required to make insurance widely affordable.

[gilraen]

So far the numbers that they have presented imply that the tax credit wouldn't cover even half the cost of a basic plan.

Also, tax credits are irrelevant for the ~45% of the population that make too little money to owe federal taxes.

[coopasonic]

The fact that they ever thought they could "swiftly repeal" anything related to insurance goes to show how clueless they all really are.

Who knew it could be so complicated?

[El Guapo]

Also, tax credits are irrelevant for the ~45% of the population that make too little money to owe federal taxes.

That's not quite true insofar as the tax credits are slated to be "refundable", so if you don't owe federal taxes, you still get the credit paid to you. Of course, I imagine that there are some desperately poor people who have trouble getting access to the federal tax filing process, and that may be an issue in terms of not getting the credit until the end of the year, though I'm not sure how that would work exactly.

[RunningMn9]

And of course with the credit, you have to have the money up front to pay for the insurance, which they probably won't be able to do.

[Fitzy]

And of course with the credit, you have to have the money up front to pay for the insurance, which they probably won't be able to do.

It's out now and interestingly the description is claiming it's an advanceable, refundable, tax credit worth 2-14k based on income and age. But it's totally not a subsidy (

Seems to kill Medicaid expansion, but no one will lose coverage unless they choose to.

And the current subsidies last until 2020. I'm shocked they pushed this off until after the next presidential election.

https://housegop.leadpages.co/healthcare/

[El Guapo]

GOP Senators Portman, Caupito, Gardner, and Murkowski released a statement saying that they'd vote against any bill that repeals the Medicaid expansion (at least as to states, such as theirs, that already adopted it). Which is good, although it leaves the GOP with room to repeal the Medicaid expansion as to states that haven't yet signed on.

[RunningMn9]

As predicted, their plan is to shift the cost of healthcare back onto individuals. Health Savings Accounts only make sense to people that have the money to save.

As has been demonstrated time and time again, most effective way to deliver health care is to incentivize people to use it early and for preventative measures.

Health Savings Accounts do the exact opposite. They encourage you to save - and the most effective way to save on health spending is to not seek healthcare until it's critical.

From a public health perspective, this will be a disaster.

[Zarathud]

Congress cares only about political expedience, not good public health policy.

ACA recognized that early treatment and medical intervention is nearly always less expensive than waiting for chronic, critical health care needs. Over time, America would have been healthier and medical care less expensive. HSAs are about discouraging initial care, and deferring the cost as long as possible. Hopefully when you're no longer covered by a for-profit insurance plan.

[malchior]

As predicted, their plan is to shift the cost of healthcare back onto individuals. Health Savings Accounts only make sense to people that have the money to save.

And the reason is clear - they don't want the rich to subsidize the poor's healthcare. This is a tax cut for the rich to yank healthcare back away from the less fortunate. There is some income support still but it is severely curtailed. To boil this down - not only is this bad policy - but it is amoral. Barnum said there would be healthcare for everyone. Instead there will be less than there is now. They are doubling down on moving back to a system that was completely failing instead of fixing a system that needed more tuning. Sad!

Congress cares only about political expedience, not good public health policy.

Which is funny because there is a decent chance this plan will crash and burn. It is full of so many compromises necessarily to form a coalition out of the nihilists that they might not be able to get it past the Senate. That'd be awesome but I've come to expect that our political system has stopped protecting non-monocle clad American people anymore so it won't surprise me when this squeaks through.

One last comment - to get rid of the mandate they replaced it with a 30% surcharge on people without continuous care. Evil. A 30% surcharge should be called what it is - no access. What a sham. It certainly feels like the GOP are locked in a race to see who can heap more abuse on the American people. Will it be the insane, amoral President or the insane, amoral Congress?

[Chaz]

The 30% surcharge for lapsed insurance means that people on the bubble are going to start falling into a chasm. Lose your job and are unable to buy insurance for two months? Getting insurance back is now 30% more expensive, so maybe now you can't afford to get it back, since those already-too-small tax credits aren't going to increase to cover the extra cost. Now we're back to a situation where an increasing number of people make too much to qualify for Medicaid, but not enough to be able to afford insurance.

But I guess they have "access", so that makes this situation okay.

What'll really happen is that insurance companies will return to offering dirt cheap catastrophic coverage plans that don't actually do anything. This will be labelled as "increasing access and choice", and hailed as a yuge victory.

[malchior]

Maybe that is how the GOP are trying to get insurance provider support. Your market will shrink now but long term you can start selling the payday loans of insurance. Progress! #Wealthcare

[stessier]

Don't worry - they know how to make this work.

In case you can't see it -

GOP Rep. Chaffetz: Americans may need to choose between "new iphone... they just love" and investing in health care

[Blackhawk]

Rich people and Hollywood.

Two groups who really understand what it is to be poor.

[El Guapo]

The Freedom Caucus is already up in arms about the proposed plan. Because this basically seems like a shittier version of the ACA (for example, the 30% continuous coverage surcharge is just a shittier version of the mandate created so that they can say that they repealed the hated individual mandate). And to thread the needle here, even going via reconciliation, with democrats a virtual lock to all vote against any GOP plan, they have to appease both the factions that hate the existence of any sort of ACA, with the factions that want to preserve at least a semi-functional health care market.

This would be fascinating to watch play out, if the livelihoods of tens of millions of people weren't at stake.

[El Guapo]

I guess Rand Paul is so mad that he can't even spell anymore.

[El Guapo]

Will 'Denounce-and-Preserve' Beat 'Repeal-and-Replace'?

[stessier]

I have to admit, Repeal and Replace is much catchier. We need someone to work on our branding.

Edit: They also missed out on the writing the headline as "Will 'Repeal-and-Replace' trump 'Denounce-and-Preserve'?

[Captain Caveman]

GOP Rep. Chaffetz: Americans may need to choose between "new iphone... they just love" and investing in health care

This guy is such an asshole.

[El Guapo]

GOP Rep. Chaffetz: Americans may need to choose between "new iphone... they just love" and investing in health care

This guy is such an asshole.

He really, really is.

[malchior]

GOP Rep. Chaffetz: Americans may need to choose between "new iphone... they just love" and investing in health care

This guy is such an asshole.

He really, really is.

I'll give him credit for openly channeling the underlying pathos that makes the GOP so damn vile. He is an honest asshole at least. Though he is probably just a little bummed he can't say Obamaphone instead of 'new iphone' anymore.

[Smoove_B]

From a public health perspective, this will be a disaster.

Very much this and it's going to be a shitshow for everyone.

Also, they had 7 years to work on this and they actually added language to prevent lottery winners from collecting Medicaid? This is is their grand plan? The plague of lottery winners cheating the system?

[malchior]

From a public health perspective, this will be a disaster.

Very much this and it's going to be a shitshow for everyone.

Also, they had 7 years to work on this and they actually added language to prevent lottery winners from collecting Medicaid? This is is their grand plan? The plague of lottery winners cheating the system?

6 pages of text for that 'edge case'! What innovation!

[stessier]

CNN has the full text of the proposal.

On page 14, it defines Qualified Lump Sum Income and it sure looks like it include inheritances. Am I reading that right?

[gilraen]

CNN has the full text of the proposal.

On page 14, it defines Qualified Lump Sum Income and it sure looks like it include inheritances. Am I reading that right?

Yes, I believe so.

[stessier]

Wait - on page 72 - Qualified Health Plans can no longer cover abortions. Wow. I'll have to keep reading to see if there are any other legal procedures that will require me to lose my qualified plan.

(For the record, I think abortions are morally wrong, but this part of the plan is quite stupid.)

[Chaz]

I disagree with that thing, therefore nobody else is allowed to do it either!

Oh, the thing I'm morally opposed to is blood transfusions. No medical plans can cover blood transfusions.

[gilraen]

Basically this health plan is a steaming pile of shit, and if it passes, we are essentially back to where you have to hold on to your job because you will never get functional health insurance without it. Hopefully enough of rabid Trump voters get sufficiently sick by the time next election rolls around where they either learn not to vote against their own best interest or they are too sick to vote at all.

[Rip]

Either go with no federal health care or single payer.

Anything in between is just a half assed solution that is destined to fail.

[stessier]

Pages 89-92 talk about the Refundable Tax Credit calculations.

They are quite low -

Age <30 - $2000
30 - <40 - $2500
40 - <50 - $3000
50 - <60 - $3500
60+ - $4000

And they cap the amount you can get for your family + dependents at $14,000. They also say they will only consider the 5 oldest members for the calculation. If I read it correctly, that means if you have 6 dependents, you're paying for that last one all on your own.

Edit: Oh - and if you make more than 75k (150k for married filing jointly), your deduction is reduced by 10% of the amount over 75k/150k (but not below zero - gee thanks).

[stessier]

Was this in Obamacare - if you have a "seriously delinquent tax debt", you get no rebate. The definition of the term is in 7345(b) - I need Isgrimnur to look that up for me...

[Zarathud]

CNN has the full text of the proposal.

On page 14, it defines Qualified Lump Sum Income and it sure looks like it include inheritances. Am I reading that right?

Yes, I believe so.

Expectations have been that Trump will repeal the estate tax and treat inheritances as income. This confirms that thinking.

It's so stupid. For estate taxes, all I need to know is the fair market value of the deceased's assets at death to determine the tax. For income taxes, I have to know that information PLUS the tax basis (cost at purchase). It's more work.

[Isgrimnur]

Was this in Obamacare - if you have a "seriously delinquent tax debt", you get no rebate. The definition of the term is in 7345(b) - I need Isgrimnur to look that up for me...

Either that, or a double robe hook.