AHCA

‘They Have to Do It By September’

June 5, 2017 by GregC

Republicans in the Senate have been pouring cold water on expectations of producing a health care reform bill anytime soon, but a leading health care expert says the GOP realistically has just over three months to get it done.

“If they’re going to do this with only 51 votes in the Senate, they have to do it by September,” said Galen Institute President Grace-Marie Turner. “Frankly, I think they want to do it before the August recess so that they can get on with the rest of the agenda.”

The can officially start working on the bill now that House leaders have finally sent it to the upper chamber. It was on hold while lawmakers waited on the Congressional Budget Office scoring of the bill to make sure their calculations on how the legislation would impact the deficit were accurate. They were.

Despite moderate Republicans like Sens. Susan Collins, R-Maine, Lisa Murkowski, R-Alaska, and Dean Heller, R-Nevada, saying the House bill was a non-starter for them, Turner suspects the final Senate version will end up looking pretty familiar.

“They will make some changes to the House bill and they will very much call it their own, but I think a lot of those structural elements of the safety net, the bridge to new coverage, the state flexibility on regulations and the Medicaid reform, I think we’re going to see all of that in there,” said Turner.

She says those four components are critical and are in the House bill: providing help for individual market consumers who no longer have reasonable coverage options, creating a transition to a market-based system, giving states more power to define plans and foster competition and changing Medicaid so it doesn’t devour state resources for all other priorities.

Turner says the House crafted it’s bill with Senate rules in mind.

“The House did try very hard to bend over backwards so that it’s version of the legislation complied with Senate rules,” she said. “They didn’t want the Senate to have to change it too much.”

Still, Turner does expect the Senate to spend more tax dollars on providing for people with pre-existing conditions.

“The Senate is going to dial things back in different ways and probably provide even more protections than the House bill did for pre-existing conditions protections. I do think that that has been an inflamed issue that is very much overstated,” said Turner.

“The House bill provided $138 billion to the states to be able to take care of people who have pre-existing conditions and have high health care costs. All evidence is that would be more than enough to do it,” said Turner.

Turner also suspects the Senate may be less conservative in curtailing Medicaid expansion than the House bill. And another issue that GOP moderates are likely to fight is the slashing of tax dollars for Planned Parenthood.

With the House bill passing precariously in May, it’s unclear what impact any substantial Senate changes will have on final passage. But Turner warns the House that whatever they get back from the Senate – if they get anything back from the Senate – may be their one chance to get anything done this year and maybe in this Congress.

“I think everybody knows that whatever the Senate gets through, the House is going to have a very difficult time changing it. I think it’s very likely going to be take it or leave it,” said Turner.

If we get to that point, Turner suspects voter outrage over the possibility of getting nothing done will likely compel passage of an imperfect bill.

“I don’t think any of them want to go back to the voters in 2018 next year and say, ‘Sorry, for four elections we told you we were going to repeal Obamacare and we just kind of couldn’t figure out how to do it.’ They all know they have to figure out how to do it,” said Turner.

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GOP Health Care Battle Heads to the Wire

March 22, 2017 by GregC

President Trump and GOP leaders are furiously trying to find the votes necessary to pass the American Health Care Act, and while some news ‘yes’ votes are trickling in, the conservative pushback is also intensifying.

By most vote counts, Republicans are still a handful of votes away from being able to send the AHCA on to the Senate. With all Democrats expected to oppose the bill, GOP leaders can only afford to lose 21 members on the final tally. Unofficial whip counts in recent hours show 25-26 Republicans as firm or likely ‘no’ votes. Sen. Rand Paul expects at least 35 Republicans to oppose it and predicts leaders will scratch the vote.

But Trump and GOP leaders have been able to sway a few more Republican votes to the ‘yes’ column, including Rep. Tom McClintock, R-Calif.

“We have to ask ourselves, if that’s all we get, does that give us a better system than the one we have right now?” said McClintock. “It’s far, far from perfect, but it does move us in the right direction. I am satisfied that, overall, it does give us a better system than the one we’ve got right now.”

McClintock believes Republican leaders made a mistake in insisting on moving a bill that does not address all needed solutions through the reconciliation process.

“The biggest problem is they’re using this convoluted process called reconciliation that doesn’t allow them to repeal the entire act, doesn’t allow them to replace the entire act and requires a lot of additional administrative regulations, which are going to be restricted by what the most liberal court in the country allows them to do, and by follow-up legislation whose future in the Senate is highly dubious,” said McClintock.

McClintock says Republicans and Democrats are responsible for the “convoluted” approach.

“Leadership chose that path precisely because of Democratic obstruction in the Senate. The reconciliation process allows us to bypass that 60-vote cloture threshold and pass the bill with a simple 51 votes,” said McClintock.

However, he believes that a full repeal with all the market based reforms could pass the House and Senate if GOP leaders were willing to play hardball.

“I think the pressure on those eight Democratic holdouts would have been irresistible, particularly if (Senate Majority Leader) Mitch McConnell said, ‘If you want to filibuster this one, you’re going to have to actually go down there and filibuster it. You’re going to have to stand by your desks and talk until you drop. The record is 58 days. Good luck breaking that. When you’re done, we’re all going to vote,'” said McClintock.

However, McClintock says that option is off the table and he’s comfortable voting for the current bill.

“Those were arguments I made months ago and lost months ago. We now have this bill in front of us and I think it more than merits an ‘aye’ vote,” he said.

McClintock wishes there were provisions in the bill allowing purchase of health insurance across state lines and that yanked out the Obamacare insurance regulations that are considered key drivers of premium and deductible increases.

But he says there is a lot to like in the bill as well.

“It ends the individual mandate that forces people to buy products they don’t want. It ens the employer mandate that’s trapped a lot of low-income workers in part-time jobs. It begins to restore consumers’ freedom of choice, which I think is the best guarantee of quality and value in any market,” said McClintock.

“It allows people to meet more of their health care needs with pre-tax dollars. It relieves the premium base of the enormous cost of pre-existing conditions by moving those expenses to a block-granted assigned risk pool,” he added.

But while there are some notable improvements in the AHCA, for conservatives who have pushed “repeal and replace” since Obamacare became law seven years ago, the House bill simply fails to deliver on that promise.

“It’s good entitlement reforms in terms of some of the Medicaid reforms that are in the bill,” said Chris Jacobs, a former aide to Mike Pence and former Louisiana Gov. Bobby Jindal, who is now senior health policy analyst at the Texas Public Policy Foundation and CEO of the Juniper Research Group.

“But I think it’s far short of a full repeal. It leaves Obamacare’s architecture in place when it comes to all the mandates and the insurance regulations that are driving up premiums. We need to repeal those mandates and go back to respecting state sovereignty and the states’ role in regulating health care and health insurance,” said Jacobs.

GOP leaders have characterized the AHCA as a binary choice for their colleagues: either support the bill or support the existing health care system by default. Jacobs is not buying that argument.

“That’s a false choice, the idea that we must do something, that this is something therefore we must do this has a flaw in that logic,” said Jacobs.

Sponsors of the AHCA say getting rid of the insurance regulations or “Obamacare architecture” is outside the bounds of what can be moved through reconciliation. Jacobs says the handling of this very bill proves that is not true.

“I understand the limitations of the reconciliation process, but you have to at least try to repeal the major insurance regulations that are in there. The bill amends some of them, repeals some of them and leaves others in place. It’s an ideologically inconsistent position,” said Jacobs.

“If your position is we can’t do any of this because of Senate procedures, then why are we repealing some of them and modifying some of them. If you can modify them, you can repeal them,” he said.

McClintock finally got on board with the AHCA after successfully sponsoring an amendment in the House Budget Committee that would provide an additional $75 billion to help people afford health insurance as they transition from Obamacare subsidies to tax credits if the new bill becomes law. He is also confident that within a few years, Americans will start to see noticeable price decreases in health coverage.

But that same manager’s amendment that satisfied McClintock also contains language that could threaten benefits for up to seven million veterans. Jacobs says the technical glitch in the language shows the need to slow down the rush to pass the legislation and avoid ugly surprises after it becomes law, similar to what occurred with Obamacare.

As the furious battle for votes plays out, Jacobs hopes leaders pull back and rework the bill to honor the original campaign promises.

“There are folks negotiating now as we speak in the Freedom Caucus to repeal some of the insurance regulations and the mandates. Hopefully that succeeds and we get to a better bill that conservatives can support,” said Jacobs.

McClintock says Republicans should not let the perfect be the enemy of the good.

“When you pull together a group of people to benefit from their combined wisdom, unfortunately you’re also going to get their combined follies, prejudices and misjudgments. You can never get a perfect product out of this process. What you can get is the product that is the most acceptable and moves us forward,” said McClintock.

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‘Let’s Do What We Said, Let’s Repeal Obamacare’

March 20, 2017 by GregC

Republican leaders are hoping to pass their health care replacement plan on Thursday, but the conservative sponsor of legislation to fully repeal the Affordable Care Act says the current GOP preserves far too much of the current system and must be rejected.

Rep. Jim Jordan, R-Ohio, is also a co-founder and former chairman of the House Freedom Caucus and has introduced legislation to fully repeal the Affordable Care Act, also known as the ACA or Obamacare. Jordan is vigorously opposed to the current version of American Health Care Act, arguing this is not what Republicans promised voters since 2010.

“We’re not repealing Obamacare. Even people who are for it, like Charles Krauthammer, has said it’s Obamacare-lite. It keeps the Obamacare structure and that’s not what we told the voters. If you don’t repeal Obamacare, you’re never going to bring down the cost of insurance for middle class and working class families,” said Jordan.

“So it is really that basic. Let’s do what we said. That’s what they sent us here to do. Let’s actually repeal Obamacare. A clean and complete repeal is what we’re after. This doesn’t do it,” said Jordan.

The American Health Care Act, or AHCA, is vigorously endorsed by President Trump and House Speaker Paul Ryan, R-Wisc. Ryan argues the plan does fulfill the promise to repeal and replace Obamacare.

Jordan laid out several areas he insists are key differences between a complete repeal and what the GOP plan does.

“We didn’t tell voters we were going to repeal Obamacare but we were going to keep some of the taxes in place, which the speaker’s plan does. We didn’t say we were going to repeal Obamacare but take the Medicaid expansion and extend it for several years, which the speaker’s plan does,” said Jordan.

“We certainly didn’t say we’re going to repeal Obamacare and start this new program of refundable tax credits and repeal Obamacare and get rid of the mandate but keep this 30 percent surcharge that we tell insurance companies you have to levy on people who don’t maintain continuous coverage,” said Jordan.

The most disturbing issue for Jordan is Republicans getting ready to own a massive health care reform that he believes will not lower the cost of health insurance.

“This is just Obamacare in a different format, and because of that it will not bring down the cost of insurance. It will not bring down premiums. Therefore, middle class families are still going to see the ridiculous high levels they’ve seen over the last several years,” said Jordan.

Jordan and several other members of the House Freedom Caucus are demanding a full repeal of Obamacare, just as the GOP-controlled Congress did in 2015 before the legislation was vetoed by President Obama.

“The one thing we know about our plan is it’s passed before,” said Jordan.

So why won’t leaders bring up that same bill?

“They’re saying some people may not vote for that, which is amazing to me. During election time you can do one thing, but once you get in office and it actually counts you can’t? That’s what drives voters crazy,” said Jordan.

Jordan also doesn’t buy the GOP leadership’s three-step approach to reform, which includes this bill, letting Health and Human Services Secretary Tom Price roll back many of the regulations in the current law and then passing market-based reforms in a separate bill that will likely require 60 votes to clear the Senate.

“That’s a joke,” said Jordan.

“We know phase two is going to get tied up in court. You saw what the courts have done on President Trump’s executive order on the travel ban. You’ve seen how he reworked it and came back with something we know is consistent with the law. And where is that right now? It’s tied up in court. So to think the left is not going to take Obamacare and tie it up in court is just ridiculous,” said Jordan.

As frustrating as it has been for full repeal proponents to plead their case with leadership, Jordan says the difference between conservatives and Democrats on the issue is like night and day.

“They view success as signing people up for government, Medicaid or Obamacare. We define success as let’s put in place the policies that make insurance affordable so that people can pick the plan that meets their needs. That’s what we’re trying to get accomplished,” said Jordan.

While Trump is vociferously supporting the GOP plan, Jordan is hopeful the president will be able to broker changes to the legislation that will rid the law of crippling insurance regulations dictating what has to be in all policies, allow for market based reforms that will drive competition and lower costs and repeal other burdensome regulations by statute.

Jordan, who met with Trump along with other Freedom Caucus members, says the White House has been far more accommodating than Republican leaders in Congress.

“We appreciate the outreach the White House did being willing to work with us. Our leadership initially talked about this binary choice, take-it-or-leave-it approach, which I don’t think is helpful. Since then I think they’ve been more open to talk with us, probably driven by the fact they don’t have the votes,” said Jordan.

With a vote planned for Thursday, Jordan suspects a scramble is underway to find more support for the AHCA.

“One thing I learned a long time ago is when leadership is out there saying they have the votes, that means they probably don’t have the votes. Based on what I know from our members of the Freedom Caucus and some other people, I believe they do not have the votes, so we’ll see how negotiations go this week,” said Jordan.

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