Health Insurance

As the Congressional Budget Office report shows how Republicans are either incompetent at and/or uninterested in actual governing (in what universe is 22 million fewer insured people seen as an improvement?), it turns out that a handful of Republican Senators got cold feet and the vote is postponed. Heather Digby Parton:

[T]he fact that there are only a small handful of Republican senators who are prepared to make some phony mumbling noises against it says everything we need to know about the moral rot at the heart of this Republican congressional majority.

Meanwhile, Senator Elizabeth Warren says single-payer insurance is the next step. Unfortunately, Democrat dominated California isn't seeing it that way. Jim Kavanagh:

[O]nce single-payer becomes a reality in California, it will catalyze a movement in every other state and on the national level. That—the fact that it will start a wildfire of imitation—and not the fact that it’s too expensive, is what the California Democratic Party is desperate to avoid, and what its donors and lobbyists are ordering it to block.

Update (June 29):  Some backlash to the California state Assembly Speaker's decision to hold back single-payer insurance.

Update (July 1):  Matthew Rozsa highlights the dilemma in Congress:

Republicans have found themselves unable to repeal Obamacare, at least to the extent that they clearly wanted to, because doing so would cause people to die.

Update (July 10):  ACA has its flaws. Which is why "Medicare for All" becomes more important. It's not like the Republicans have any useful ideas.

Update (July 12):  Christy Ford Chapin explains why Republican aren't going to be able to figure out anything on health insurance.

The House and Senate bills obliterate the idea – for which their party purportedly stands – of competitive markets lowering prices and enhancing consumer welfare. That’s both a political and a policy problem for Republicans.

[A]re they ready to create a health care system that aids every group except the working poor? The wealthy will have their health care and their tax cuts. The middle classes will continue to enjoy expensive, generous insurance that’s indirectly funded through the tax code. And insurance companies will accept whatever assistance the government provides – from tax cuts to coverage penalty periods – to continue increasing their authority over the medical system.

That’s an arrangement that leaves out the very groups that are most desperate for health care reform: lower-income families and the working poor.

Update (July 14):  Boo hoo.

[Majority Leader] McConnell released a revised version of the Senate GOP’s plan to repeal and replace the Affordable Care Act, or Obamacare. Faced with complaints and threats of defection from both flanks of his party — ultra-conservatives and so-called moderate Republicans — McConnell opted to revise the bill towards appeasing conservatives. In turn, the moderates greeted Thursday’s release of the revised bill with reservations.

Despite his cajoling, the so-called master tactician of the Senate is now at the edge of not having enough votes to even call up the health care bill next week for a vote, as McConnell pledged he would do after he delayed the Senate’s August recess by two weeks.

Update (July 15):  When insurers don't like your bill, that should tell you something.

Update (July 18):  McConnell doesn't even have the votes to repeal without replacement.

Update (July 19):  It pleases me to no end that health insurance reform failed because Republicans can't agree on how hard they wanted to fuck over poor people. Now they hope the ACA fail will on it's own. Jeffrey Young:

The president of the United States and members of the party that controls Congress are saying that they see problems in the health care system, and their plan is to stand by and do nothing while people suffer.

This is breathtakingly cynical, and reveals the Republican Party’s priorities. Getting rid of the dreaded Obamacare at any cost is more important to [Fuckface] and his party than acting to improve the health care system for the people they represent.

Update (July 22):  The fuckers just can't catch a break.

Efforts to repeal the Affordable Care Act ran into big trouble on Friday afternoon, when the Senate parliamentarian ruled that nearly a dozen key provisions of GOP repeal legislation violate special procedural rules that Republicans are using to pass their bill.

Update (July 24):  Totally nuts.

Update (July 25):  The vote was 51 to 50 to start debate on who the fuck knows. Heather Digby Parton:

This is just a mindless drive for a “win,” in order to justify a cynical political ploy that energized their voters to oppose the hated Obama and took on a life of its own. Now Republicans would rather see people’s lives destroyed than admit to all that.

And they are scrabbling to find anything that can pass after the Better Care Reconciliation Act was defeated 43 to 57. There's a bit more dissent than I thought when it seemed they might have 48 votes.

Update (July 26):  The  Obamacare Repeal Reconciliation Act failed 45 to 55. Keep trying you immoral assholes.

Update (July 27):  An insurance trade group sent the Senate a stern letter. And this is how we run the government now.

All of the entreaties by Democrats, and some Republicans like Arizona Sen. John McCain, to resurrect the traditional Senate way of doing business—legislating in the open and holding hearings, debating amendments, etc.—seemed to be for naught.

Also, still a thug.

Update (July 28):  The Health Care Freedom Act failed 49 to 51. Interesting that McCain is the only senator to vote for both starting debate and against this (possibly) last failed attempt. I'm thinking this is a little bit of payback to good old Fuckface.

It's important to remember that Susan Collins and Lisa Murkowski were the most consistent Republican Senators in their opposition to this legislative charade.

Update (July 29):  Celisa Calacal highlights the work of ADAPT and other activists in defending the Affordable Care Act.

Update (July 30):  Even as repeal has been stopped for now, the Republican sabotage continues.

Update (July 31):  Constant bullshit threats from Fuckface.

If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!

Update (August 7):  Steven Rosenfeld examines what states can do to start transitioning to a single-payer insurance system.

Update (August 9):  Grab some popcorn.

Last month’s epic failure to deliver on their 7-year-old promise to repeal the Affordable Care Act is causing angst among GOP candidates up and down the ticket ahead of next year’s congressional midterm election.

Update (August 14):  Jonathan Cohn explains how it all went wrong.

[H]e never stopped making ambitious promises about repeal legislation, vowing over and over again that it would mean lower premiums and deductibles while protecting people with pre-existing conditions ― vows that, independent analyses showed repeatedly were simply not true.

It is possible that [von Clownstick] understands he is lying when he says these things, and simply doesn’t care. It is also possible that [Fuckface] has no idea what’s actually in the recent Republican legislation and actually believes it would improve access and affordability. Nothing he has said or done, as a candidate or president, suggests he understands health care policy at even the most basic level.

Either way, the Republican dilemma remains the same. Their health care agenda is incompatible with their rhetoric and, from the looks of things, inconsistent with what the American people want as well. Instead of acknowledging this reality, and adjusting either what he’s been promising or what he’s been proposing, [von Clownstick] is continuing to demand the impossible ― and then acting indignant when it doesn’t happen.

Update (September 15):  They lost the Senate vote, but are still looking for ways to screw over people who benefit from ACA.

[Von Clownstick's] intransigence about paying Obamacare subsidies [which could raise premiums by 15 percent in 2018] is one facet of marketplace chaos created by Republicans that is making health care more expensive. In Congress, a handful of senators are making a final effort to repeal Obamacare and eviscerate Medicaid, which analysts said could cause 32 million people to lose coverage over the next decade.

Update (September 17):  Unbelievably, there may be yet another attempt to repeal.

Update (September 18):  The saucer sure knows how to fuck people over in a hurry when they want to.

And because the Senate has weird rules, the Cassidy-Graham legislation could go straight to a vote after just two minutes of debate or less.

Update (September 19):  These fucking fucks are not only misleading their own colleagues, they also want to prevent states from establishing single-payer systems. They just want to pressure one person to change their vote and rush this thing through.

Update (September 22):  Suddenly, ACA is unfair because "red" states refused to expand Medicare and accept federal funding. The new repeal effort is widely unpopular. Unfortunately, Republican Senators who stand for any principle whatsoever are very scarce. One is John McCain.

As I have repeatedly stressed, health care reform legislation ought to be the product of regular order in the Senate. Committees of jurisdiction should mark up legislation with input from all committee members, and send their bill to the floor for debate and amendment. That is the only way we might achieve bipartisan consensus on lasting reform, without which a policy that affects one-fifth of our economy and every single American family will be subject to reversal with every change of administration and congressional majority.

I would consider supporting legislation similar to that offered by my friends Senators Graham and Cassidy were it the product of extensive hearings, debate and amendment. But that has not been the case. Instead, the specter of September 30th budget reconciliation deadline has hung over this entire process.

... 

I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will effect insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won't be available by the end of the month, we won't have reliable answers to any of those questions. 

...

I hope that in the months ahead, we can join with colleagues on both sides of the aisle to arrive at a compromise solution that is acceptable to most of us, and serves the interests of Americans as best we can.

So the donors are disappointed, but they'll still get most of their tax cuts.

Update (September 26):  Looks like the old, white men who run the country have failed again. Sure would be nice if someone else could be in charge for a change.

Update (October 2):  Will those old, white, rich men give health insurance to children?

Update (October 9):  Fuckface is planning to use an executive order to undermine parts of the ACA.

Update (October 12):  The executive order could definitely make the markets worse, but Matthew Rozsa thinks the impact is somewhat mitigated.

[T]he regulatory process is notoriously slow. Any real-world impact would likely take years -- if it ever happens at all.

Update (October 13):  The executive order is deliberate sabotage and is a failure to "take care that the laws be faithfully executed".

Update (October 15):  Even Steve Bannon says Fuckface is trying to destroy the ACA.

Update (October 17):  There might be some kind of fix for ACA, but von Clownstick's position seems unclear.

Update (October 18):  Paul Ryan opposes the new ACA plan.

Update (October 24):  Von Clownstick's actions might unintentionally boost ACA.

Update (November 25):  Jonathan Cohn reports that Republican Senators are ready to eliminate the penalty for the individual mandate even though the idea originated with the Heritage Foundation.

[I]t’s telling that, as these efforts to repeal the mandate move forward, only one Republican senator, Susan Collins of Maine, is talking seriously about different policy mechanisms that could achieve the same basic goals of spreading the financial burden of illness and keeping a stable market for comprehensive coverage.

The rest are talking about jettisoning the mandate without a real replacement ― a move that would mean fewer people with insurance, higher premiums for those who hold onto coverage and less stable insurance markets generally. Apparently that outcome is ok with the vast majority of Republicans and their allies. That’s quite a statement about the party’s priorities.

Update (December 10):  Cohn recounts the Republican "campaign of neglect and sabotage" against ACA.

Update (December 19):  While they couldn't pass outright repeal, Republicans managed to do a lot of damage through the tax bill.

Update (February 7, 2018):  Jeff Bezos, Warren Buffett, and Jamie Dimon apparently want to do something about the cost of health care in the U.S. Marshall Auerback has an answer for them: Medicare for All.

Update (April 8, 2018):  Republicans in Iowa have found a devious way to undermine ACA with new "health plans".

[T]he legislation declares that the new plans “shall not be deemed to be insurance,” and there’s a reason for that. Iowa’s lawmakers want to make sure the policies aren’t subject to the Affordable Care Act’s insurance regulations, including those that protect people with pre-existing conditions.

Unless a court challenge gets in the way, nothing will stop the Farm Bureau and Wellmark from jacking up premiums on people with conditions such as cancer and diabetes ― or denying those people coverage altogether. Nor will anything keep the plan sponsors from limiting or excluding benefits the Affordable Care Act considers “essential,” a list that includes treatment for mental illness, maternity care and prescription drugs.

And if the Farm Bureau and Wellmark want to impose annual or lifetime limits on benefits, they can do that, too. People who receive organ transplants or have rare genetic disorders, such as hemophilia, frequently run up bills that exceed those limits.

There is an issue with unsubsidized, higher income people paying increasing premiums. But other states are finding ways to lower premiums while preserving ACA protections.

In Alaska and Minnesota, state officials faced remarkably similar situations, with premiums that put insurance out of reach for consumers who got little or no financial aid. They responded very differently than their counterparts in Des Moines. They created “reinsurance” pools that reimburse carriers for their most expensive-to-cover beneficiaries. Premiums fell in both states, and just this past week officials in Wisconsin said they were going to try the same thing.

Iowa’s GOP leaders could have tried some version of that. They also could have launched, finally, a serious outreach effort to boost enrollment.

Update (June 12, 2018):  Here's the Republican argument: Because ACA doesn't work as it was intended since we destroyed a key part of it, then we shouldn't have to enforce any of it.

On Thursday the Justice Department threw its support behind a lawsuit arguing that Obamacare’s protections for people with pre-existing conditions are unconstitutional. The suit, brought by 20 states led by Republicans, argue that those protections were supposed to work in tandem with the mandate that individuals have health insurance. Because Congress is no longer enforcing the mandate, they say, insurers no longer have to sell policies to everyone regardless of medical status.

Update (August 1, 2018):  A study sponsored by the libertarian Mercatus Center and apparently funded by the Koch brothers finds that Medicare for All would reduced health care spending by $2 trillion over ten years.

Update (August 4, 2018):  Justin Anderson points out how most headlines about the Medicare for All study gave the total cost of the plan and overlooked the savings.

Update (August 13, 2018):  Dean Baker criticizes the "fact-checkers" who blasted Democrats for emphasizing savings over costs.

Update (August 29, 2018):  Kevin Zeese and Margaret Flowers say the time is right for Medicare for All citing a poll from Reuters/Ipsos showing 70 percent support nationwide.

Update (October 15, 2018):  Maine's former health commissioner Mary Mayhew has been hired by the administration. According to Dr. Cathleen London:

She destroyed Medicaid in Maine now she will destroy it in the whole country.

Update (December 1, 2018):  A study from the Political Economy Research Institute finds that Medicare for All would save $5.1 trillion over the first ten years.

Update (January 7, 2019):  Hearings on the topic of Medicare for All are being planned by two House committees.

Update (January 16, 2019):  Analysis of the midterm election shows that Democrats who support Medicare for All are not more likely to lose.

Update (February 27, 2019):  Representative Pramila Jayapal has introduced the Medicare for All Act of 2019.

Under the new House bill, an expanded Medicare program would replace private health insurance, Medicaid and all other forms of health coverage except existing programs for military veterans and Native Americans. Private plans would be permitted only to cover services, such as cosmetic procedures, not covered by Medicare.

Update (April 2, 2019):  With Fuckface making noise again about repealing ACA, Cody Fenwick argues Republicans have backed themselves into a corner.

If Republicans do nothing, Democrats will run against their failure to improve health care. If they move forward with a plan that would make health care worse, Democrats will run against that. And if they allow the courts to destroy Obamacare, Democrats will run to restore coverage to millions.

Of course, they could "pass legislation that would actually improve health care in the United States", but that's crazy talk.

Update (May 14, 2019):  Washington State will be the first to offer a public option for health insurance.

Update (July 3, 2019):  Only four of 20 Democratic presidential candidates supported ending private insurance (though one claimed she "misheard" the question).

According to a Morning Consult/Politico survey conducted after the first Democratic presidential primary debates, support among voters for Medicare for All falls to 46 percent from 53 percent when respondents are told the government-run health system would diminish the role of private insurers — but rises back to 55 percent when voters learn that losing their private plans would still allow them to keep their preferred doctors and hospitals.

Update (July 14, 2019):  Shira Tarlo examines the benefits and addresses criticism of Medicare for All.