While you aren't looking, Senate prepares to pass healthcare

Discussion in 'Politics, Religion, Social Issues' started by LizKat, Jun 12, 2017.

  1. LizKat macrumors 68040

    LizKat

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    #1
    Oregon Senator Wyden's tweet sums up the amount of public scrutiny the Senate's version of Health Care reform can expect to receive if Mitch McConnell has his way with it.

    WydenTweetJune10HealthcareDebateComparisons20092017.jpg

    Meanwhile we haven't a clue what's in it, which is how the Senate wants to keep it, having learned from the House experience that the longer the pending legislation is out there in front of the public, making it clear where the tax cut money is going to come from, the more pushback will ensue from the public and health advocacy organizations including hospitals, medical associations, insurers and the governors of states left holding the bag while the 1% get tax "relief".

    The House is supposedly amending its own bill behind closed doors, since it was loathed by the public, and the Senate expects not to "start over" after all but largely to adapt whatever emerges from that House process.

    Needless to say, the secrecy approach and timetables are not sitting well with health care organizations; here is what an association of South Dakota caregivers thinks:

    https://sdaho.org/2017/06/07/senate-continues-work-on-ahca/

    The U.S. Senate returned from recess to tackle the issue of passing the American Health Care Act (AHCA), and it now appears that majority leader Mitch McConnell, R-Ky., intends to complete work and have the Senate vote on the bill by the end of June to avoid weighing down the rest of Republicans’ agenda. McConnell is leading a 13-member working group that is getting close to a framework considering provisions that would reduce premiums and provide more generous tax subsidies than those in the House version. The Senate is expected to have a draft of the bill this week.


    The American Hospital Association (AHA) and SDAHO are urging members to reach out to their senators and ask them to ensure that the Senate version of the AHCA protects the most vulnerable – children, the poor, the disabled and those with pre-existing conditions.

    McConnell is likely to push for some “modest” changes to the House bill that would involve maintaining the required $133 billion in savings and $666 billion in tax cuts. These cuts would have a larger negative impact on non-expansion states, including South Dakota. There is wrangling over which inflationary index would be utilized, along with discussions on a new cap for Medicaid payments. Conservatives prefer the urban consumer price index that would reduce Medicaid spending even further. While moderates would like to see an inflationary index more closely tied to the rate of medical inflation.

    Here's background on where things stood as the Hill departed for the recess that's now ended with both sides working on the legislation again, and a Congressional Budget Office report on the newest version still needed:

    Here's an opinion of what's going on offered by the former acting administrator of the Centers for Medicare and Medicaid Services

     
  2. samcraig macrumors P6

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  3. citizenzen macrumors 65816

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    #3
    From what I'd read, the Senate wasn't close to coming up with their version of the bill.

    Have they actually come up with a bill?
     
  4. daflake macrumors 6502a

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    #4
    He acts like the 2009 numbers was a success story! Ugh, we are doomed....
     
  5. chagla macrumors 6502a

    chagla

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  6. daflake macrumors 6502a

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    #6
  7. LizKat thread starter macrumors 68040

    LizKat

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    No I don't think so. But their plan before the recess seems to remain their plan now. Whatever the House does to try to amend for the latest CBO report, the Senate apparently still figures "80%" of it will be good to go on their side. We still know nothing, really.

    http://www.rollcall.com/news/politics/cbo-estimate-revised-house-health-care-bill-changes-little

    The practical matter is that 80 percent of what the House did we’re likely to do, but you know the first thing we have to do is hit 50 senators and the VP and then we can work out those differences,” Senate Majority Whip John Cornyn of Texas said Wednesday. Republicans have opted to try to move their bill under special budget rules and intend to pass it in the Senate with only GOP votes. At least a simple majority will be required.

    Before the release of the new CBO score, Cornyn said GOP efforts to revise the 2010 health law should try to bring down costs for consumers.

    “The most important part about this to me is to make it more affordable and that’s where we need to focus our goal,” he told reporters. “That’s where we can help people who want to buy health insurance.”

    Cornyn said he expected his Senate colleagues to begin to piece together legislative proposals soon. “We’re going have to start putting things on paper because we need to get it voted on,” he told reporters.

    Separately, Senate Majority Leader Mitch McConnell, R-Ky., spoke to Reuters ahead of the release of the CBO score about the challenges in moving a health bill through his chamber.

    “I don’t know how we get to 50 (votes) at the moment. But that’s the goal,” McConnell said.

    McConnell has made this legislation a top priority for his conference, with the topic dominating its gatherings.

    Sen. Roger Wicker, R-Miss., on Tuesday referred to the latest meeting as “part of our continuing three-day-per-week, hour-and-a-half focus group” of 52 GOP senators working on the health bill.

    GOP leaders have delayed sending the health bill to the Senate until the new estimate was released, which last week sparked concern about what the estimate could say. Republicans need to keep the bill within the dictates of the budget reconciliation process to move the bill with a simple majority in the Senate.​
     
  8. A.Goldberg macrumors 68000

    A.Goldberg

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    #8
    I didn't like the way Obamacare was passed... even with 80 days of talks (with no one really understanding what the package was, closed door meetings, backroom deals). I don't like the sound of how this deal is being worked out either (quickly, with no one knowing that the package is).

    Healthcare doesn't seem like a topic that could be ironed in 20 hours, or even 80 days.
     
  9. LizKat thread starter macrumors 68040

    LizKat

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  10. Huntn macrumors G5

    Huntn

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    #10
  11. LizKat thread starter macrumors 68040

    LizKat

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    Right. And the problem is the main reason the GOP wants to pass health care in 2017 is they can't get to a passable tax "reform" bill until they lock down some numbers they can say will pay for it, which is via healthcare "repeal and replacement". Their focus is on the calendar and on getting the tax bill this term, and they know they have to have a budget with $2 billion in savings turned up somehow from each House, and they will still likely have to raise the debt ceiling, especially because companies have been sitting on taxable transactions hoping for retroactive tax cuts.

    They must not be sleeping well at night.... it all interlocks and hangs on something the public's anntennae have already been raised on by having seen that House bill. Apparently the 20 hours for Senate debate is McConnell's way of signaling to the GOP that he means for them to get the thing in the rear view mirror 51-50 with the VP voting, so just get over it, get along, go along.

    There's not such a distinct break on conservative vs more conservative GOP wings in the Senate as in the House, which break contributed to the hassle and the tight vote on the House bill, but there will be resistance to this plan, whatever the bill ends up being, because of constituent resistance expressed to the Senators.

    Whatever the House does if it tweaks its own bill to adapt to the newer CBO estimate, the Senate does now mean to adapt and then mess with items in the budget reconciliation to make it work out. In the House and Senate they have different committees charged with working out the budget cuts. Here's from that Roll Call piece I had cited earlier:

    The fiscal 2017 budget resolution calls for proposals for at least $2 billion in savings from each chamber, with that target split in the House between the Ways and Means and the Energy and Commerce committees. In the Senate, this work falls to the Finance and the Health, Education, Labor and Pensions committees.

    Thune, who serves on Finance, said Republicans in his chamber may look to keep in place the House’s approach to the Medicaid program. The House bill intends to end the current open-ended federal commitment, and move to a system based on per-capita caps or block grants. It also calls for allowing states more flexibility in managing these programs. The House bill would halt higher federal payments for the Medicaid expansion created by the 2010 health law by 2020.

    The House bill’s changes to Medicaid lost the support of moderate Republicans in that chamber, and may prove a tough issue in the Senate.

    “We’ll probably have a slightly different glide path for expansion states for a phaseout, “ Thune said.

    Bottom line because they so want to "repeal Obamacare" and don't care what the replacement looks like and they so want that tax cut, they are probably going to be able to come up with something and pass it 51-50 and then juggle numbers in reconciliation to make it happen within budget process constraints.

    And if they do that it will be a horror show, and Trump and the GOP will own it.

    Pride in majority rule and greed goeth before a fall.
     
  12. ibookg409 Suspended

    ibookg409

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    #12
    LOL. Sounds like history repeating itself.
     
  13. LizKat thread starter macrumors 68040

    LizKat

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    #13
    You mean "we have to pass it to find out what's in it?"
     
  14. ibookg409 Suspended

    ibookg409

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    Yes.
    --- Post Merged, Jun 12, 2017 ---
    It's also about sneaking a lot of extra crap into the bill.
     
  15. oneMadRssn macrumors 68040

    oneMadRssn

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    #15
    The issue the GOP is running up against is the fact that the ACA is best possible system if the goals are (1) keeping the insurance system private with no public option, and (2) maximizing amount of people with coverage.

    If the GOP wants to further bolster any of these two interests or add a third interest, it must be at the expense of one of the two interest.

    In other words, anything the GOP is likely to do will inherently cause people to lose their coverage. Period.

    The only thing that will increase coverage at this point is a public option or an entirely single-payer system, but that is highly highly unlikely under this congress.

    Also, why are we still calling this a healthcare plan? It's a tax-cut for the rich, paid for by taking away healthcare from the sick and elderly. #wealthcare
     
  16. samcraig macrumors P6

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    #16
    yes. at the detriment of the citizens of this country. Except I would say this is slightly worse given the rush job involved and the missteps already taken
     
  17. LizKat thread starter macrumors 68040

    LizKat

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    Yeah and we'll still be reading the thing while the Senators are "debating" it. Let's see. 20 hours, 100 Senators, that's 12 minutes each more or less... HOT AIR BALLOONS AHOY.

    Depending on whether any blue dogs cross the line, there may not be much the Democrats have to say, just let the Republicans own it. Means the Dems get to honk on the general atrociousness of it for 10 minutes each after picking some particular thing they don't like for their own state's interests. And many, maybe most states really hate this thing so the governors have been redlining the DC phone banks for weeks already.
     
  18. A.Goldberg macrumors 68000

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    #18
    I'm very fearful of what the replacement is... but I am somewhat hopeful that it won't be anything too drastic (perhaps a reshuffling of the existing system) because negatively effecting healthcare for millions is political suicide... and they know that.

    My bigger fear is the long term. Obama institutes the ACA, it takes years to go into effect. Trump comes in and will do his own thing. Next president/political majority I'm guessing will be a democrat, and Trumps changes will be traversed. The republican afterwards will probably reverse the reversal. It just all sounds highly unstable.

    The President doesn't care about coverage. I think much of America doesn't care so long as they're insured. The focus is the cost- which is a legitimate problem too. I don't see how insuring more people will necessarily make healthcare cheaper- I think that has been demonstrated. As I've said 100000000 times until someone (consumers, the government, insurers, etc) get a handle on the cost of goods and services in healthcare, healthcare will continue to climb in price.

    If the real cost of healthcare is cheaper, not only are people happier and healthier (because they can actually afford treatment), it's also cheaper to treat the otherwise uninsured and therefore more people can be covered.

    I don't believe healthcare is a god-given right. You can't force someone to give you medical care, that would infringe on healthcare workers rights. I do however believe as a first world country it is our responsibility to ensure everyone has the ability to recieve healthcare including preventative care. It is in our best interest to keep our society healthy. Same deal with public education- not a right, but an accepted and expected responsibility of society.
     
  19. oneMadRssn macrumors 68040

    oneMadRssn

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    #19
    I think the first part of the bolded part above is not true, and is contradicted by the second part. If people care that they are insured then they inherently care about coverage. It may not be direct, but they care.

    Also, I do not believe people are so selfish as to only care about themselves. People will care if people see that their neighbors, their cousins, their church-members, or their friends lose coverage because of the GOPs legislation.

    For example, everyone knows someone affected by cancer directly or indirectly. America will care if they hear stories about their friends or friends of friends who are priced out of health insurance because of the pre-existing condition situation in the current bill.

    Even if only 10 million people lose coverage or are priced-out of coverage, that is a huge number (taking a very conservative number here by the way, lower than CBO estimates by far). That is one out of every 30 people in the US, more or less. I know at least 30 people, and I certainly would be upset if I heard that the sickest or oldest among those I know lose their coverage. Imagine a church congregation comprised of a few hundred people, and 10 of the sickest and poorest lose their coverage. It's not going to be good look for the GOP.
     
  20. LizKat thread starter macrumors 68040

    LizKat

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    I agree with that entirely, although more w/ @oneMadRssn about the "caring about coverage" issue. I think the Senate knows constituents care and if it doesn't, it's hearing about it right now from governors who are in the line of fire on Medicaid cutbacks.

    But I think you're quite right about the long term effects being unstable since each successive power shift tweaks the recipe for current advantage and leaves just estimates for the longer run. What is an estimate for ten years out worth in a world that plans in quarters and decides in minutes now and then. A collapse could ensue at some point and the fingerpointing could overwhelm the need to "fix it, now". We are already at the "fix it, now" point and can't do it.

    What they must but cannot bring themselves to do is work across aisle directly instead of "my turn now, you so and so" across congressional terms and shifts in control of the White House. It's all so exasperating. And the general population, we are not going out in the weeds on the arcane nature of "how it works" so we're at the mercy of the interests with enough money to buy ads to "explain" their view in terms they hope willl appeal to us.

    The ones whose Twitter accounts I'd be likely to follow for awhile now are governors in both red and blue states and mayors of a few representative cities across the country. The Senators will be selling but I want to hear what the prospective forced buyers have to say. I want the mainstream media to home in on that too.
     
  21. A.Goldberg macrumors 68000

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    #21
    I said "much of America", meaning a large percentage, not necessarily the majority. If everyone cared about others being insured I'm not sure why it was so hard to get the ACA passed and why many republicans are looking to repeal it. As I recall many considered the ACA another means of "redistribution of wealth". I suppose the reality is for those that oppose, they hope for everyone to have healthcare, but not want to pay for it... but that's really just splitting hairs.

    For whatever reason people often don't vote to their own benefit. Afterall many republican voters vote against their self interest (ex. Entititlement programs that they receive) while many liberals do the same (ex. Increasing taxes on the wealthy). People care about healthcare when it affects them or someone close, but at the sametime people easily can make justifications.

    There are fortunately a lot of compassionate people in the world, but sadly there are a lot of selfish people too. I'm confident compassion over selfishness in terms of healthcare. Despite this Trump hiccup, I wouldn't be surprised to see nationalized healthcare in the US in my lifetime.

    It really just pains me to see the government try to rationalize healthcare cost by adjusting the number of subscribers up or down. Like I said, I believe we have the responsibility to ensure our peers all have healthcare one way or another. Virtually no attention is paid to reducing the actual cost of healthcare and I see that as a major problem.

    Drug companies spend as much money on marketing as they do on R&D. They arbitrarily raise prices on a whim. Insurance companies and PBM's pocket massive sums of money every year. Mega-hospital networks control so much market share that they can charge whatever they want and insurers essentially. Meanwhile smaller hospital networks are being driven into the ground. Why aren't these issues being addressed?

    What is the biggest justification for not insuring everyone?
     
  22. PracticalMac macrumors 68030

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    #22
    Meanwhile Trump has spent even less time, as in 0 hours, thinking about it.
     
  23. LizKat thread starter macrumors 68040

    LizKat

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    #23
    Well opposition to it is pitched as "smells like socialism".

    Socialism? Oh. Hell no.

    Period. End of willingness to explore.
     
  24. oneMadRssn macrumors 68040

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    #24
    I agree for the most part. You seem to be more concerned with the cost of healthcare, whereas I am concerned with healthcare coverage.

    I would love to have a debate about healthcare costs, but nothing about it is in the House bill, and probably won't be in the Senate bill either. So it's sort of a moot point. Cutting payroll tax and a tax on investments won't lower healthcare costs either.

    Indeed, most GOP policies seem to push the opposite agenda. They want to prevent the government from taking regulatory action designed to bring costs down. While Medicare is not ideal at all, they do have some ability to negotiate favorable prices. However, any suggestion that the same negotiation scheme be applied to other forms of coverage has been shut down by the GOP. For what reason?

    Not to sound trite, but I think the reason it was hard to get ACA passed and why the GOP is looking to repeal it is because it was branded Obamacare, with all the attendant misleading arguments about death panels and wealth redistribution. More recent polls actually show that the term "ACA" polls quite well, and especially well when people know what ideas ACA encompasses. In essence, when you take the partisanship out of it, the ACA is quite popular. GOP is learning this too, which is why they are having such a hard time repealing it.
     
  25. Lord Blackadder macrumors G5

    Lord Blackadder

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    #25
    No matter what the GOP does to massage the bill, it will cause millions of people to lose healthcare coverage - at any rate, every version they've proposed so far has that outcome. That is the one hurdle they cannot dodge, unless they can keep it out of the public eye until they pass it. Even then, it becomes a large stick Democrats will use to beat their opponents with in the midterm elections. The few remaining moderate Republicans will not want to find themselves in that position.
     

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