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Senate GOP tries one last time to repeal Obamacare

The new GOP health-care measure goes further than the failed one

The measure would actually cut federal health-care spending even more than BCRA, and aim the cuts more directly at states that expanded Medicaid under the Affordable Care Act. It was the governors and senators from those states who were most deeply worried about Medicaid cuts to begin with. It would work roughly like this: Starting in 2021, the federal government would lump together all the money it spends on subsidies distributed through the ACA marketplaces and expanded Medicaid programs covering poor, childless adults living at up to 133 percent of the federal poverty level.This approach would generally result in less money for states that expanded Medicaid under the ACA and more money for states that didn’t. That’s because Graham-Cassidy would redistribute the money allotted to the 30 states that opted to expand Medicaid under the ACA and spread it out among all 50 states. Cassidy’s own state, Louisiana is among the states that stand to lose the most funding under this approach. Others include California, Connecticut, Delaware, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, New Jersey, New York, North Dakota, Oregon, Rhode Island, Vermont and Washington, whose Medicaid expansion dollars would be cut anywhere from 35 to 60 percent. By 2026, the federal government would be spending 17 percent less on subsidies and Medicaid expansion overall than under current projections, according to an analysis by the Center for Budget and Policy Priorities.

Then, in 2027, states would face a big fiscal cliff, when the Cassidy bill would halt all that spending. That’s a major step further than BCRA, which would have retained the marketplace subsidies (despite reducing them somewhat) and allowed states to keep Medicaid expansion (albeit paying for these enrollees at the normal matching rate and not the ACA’s expanded matching rate). But there’s another way the Cassidy bill goes further than previous Obamacare rollback measures: It would allow states to opt out of the law’s “essential health benefits,” the baseline services insurers must cover. That means there will no longer be a rock-solid prohibition on charging higher premiums to people with preexisting medical conditions, although states would need federal waivers. The bottom line is this: The Cassidy bill will appeal to most conservatives in the House and the Senate, who can make the case to their base that they’re unshackling states from federal mandates and giving them huge leeway to construct a health-care approach that works best for them. But if the moderate Republicans go along with this latest approach, they’d have to ignore the type of hefty Medicaid cuts they had previously opposed.
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Many states would see permanent major funding cuts. The poor/elderly/disabled are going to get chopped off at the knees. The Cassidy-Graham bill also does away with the ACA "Essential Health Benefits" mandate...

--Ambulatory patient services (outpatient care you get without being admitted to a hospital)
--Emergency services
--Hospitalization (like surgery and overnight stays)
--Pregnancy, maternity, and newborn care (both before and after birth)
--Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
--Prescription drugs
--Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
--Laboratory services
--Preventive and wellness services and chronic disease management
--Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

I have no idea how/why Cassidy-Graham consider this monstrosity superior/more palatable to previous GOP repeal and replace measures. It's actually worse.
 
JasperL said:
Of course - that's what the poll tells us!



I assume this is a serious question, so I'll answer it seriously. If you want to use polls to tell you something like that, you'll need a long series of questions with objective responses. Like:

Have you been continuously insured for the past 10 years.
If not, in which years did you NOT have insurance?
What were your premiums each year for the past 10 years.
Was it an employer plan?
How much did the employer pay on your behalf?
How has your coverage changed?
What is the total amount OOP you paid in each of the past 10 years excluding insurance premiums?
Did you have any extraordinary health events - bad accident or illness that required an extended period of time off work?
Etc.

It would be VERY difficult to determine objectively, even if you got correct answers to all the above, and that would be nearly impossible in a poll setting.



That might work well - just haven't looked at the question in detail. The problem is, though, that most independents are just as 'partisan' as those who declare a party, so you have to somehow cull those folks out to get to 'true' independents.
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So the bottom line if Obamacare has hurt of helped someone is making an educated guess. Those for will always say it has and those against will always say it hasn't. Thus we can't trust the people to give us an answer even to an indepth poll, especially if the answer is something you don't want to hear.

We're back to not trusting the people again. Back to the elites always know what best for the people because the people or the masses are too dumb to figure that out themselves. The I from upon high know what's best for you, so accept it. The problem with that is the elites are always serving themselves first.
 
Fenton said:
Weird, a law that led to staggering Democrat losses over the last 7 years sudddenly for no apparent reason is a success and popular.

Whats changed ? Premiums and deductibles are still rising, and more and more Counties are down to only one provider leaving people with only one choice for a provider.

Does this mean Democrats can stop pretending it doesnt exist like they did in the last 3 election cycles in their run up for re-election and brag about its greatness ?
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The polls say what they say. *shrug*
 
Rogue Valley said:
The new GOP health-care measure goes further than the failed one



Many states would see permanent major funding cuts. The poor/elderly/disabled are going to get chopped off at the knees. The Cassidy-Graham bill also does away with the ACA "Essential Health Benefits" mandate...

--Ambulatory patient services (outpatient care you get without being admitted to a hospital)
--Emergency services
--Hospitalization (like surgery and overnight stays)
--Pregnancy, maternity, and newborn care (both before and after birth)
--Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)
--Prescription drugs
--Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
--Laboratory services
--Preventive and wellness services and chronic disease management
--Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

I have no idea how/why Cassidy-Graham consider this monstrosity superior/more palatable to previous GOP repeal and replace measures. It's actually worse.
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The monstosity is the ACA and ObamaCare's one size fits all policies obviously needed to go. The Federal Govt under the pretense of fairness and affordability decided what Americans Insurance companies could sell but more importantly what American consumers should purchase by mandating that all policies include these services.

The Obama administrations intervention in our health insurance industry led to premium and deductible spikes, less choice for consumers and exchanges that are bleeding money and insurers leaving many Counties with only one choice for consumers.
 
Superfly said:
Um - wow. He instituted a ban against Muslims. He wants to build a wall to keep out brown people. He didn't want an American-born judge to preside over his case because he was of Mexican descent (that means he was born to Mexican parents - both brown!). He was sued by the DoJ twice for not renting to black people. His companies have been sued over African American discrimination. He said black people were lazy, and didn't want them counting his money. He refused to step away from the White Supremacist groups who supported him, and even hired people who knowingly were racist (see Steve Bannon, Jeff Sessions). He accused Mexicans of being rapists and drug dealers. He has insulted owners of Native American casinos and even implied that they'd been infiltrated by the Mafia.

There are other instances of his blatant racism against people of color, but I'm sure you knew that. It's just easier to hide your head under a rock and pretend like it doesn't exist. Makes it a lot easier to swallow, I guess.
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It was a temporary travel ban on all people from certain countries.
He want to build a wall to keep out ILLEGALS
He did not refuse to step away fron White Supremacist groups. That's your take on it.
He said SOME Illegal Mexicans were rapists and drug dealers.....which is true, is it not?

He may very well be racist. But YOU said everyone who voted for him dislikes brown people. Did you not?
 
Perotista said:
So the bottom line if Obamacare has hurt of helped someone is making an educated guess. Those for will always say it has and those against will always say it hasn't. Thus we can't trust the people to give us an answer even to an indepth poll, especially if the answer is something you don't want to hear.
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I've been involved in quite a few polls having to do with healthcare as it happens. People just don't know the answer. There is one question every year where about 5-10% or so give an answer that is IMPOSSIBLE. And I do taxes and several times for fun I've asked people if they know what their total tax bill is - not the dollar amount, but if they know. 9 times out of 10, if they know anything they know their REFUND or what they paid with the return, but nearly NO one knows how much they actually paid in total in taxes in a given year. When I do taxes I print off a summary sheet that has their marginal rate and effective rate just because I think everyone should know that. Without that report, I doubt if 1/20 could give an accurate answer to both questions.

And before ACA, employers didn't have to report the share paid by employer, so lots of folks CANNOT know. And if they don't KNOW that, they have no idea in hell whether or not the ACA helped or hurt them. If their premiums went up by $3,000 last year, if you don't know how much was employer shifting costs to employees versus premium increases, you're clueless to start. And if the total premium went up by 5%, how much of that was because of ACA? Can you tell me? How do YOU know?

Next time you're at a party or something ask 10 people how much their employer based insurance costs, what their annual contribution is and how much their employer kicks in each month per person. I'd make a friendly $1 wager not ONE knows the answer to those questions off the top of their head and only a minority would know where to look that up at home.

We're back to not trusting the people again. Back to the elites always know what best for the people because the people or the masses are too dumb to figure that out themselves. The I from upon high know what's best for you, so accept it. The problem with that is the elites are always serving themselves first.
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Just being realistic.
 
holbritter said:
It was a temporary travel ban on all people from certain countries.
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Um - right. Countries that we have no issue with. He didn't institute travel bans on Saudi Arabia, did he? Even though 15 of the 19 hijackers from 9/11 were from Saudi. Ever stop to think about that? And if you think that the travel ban is temporary, I have a bridge to sell you.

He want to build a wall to keep out ILLEGALS
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What exactly is an "illegal," holbritter? No such thing as an "illegal" person. Legality is based on an act, not the person committing the act. If someone came across the border illegally, then the act itself is illegal - not the person. Even then, a person cannot be determined to be here legally or illegally unless an immigration judge says so, and I don't see you wearing a robe.

He did not refuse to step away fron White Supremacist groups. That's your take on it.
He said SOME Illegal Mexicans were rapists and drug dealers.....which is true, is it not?
He may very well be racist. But YOU said everyone who voted for him dislikes brown people. Did you not?
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You know - I had individually quoted each of your comments, with plans to respond, but then I got to the "he did not refuse to step away from white supremacist groups. That's your take on it," and I am pretty much finished here. I try not to waste my time talking to people who simply refuse to listen to verifiable fact. Time is too precious to talk to walls.
 
JasperL said:
I've been involved in quite a few polls having to do with healthcare as it happens. People just don't know the answer. There is one question every year where about 5-10% or so give an answer that is IMPOSSIBLE. And I do taxes and several times for fun I've asked people if they know what their total tax bill is - not the dollar amount, but if they know. 9 times out of 10, if they know anything they know their REFUND or what they paid with the return, but nearly NO one knows how much they actually paid in total in taxes in a given year. When I do taxes I print off a summary sheet that has their marginal rate and effective rate just because I think everyone should know that. Without that report, I doubt if 1/20 could give an accurate answer to both questions.

And before ACA, employers didn't have to report the share paid by employer, so lots of folks CANNOT know. And if they don't KNOW that, they have no idea in hell whether or not the ACA helped or hurt them. If their premiums went up by $3,000 last year, if you don't know how much was employer shifting costs to employees versus premium increases, you're clueless to start. And if the total premium went up by 5%, how much of that was because of ACA? Can you tell me? How do YOU know?

Next time you're at a party or something ask 10 people how much their employer based insurance costs, what their annual contribution is and how much their employer kicks in each month per person. I'd make a friendly $1 wager not ONE knows the answer to those questions off the top of their head and only a minority would know where to look that up at home.



Just being realistic.
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Hmm, so in reality there is no way to tell whether the ACA has helped or hurt anyone. All we can do is take an elected official's word for it. Or some pollster, but isn't politics all about perception. Not truth or facts. The ACA seems to be in that same category. A person good with numbers, figures can make or display those numbers and figures to attest to what he wants to present. My figures state the ACA help 30 million people, but another number cruncher can show where the ACA hurt 40 million or vice versa.

So since in reality, there is no way to know one way or the other, one can just go on believing which ever or what ever figures one wants to. Fantastic.
 
Perotista said:
The part that gets ignored when it come to the ACA/Obamacare is that the law is hurting about twice as many people as it helps. At least according to Gallup. 29% hurt, 18% helped.

More Americans Negative Than Positive About ACA
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oh look, Pero is reposting the narrative that "Obamacare hurts more than it helps". Again, please explain how you think Obamacare "hurt" anyone. Its your narrative and you do post it over and over and this is a debate forum. Now stop being as "stubborn as a Missouri mule" (or is it as "cowardly as a conservative?) and explain how you think Obamacare "hurt" anyone.

Vern said:
Pero, intentionally or not, you are deflecting from my post. I didn't ask you to repeat the numbers and I certainly didn't ask you to accuse me of ignoring the numbers. I simply asked you to explain how you think Obamacare hurt 29% of all Americans? The reason you cling to the poll, "misparaphrase" my post and explain nothing is because you want to cling to your narratives. That requires you to ignore the facts. So as much as you want to believe you're an independent, you do the exact same things as conservatives.
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Perotista said:
Hmm, so in reality there is no way to tell whether the ACA has helped or hurt anyone. All we can do is take an elected official's word for it. Or some pollster, but isn't politics all about perception. Not truth or facts.
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I didn't say there is no way to tell, just that most people don't have the data available to answer the question or even know where to find it.

There will be some subjective things - I think it's great that a cancer survivor can quit his or her corporate job, start a business, and get health insurance. Tough to put a value on that, but most of the time the analysis is simple enough I'd think. It's just got to be done with hard numbers...

The ACA seems to be in that same category. A person good with numbers, figures can make or display those numbers and figures to attest to what he wants to present. My figures state the ACA help 30 million people, but another number cruncher can show where the ACA hurt 40 million or vice versa.
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I don't really agree that this is an impossible problem to solve - did it help or hurt. Disagreements will be on the margins I'd think if two people are honest about answering the question.

So since in reality, there is no way to know one way or the other, one can just go on believing which ever or what ever figures one wants to. Fantastic.
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There is a way to know - do the analysis. Not sure what point you're trying to make here, so I'm kind of lost.
 
JasperL said:
I didn't say there is no way to tell, just that most people don't have the data available to answer the question or even know where to find it.

There will be some subjective things - I think it's great that a cancer survivor can quit his or her corporate job, start a business, and get health insurance. Tough to put a value on that, but most of the time the analysis is simple enough I'd think. It's just got to be done with hard numbers...



I don't really agree that this is an impossible problem to solve - did it help or hurt. Disagreements will be on the margins I'd think if two people are honest about answering the question.



There is a way to know - do the analysis. Not sure what point you're trying to make here, so I'm kind of lost.
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There's two easy ways to measure positive impact: removing bans on coverage for persons with pre-existing conditions, essential health benefits. Often the two work together to benefit roughly 1/4th or more of the the U.S. population at any given moment. Right now, I can also anecdotally tell you that feeding released convicts into Medicaid Expansion is probably a really, really good idea if you want to reduce substance abuse relapses or criminality in general. The two tend to be linked quite well, aren't they? My state government hasn't done a good job compiling data and releasing it (it's become a tired problem in legislative sessions over the past decade or longer), but they're learning awfully damn quick with the exploding Corrections budget and climbing substance abuse-related crimes, arrests, and deaths. It's gotten to the point where we (were, before the Trump administration gutted these programs in the last month) had folks constantly visiting the jails getting people healthcare coverage so they could get, I don't know, addiction treatment instead of winding back in prison.
 
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Fiddytree said:
Meanwhile the BCRA prohibits individuals from getting insurance by penalizing those who lost insurance by making them wait 6 months before applying again....

But let's go on and insist that the ACA's problem was trouncing on our liberties.

Sent from my LG-H910 using Tapatalk
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Two wrongs do not make a right.
 
Fenton said:
Major Health Insurer Bailing On Most Obamacare Exchanges

http://www.huffingtonpost.com/entry/unitedhealth-group-obamacare-exchanges_us_571554d9e4b0018f9cbade3b
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You missed my point entirely. The current problem with healthcare in the US has everything to do with the insurance companies. No matter what Obama came up with it was going to fail. No matter what the Republicans come up with its going to fail. The reason is that the insurance companies do not have Americas best interest in mind, they understandably have money on their minds, its would they do, they do not give a rats ass if people die unless it costs them money.
 
Superfly said:
Exactly. It was extremely pricey, and forced people to get insurance. I have had a problem with that since the beginning. While I think it's wonderful that 12 million more people have insurance, and I support Obama 100% in this (as I would have any president who could have provided insurance for millions), I think that there had to be a better way to get them there.
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I agree there were better ideas, but politics you know..
 
Superfly said:
Um - right. Countries that we have no issue with. He didn't institute travel bans on Saudi Arabia, did he? Even though 15 of the 19 hijackers from 9/11 were from Saudi. Ever stop to think about that? And if you think that the travel ban is temporary, I have a bridge to sell you.



What exactly is an "illegal," holbritter? No such thing as an "illegal" person. Legality is based on an act, not the person committing the act. If someone came across the border illegally, then the act itself is illegal - not the person. Even then, a person cannot be determined to be here legally or illegally unless an immigration judge says so, and I don't see you wearing a robe.



You know - I had individually quoted each of your comments, with plans to respond, but then I got to the "he did not refuse to step away from white supremacist groups. That's your take on it," and I am pretty much finished here. I try not to waste my time talking to people who simply refuse to listen to verifiable fact. Time is too precious to talk to walls.
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I agree. Thank you
 
Well.....I'm not going to hold my breath on this. Or any other issue that needs attention in DC....watching politicians try to agree and get work done is like watching monkeys humping a football; vastly amusing at first , but in the end, very disappointing and nothing gets accomplished.
 
MTAtech said:
The mandate isn't a bug, it's a feature -- a necessary feature. You can't cover people with preexisting conditions if the pool of insured are only sick people.
FreedomFromAll said:
Which is a flaw and it dooms the law to failure. The problem is the insurance companies. ACA seems to have been written to make insurance companies even richer. See, the insurance companies are nothing but, middlemen taking their cut. That cut is why medical costs are so high. The heartless bastards are the ones refusing service for many people who need it. Our focus should be on the insurance companies. But that isnt happening because of hyper partisan finger pointing and ideological warfare.
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This is why the mandate is needed and you can't cover preexisting conditions and not have a mandate.

Suppose you want to make health coverage available to everyone, including people with preexisting conditions. Then you start by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of preexisting conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.

So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.

But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid. The key point is that all three legs of this stool are necessary. Take away any one of them, and the program can’t work.

The GOP plans all cut at least one leg off the stool, resulting in an unsustainable alternative that raises premiums and cuts millions of people out of the insurance market.
 
holbritter said:
If they are that poor that they can't visit a regular doctor, then they are on Medicaid. You can go to the regular doctor on Medicaid.
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Just to clarify, some people who are that poor are on Medicaid. In Tennessee, adults with no children, or grown children, do NOT qualify for Medicaid unless they are disabled, or women with breast or cervical cancer. The little charity I help out takes in poor and homeless, most of them addicts of one kind or another. The VA helps the veterans - the non-veterans have no insurance and no Medicaid, no anything, except for the rare married person with children under 18.

Even for those who MIGHT qualify for Medicaid - non-disabled adults with minor children - there is a big difference between "not poor enough for Medicaid" versus not functionally poor. Millions are poor but make too much for Medicaid, and cannot afford insurance or have enough savings to cover any healthcare bill beyond the completely ordinary - like a visit to the physician. Drugs? LOL in a lot of cases. Surgery? No way in hell for most surgeries with charges that start at 5 figures. Cancer treatment, chronic heart or liver disease? Hepatitis? Also impossible.

That's why the ACA Medicaid expansion (partially killed by the Roberts court) was and is so key to solving the problem of lack of insurance. In expansion states, it's much more 'true' that the poor qualify for Medicaid. In non-expansion states, that's mostly or at least often false.
 
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holbritter said:
If they are that poor that they can't visit a regular doctor, then they are on Medicaid. You can go to the regular doctor on Medicaid.
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Unless they are in a state with expanded Medicaid then just being poor is not enough to qualify for Medicaid. In Texas you must not only be poor, pass (fail?) the income and asset test, but also have dependent minor children, be disabled or be at least age 65 to get Medicaid.
 
Cardinal said:
So this ****ing thing is back.

So we all have a reason to hate the month of September now.
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Why would anyone expect this to be a last time?

Even if it succeeds it seems to be a money shuffling con game at this point.

They are not planning on repealing anything regardless of what they call it. The tax money is kept and moved it around to the states.

At this point we need to repeal and replace congress as a whole. They are too infected with lobbyists and special interests and not doing their jobs in looking out for the US people.

Just give the people back their own money. It was constitutionally wrong to take it in the first place.
 
JasperL said:
Just to clarify, some people who are that poor are on Medicaid. In Tennessee, adults with no children, or grown children, do NOT qualify for Medicaid unless they are disabled, or women with breast or cervical cancer. The little charity I help out takes in poor and homeless, most of them addicts of one kind or another. The VA helps the veterans - the non-veterans have no insurance and no Medicaid, no anything, except for the rare married person with children under 18.

Even for those who MIGHT qualify for Medicaid - non-disabled adults with minor children - there is a big difference between "not poor enough for Medicaid" versus not functionally poor. Millions are poor but make too much for Medicaid, and cannot afford insurance or have enough savings to cover any healthcare bill beyond the completely ordinary - like a visit to the physician. Drugs? LOL in a lot of cases. Surgery? No way in hell for most surgeries with charges that start at 5 figures. Cancer treatment, chronic heart or liver disease? Hepatitis? Also impossible.

That's why the ACA Medicaid expansion (partially killed by the Roberts court) was and is so key to solving the problem of lack of insurance. In expansion states, it's much more 'true' that the poor qualify for Medicaid. In non-expansion states, that's mostly or at least often false.
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Expanded Medicaid has some features not present in standard Medicaid - no asset test, a higher (low?) income threshold (133% of FPL instead of 100% of the FPL) and a different (more generous) fund matching level for the state.
 
The CBO will not provide a full analysis of the newest version of Trumpcare.

CBO aims to provide preliminary assessment of Graham-Cassidy bill by early next week

Posted by Deborah Kilroe and Leigh Angres on
September 18, 2017
CBO is aiming to provide a preliminary assessment of the Graham-Cassidy bill by early next week. That assessment, which is being prepared with the staff of the Joint Committee on Taxation, will include whether the legislation would reduce on-budget deficits by at least as much as was estimated for H.R. 1628, the American Health Care Act, as passed by the House on May 4, 2017; whether Titles I and II in the legislation would each save at least $1 billion; and whether the bill would increase on-budget deficits in the long term. CBO will provide as much qualitative information as possible about the effects of the legislation, however CBO will not be able to provide point estimates of the effects on the deficit, health insurance coverage, or premiums for at least several weeks.
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https://www.cbo.gov/publication/53116
 
Fenton said:
Well, at least we have the projections for next years Premium hike
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No we don't. The CBO will not be able to assess the rise in premiums under the new bill.
 
Cardinal said:
No we don't. The CBO will not be able to assess the rise in premiums under the new bill.
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Yes we do, I just posted Colorado's premium hike for 2018.

Its 27 percent under the ACA not Trump Care.
 
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