What A Disastrous Health Care Rollout Ryan Orchestrated!

Yesterday, Houston cancer specialist and brand new TX-07 congressional candidate, Jason Westin, led a deep dive into Republican health care "policy" for us. Even as we were posting it, the extremists inside the Republican House Conference-- the "Freedom Caucus-- was attacking the Ryan-Pence-Price TrumpCare proposal from a very different perspective. Justin Amash, one of the only serious members of that crackpot caucus, was on CNN Wednesday morning not just claiming that Ryan and McCarthy don't have the votes to pass their abomination but that it's not even a "real" Republican piece of legislation. Of course, he may be right about the vote count but he's very wrong about trying to brand it as "not Republican." What he told CNN is that Ryan-Pence-Price have "taken the Obamacare framework and are trying to call it a Republican piece of legislation." Of course, the Obamacare framework is a Republican framework, having come directly from Massachusetts' RomneyCare (which was put together by... the Heritage Foundation, a very right-wing Republican think tank. A Democratic piece of legislation would be Medicare-For-All.

There are about 30 members of the Freedom Caucus, several having retired (like Curt Clawson, Cynthia Lummis and Matt Salmon), several having been beaten by the Republican establishment (like Tim Huelskamp and Scott Garrett, and several having found them too insane so resigning from the group (like Tom McClintock, Keith Rothfus and, before retiring, Reid Ribble. The new chairman is Mark Meadows (NC) and it's home to sociopaths, racists and extremists like Mo Brooks (AL), Trent Franks (AZ), Dave Brat (VA), Jody Hice (GA), Jim Jordan (OH), Scott DesJarlais (the Tennessee doctor famous for drugging and raping his female patients), Ken Buck (CO) and Rod Blum (IA).

Jordan (plus Rand Paul in the Senate) filed their own bill to repeal Obamacare, which just makes the Affordable Care Act disappear outright and doesn't offer any hope for the millions of Americans dependent on it for health insurance, except whatever hope people have of marrying an heiress, winning a lottery or getting elected to Congress.

Ryan and McCarthy are working furiously to lock up the 218 votes they need to pass their bill. Presumably not even fake Democrats at the bottom on the shitpile-- like Colin Peterson (Blue Dog-MN), Tom O'Halleran (Blue Dog-AZ), Josh Gottheimer (Blue Dog-NJ), Kyrsten Sinema (Blue Dog-AZ), Henry Cuellar (Blue Dog-TX), Stephanie Murphy (Blue Dog-FL), Charlie Crist (FL), Lou Correa (Blue Dog-CA) and Jacky Rosen (NV)-- would dare vote with the Republicans on this. So all 218 votes have to come from the 241 GOP majority. If 30 Freedom Caucus extremists vote NO and none of the Blue Dogs and New Dems vote YES, the bill doesn't move on to the Senate, where it would likely die anyway, since McConnell could only afford to lose 3 votes-- even the most conservative Democrat in the Senate, Joe Manchin, said he won't vote for it-- and there are already between 3 and 8 who have said they won't vote for it or won't vote for it in its current form. So far we have pretty definitive NOs from Lisa Murkowski (AK), Shelley Moore Capito (WV), Ron Portman (OH), Cory Gardner (CO), Susan Collins (ME) and possibly Dean Heller (NV) and Bill Cassidy (LA). Even Rand Paul (KY) has threatened to break with the party if they don't make significant changes more in line with what the extremists at the Freedom Caucus are asking for.



Jordan said his repeal-only plan "is consistent with what we told the voters we’re going to do: Repeal Obamacare and replace it with a market-centered, patient-centered, and doctor-centered plan that actually brings down the cost of insurance," except it doesn't offer anything to anyone except for tax cuts for mammoth millionaires and billionaires. "[T]he first thing that Republicans are bringing forward is a piece of legislation that we are going to put on a Republican president’s desk, that doesn’t repeal it, but keeps Medicaid expansion-- and actually expands it-- that keeps some of the tax increases. That is not what we promised the American people we would do."

After the American Hospital Association and the American Medical Association came out against the proposal, the White House sent Pence and Price over to the House to quell the panic. (Remember, the American Medical Association's PAC-- AMPAC-- is huge and gives cycle after cycle after cycle, primarily to Republicans. Last year it contributed $1,501,000-- $774,500 to Republicans and $515,500 to Democrats, including $10,000 pops to Ryan, Kevin McCarthy, Steve Scalise, Tom Price, Fred Upton, and to Roger Marshall, the Kansas crackpot who was babbling about how Jesus says the poor don't want healthcare. AMPAC also gave $30,000 each to the NRCC and the NRSC (and $10,000 each to the New Dem Coalition and the Blue Dog PAC). AMPAC also runs independent expenditure campaigns for candidates they like. And they give like clockwork... every single cycle. Here was the statement the White House put out when they sent Pence and Price scurrying over to the House:

The Vice President today met with conservative leaders in the House to discuss the failures of Obamacare and the need to repeal and replace that disastrous law. Participants discussed their shared desire for fiscally responsible, market-based reforms that encourage competition and provide individuals and families with the ability to choose the health insurance option that is best for them. The Vice President stressed this is the first step in the process to deliver on the President's promise to the American people and looks forward to House passage of the American Health Care Act.

MO!

As far right extremist Mo Brooks was leaving the meeting he told the media hanging around outside that "Right now the Speaker of the House does not have the votes to pass this bill unless he's got substantial Democratic support." Another fanatic, Rep. Raúl Labrador (R-ID) floated the idea that Trump doesn't really think much of the bill either. "I find it a little bit interesting when I heard leadership say that they have a bill that is the set bill and that the president is fully supportive of the bill. I think he's fully supportive of the process. Trump's OMB Director, Mick Mulvaney-- a far right extremist who was a Freedom Caucus member before Trump drafted him-- was in that meeting and came out of it emphasizing that Trump isn't really fully on board yet anyway. Mo Brooks happily accused the White House of sending "mixed messages." In fact, after the meeting, Freedom Caucus chairman, Mark Meadows, said Mulvaney let them know that the White House is still open to negotiations. "We heard that directly from him. This is not something that is in stone."

Kyle Cheney at Politico senses something similar: Pence and Price are pushing hard but Trump...? No one knows for sure and he's... unpredictable and feckless. He referred to the rollout as a "negotiation," which probably wasn't what Ryan, Pence and Price wanted to hear from him. Señor Trumpanzee has managed, wrote Cheney, "to plunge his party into days of turmoil with stray tweets about Russia. Similar snafus wouldn’t just be distractions now that the repeal drive is underway; they’d be detrimental to the GOP policy agenda and message... And Trump hasn’t always spoken from the same messaging playbook as Republicans on health care, a fact he once wore proudly during his presidential primary fight. 'You cannot let people die on the street, OK?' Trump said during a February 2016 primary forum. 'Now, some people would say, "that's not a very Republican thing to say." … I said, you know, the problem is everybody thinks that you people, as Republicans, hate the concept of taking care of people that are really, really sick and are gonna die ... That's called heart. We gotta take care of people that can't take care of themselves.' Watch how he responds if the CBO says millions would lose coverage." But he's certainly correct that that wasn't a very Republican thing to say. As long as it doesn't impact their reelection efforts, House Republicans could care less if people are left without healthcare-- including "dying on the street," as Trump phrased it.

And now Trump has to grapple with what his home-town paper is saying about the plan, namely that "the biggest losers under the change would be older Americans with low incomes who live in high-cost areas. Those are the people who benefited most from Obamacare."

Obamacare's subsidies were structured to limit how much low- and middle-income Americans could be asked to pay for health insurance. Under the G.O.P. proposal, many of the people whose tax credits would fall sharply would be likely to end up uninsured. For people with few resources, a gap of several thousands of dollars between their tax credit and the cost of coverage would be impossible to make up.

That's why many policy experts believe that the new system would result in fewer Americans having health insurance.

This morning John Harwood made the case that Ryan's proposal hurts Trump voters even more than the country as a whole. (Don't be tempted to think they deserve it. Most are more stupid or steeped in ignorance than evil.) "Instead of broadly rewarding Trump's backers," he wrote, "the House bill hands huge benefits to the tiny share of his voters earning the highest incomes. Their gains come at the expense of the much larger group of older, blue-collar whites who flocked to his "Make America Great Again" banner... Exit polls showed that just 10 percent of Trump's votes came from Americans earning $200,000 or more. Yet those voters would derive all benefits from the repeal of the two individual tax hikes targeting them: a 0.9 percent tax on their earnings, and a 3.8 percent tax on their investment income. An even smaller group, the top 1 percent of earners, would receive an average tax cut of $33,000, according to the Tax Policy Center. The top 0.1 percent of earners would receive an average tax cut of $197,000. But half of Trump's votes came from white voters without college degrees. And those less-affluent voters stand to lose in multiple ways if Congress rolls back Obamacare in favor of the House GOP plan."

An Urban Institute study found that Obamacare reduced the number of noncollege whites without insurance by 6.2 million between 2010 and 2015, a drop of 39 percent. In 20 of the 30 states that Trump won, more noncollege whites gained coverage than any other group.

Under the House GOP bill, those who have gained coverage would face higher costs because the bill's tax credits are generally smaller than premium subsidies through Obamacare exchange marketplaces. An analysis led by Harvard health economist David Cutler estimates those increased costs will total an average of $2,409 in 2020.

Whites aged 45 or older provided 56 percent of Trump's votes. Older Obamacare enrollees would be hit particularly hard by the House bill because it curbs age-based insurance subsidies.

Enrollees aged 55 to 64, the Cutler study found, would face higher costs averaging $6,971 in 2020.

The House bill would also produce major reductions in spending on Medicaid, the expansion of which generated a large proportion of Obamacare's gains in insurance coverage. The liberal Center on Budget and Policy Priorities estimates the reduction in federal spending on the program at $370 billion over 10 years.

Medicaid has long been a target of Republican budget cutters, both because the party favors smaller government and because it provides health care to poor Americans who tend to support Democrats. Nationally, most Medicaid enrollees are nonwhite.

But in some key states that backed Trump, whites comprise a large majority of nonelderly Medicaid beneficiaries: 65 percent in Ohio, 60 percent in Wisconsin, 60 percent in Michigan. Those proportions are as high or higher in smaller Trump states such as West Virginia (89 percent), Montana (83 percent), Kentucky (77 percent) and Arkansas (62 percent).

The House GOP's reductions would affect all Medicaid beneficiaries, not just those added to the rolls under Obamacare. That includes more than 6 million senior citizens with incomes and assets low enough to qualify for the program.

Medicaid finances most nursing home care in the United States. Unlike the program's nonelderly beneficiaries, a 54 percent majority of beneficiaries aged 65 or older are white, according to the Kaiser Family Foundation.

That means the House bill would pinch Trump's blue-collar white supporters in two ways-- crimping their own Medicaid coverage, and that of their elderly parents.

CNN reported this morning that Trump met with Tea Party extremists in the Oval office and told them that if Ryan's bill fails, as looks likely, he'll "allow Obamcare to fail and let Democrats take the blame... During the hour-long meeting, sources said Trump chastised the groups-- including Club for Growth, the Heritage Foundation, Americans for Prosperity, FreedomWorks and the Tea Party Patriots-- for calling the House GOP proposal 'Obamacare lite,' warning the tea party activists, 'you are helping the other side.'" He really is the worst and most venal little man to ever occupy the White House.