Will TrumpCare Signal The End Of The Republican Party In California's Federal Politics?

Whip counts change. The most worthless ones-- aside from Steve Scalise's-- come from the clueless Beltway media clods. I laughed when I saw Lou Barletta (R-PA) start turning up on lists of NO votes. There's no one in the House more easily bought-off by a thug like Trump than Barletta. So I wasn't quite as breathlessly in shock as the little children at The Hill when Barletta took his bribe and switched his vote:

Mark Meadows, head of the Freedom Caucus, said a few days ago his own whip count shows 40 NO votes in the House. That's the highest I've seen and I wouldn't count on that big a fuck you to Ryan, who has been busy showing Republicans he knows how to get even with expensive TV ads and cheap rob calls in their own districts. As late as yesterday-- after arm-twisting and some pretty massive bribe promises that netted Trump-- besides Barletta-- John Faso (R-NY), John Katko (R-NY), Tom Reed (R-NY), Martha McSally (R-AZ), paper tiger Steve King (R-IA), Tom MacArthur (R-NJ) and Mario Diaz-Balart (R-FL), Meadows said he had firm NOs from 25 Freedom Caucus members alone. They only need 22 to kill TrumpCare so that it never even goes to the Senate at all.

Last night many of our Senate contacts were telling us they expected Ryan to have a heart to heart with Scalise, realize he doesn't have the votes, and postpone today's do-or-die attempt. Yesterday Trump set Mike Pence, Kellyanne Conway and #PresidentBannon loose on a dozen or so Freedom Caucus members he lured over to the White House. A staffer for one member told me that after the meeting, his boss was more sure than every he would be a NO vote. Several members complained that there is no talk about substantive poilicy-- just politics, crude bribes and usually subtle threats.

One firm NO vote is Thomas Massey, a Libertarian-leaning independent thinker from Kentucky. He says he knows over 35 Republicans against it and he feels they can force Ryan to raise the white flag and repeal ObamaCare without replacing it. "This is worse than Obamacare," he told the media, "and we’re going to own it. We’re going to own it lock, stock and barrel." He tweeted jokingly that he had changed his vote late yesterday, sending out this as a tweet:

Ryan and Trump, though, aren't the only ones holding cash under Republicans' noses to get them to vote on TrumpCare. The Kochs want to see it defeated and CNN reported late yesterday that the Koch network is creating a new multimillion dollar fund for Republican candidates in the 2018 reelection races-- but only for the ones who vote against TrumpCare today.

The Koch-aligned networks oppose the bill because they think it does not do enough to scale back former President Barack Obama's health care policies.

"We want to make certain that lawmakers understand the policy consequences of voting for a law that keeps Obamacare intact," Americans for Prosperity president Tim Phillips said. "We have a history of following up and holding politicians accountable, but we will also be there to support and thank the champions who stand strong and keep their promise."

Ted Lieu addressed a statement directly to the California Republicans in Congress: "Today’s revelation by Governor Jerry Brown of a $6 billion a year tax bill for California under President Trump’s health care plan is astounding.  I triple-dog-dare moderate House Republicans from California to vote for TrumpCare." What he's talking about is that any Republican who votes for TrumpCare is voting to deny their own constituents federal support for health insurance for a simple reason: in California state law mandates abortion coverage in health insurance, while Ryan specifically wrote TrumpCare to deny tax credits for any policy that does that. The consequences would be calamitous for the state's insurance markets and probably signal-- if (and it's a BIG if) the DCCC could find good candidates-- the end of the careers of at least half a dozen California Republicans, namely Steve Knight, David Valadao, Darrell Issa-- regardless of which was he flip-flops today-- Jeff Denham, Mimi Walters, Dana Rohrabacher, Ed Royce maybe even Paul Cook, Ken Calvert and Tom McClintock. The losses of health care under these circumstances go way beyond what was implied by the CBO because they didn't take the abortion inclusion statute into consideration.


If the DCCC is smart they'll nudge their losing import/invention from last cycle, Brian Caforio, aside and get behind local progressive Katie Hill in CA-25 and retire Steve Knight, the right-wing Republican incumbent. Last night, Hill reiterated that she's far from being a fan of TrumpCare while Knight runs around like a chicken without a head trying too decide which position on TrumpCare hurts him more, backing it or opposing it. Katie Hill:

Representative Knight has been non-committal regarding how he will vote on Ryan's repeal bill. At this point, we have no idea if he will vote in favor of a bill that will result in more than 60,000 of his own constituents losing health coverage, and ultimately decimate the entire insurance market here in California. However, given the tremendous pressure he and other Republican members of congress are receiving from GOP leadership and President Trump, it is likely that he will end up voting yes tomorrow.

Health care is a basic human right. If I am elected to congress, I will fight each day to ensure that every single person is able to receive health care that they can afford. It's common sense-- if our people aren't healthy, our society isn't healthy. If anyone gets sick or dies because they can't afford insurance or the care they need, then we are failing as a country and as a community. I won't rest until we know that that won't happen anymore.

Congressman Knight, it's time to put people over party. I know I will.

UPDATE: What Ryan Did To TrumpCare Overnight-- Aromatherapy Is Nice, But Who Will Cover Chemotherapy?

Looks like the GOP Establishment still doesn't have enough votes to pass this Frankenstein's monster of a bill and that it will be postponed 4 or 5 days while they threaten and bribe more Republican members. The changes they made to the bill last night actually turned off even more members! Margot Singer-Katz covered the sausage-making for the NY Times this morning.

There are two main problems with stripping away minimum benefit rules. One is that the meaning of “health insurance” can start to become a little murky. The second is that, in a world in which no one has to offer maternity coverage, no insurance company wants to be the only one that offers it.

Here is the list of Essential Health Benefits that are required under the Affordable Care Act:

• Ambulatory patient services (doctor’s visits)
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health and substance abuse disorder services, including behavioral health treatment
• Prescription drugs
• Rehabilitative and habilitative services and devices
• Laboratory services
• Preventive and wellness services, and chronic disease management
• Pediatric services, including oral and vision care

The list reflects some lobbying of the members of Congress who wrote it. You may notice that dental services are required for children, but not adults, for example. But over all, the list was developed to make insurance for people who buy their own coverage look, roughly, like the kind of coverage people get through their employer. A plan without prescription drug coverage would probably be cheaper than one that covers it, but most people wouldn’t think of that plan as very good insurance for people who have health care needs.

Under the Republican plan, the government would give people who buy their own insurance money to help them pay for it. A 20-year-old who doesn’t get coverage from work or the government, for example, would get $2,000. If the essential health benefits go away, insurance companies would be allowed to sell health plans that don’t cover, say, hospital care. Federal money would help buy these plans.

But history illustrates a potential problem.

In the 1990s, Congress created a tax credit that helped low-income people buy insurance for their children. Quickly, it became clear that unscrupulous entrepreneurs were creating cheap products that weren’t very useful, and marketing them to people eligible for the credit. Congress quickly repealed the provision after investigations from the Government Accountability Office and the Ways and Means Committee uncovered fraud.

Mark Pauly, a professor of health care management at the Wharton School of the University of Pennsylvania, who tends to favor market solutions in health care, said that while the Obamacare rules are “paternalistic,” it would be problematic to offer subsidies without standards. “If they’re going to offer a tax credit for people who are buying insurance, well, what is insurance?” he said, noting that you might end up with the government paying for plans that covered aromatherapy but not hospital care. “You have to specify what’s included.”

A proliferation of $1,995 plans that covered mostly aromatherapy could end up costing the federal government a lot more money than the current G.O.P. plan, since far more people would take advantage of tax credits to buy cheap products, even if they weren’t very valuable.

There’s another reason, besides avoiding fraud, that health economists say benefit rules are important. Obamacare requires insurers to offer health insurance to people who have pre-existing illnesses at the same price as they sell them to healthy people, and the Republican bill would keep this rule. But if an insurance company designs a plan that attracts a lot of sick people, it will be very expensive to cover them, and the insurance company will either lose money or end up charging extremely high prices that would drive away any healthy customers.

...Before Obamacare passed, there were few federal standards for health insurance bought by individuals, and it was not uncommon to find plans that didn’t include prescription drug coverage, mental health services or maternity care. But plans tended to cover most of the other benefits. That was in a world where health insurers could discriminate against sick people. In that era, insurers in most states could simply tell the mother of a mentally ill child that she couldn’t buy insurance. That made it less risky for insurers to offer mental health benefits to everyone else.

David Cutler, a professor at Harvard who helped advise the Obama administration on the Affordable Care Act, said he thinks the kind of insurance products that would be offered under the proposed mix of policies could become much more bare-bones than plans before Obamacare. He envisioned an environment in which a typical plan might cover only emergency care and basic preventive services, with everything else as an add-on product, costing almost exactly as much as it would cost to pay for a service out-of-pocket.