Thursday, March 02, 2017

Are The House Republicans Drowning In Healthcare Quicksand?


The third-ranking Republican in the House, Majority Whip Steve Scalise (R-LA) is responsible for running a team that counts votes for Ryan and McCarthy. When Ryan releases a trial balloon-- like, say, the Obamacare replacement plan he "leaked" last week-- it's up to Scalise to find out if there are enough votes inside the Republican conference for them to introduce it without having to go make deals with pesky New Dems and Blue Dogs. The largest group of right-wing Republicans in the conference-- 170 members-- is the Republican Study Committee and this week their chairman, Mark Walker (R-NC), gave the plan a big thumbs down, as did fellow Noth Carolina wing-nut, Mark Meadows, chairman of a smaller but more effective far right grouping, the Freedom Caucus. Opposition from the Republican Study Committee would instantly end Ryan's repeal and replace plan. Opposition from the Freedom Caucus could be countered by making a deal with Jim Himes' right-wing New Dems, the Republican wing of the Democratic Party, who are often easier for Ryan and McCarthy to deal with than the ideologues at the Freedom Caucus. The New Dems are all about corruption and are easily bought off, while the Freedom Caucus has very extreme positions that make it impossible for more mainstream conservatives to support their demands.

So... Scalise now says the leaked draft is old and no longer operative and everyone should just forget it until there's a new draft Ryan, Tom Price, Mike Pence and whomever are working on with Walker. Walker-- and many other Republicans-- hate the plan's dependence on the refundable tax credits Trump was extolling in his address to Congress Tuesday evening. They call it "an entitlement program" and worry it will make it too easy for too many non-white people to get health insurance. Ryan, and presumably Price, insist that the refundable tax credits are necessary for the "replace" part of "repeal and replace" to work in the real world.

Wednesday morning, Jennifer Haberkorn, writing for Politico, reported that the extremists in the conference don't give a damn about what Trump read from his teleprompter Tuesday night. There is no common ground among congressional Republicans on the most basic questions of how to do this-- "how much to spend to reshape the health system, how much financial help to give Americans to buy insurance and how to come up with the money to pay for it all."
Many Republicans agree that Americans should get some help with buying health insurance-- an alternative to Obamacare’s subsidies. But conservatives are somewhat skeptical, warning that they won’t support tax credits for recipients that could become a “new entitlement.” The leaders of two House conservative groups-- Republican Study Committee and House Freedom Caucus-- on Monday said they wouldn’t support the repeal legislation because of its refundable tax credits, which they liken to a new entitlement.

“It kicks the can down the road in the hope that a future Congress will have the political will and fiscal discipline to reduce spending that this Congress apparently lacks,” Republican Study Committee Chairman Rep. Mark Walker (R-N.C.) said. “Worse still the bill contains what increasingly appears to be a new health insurance entitlement with a Republican stamp on it.”

Republicans have to resolve several critical questions that will have a big effect on the price tag of a repeal-replace bill. One area where the GOP has to find consensus is how many Obamacare taxes to repeal. After initially saying all the taxes should go, some Republicans now think they should be retained, if only partially, to help cover the cost of the GOP replacement.

An even more controversial way to pay for the bill is the proposal from House leaders to cap the tax credit that employers get for providing health insurance to their employees. The policy is considered an alternative to Obamacare’s Cadillac tax on high-cost health insurance plans. Both are hated by employers and unions.

Those who want to cap the tax break say that the idea of tying health insurance to a job is a World War II-era relic that no longer makes sense in a mobile economy. But even they admit it is politically unpopular.

“The idea of changing, that makes sense,” said Rep. Mark Sanford (R-S.C.). “The question of having some cap at $30,000 and anything above that is in essence a de facto tax increase, is something that’s probably going to give a lot of Republicans pause.”

Republicans want to dramatically overhaul the Medicaid entitlement by giving states a fixed amount of money tied to the number of residents enrolled. But first, they have to prevent a food fight between the states that expanded Medicaid under Obamacare, a mix of Democratic- and Republican-led states, and those that held out, a group consisting of almost entirely red states.

The states that didn’t expand their Medicaid programs are poised to get significantly less money than the states that did opt in. Republicans are now figuring out how to make sure they’re not financially punished for rebuffing Obamacare.

“We’re going to have to find a solution that accommodates each of these two concerns,” House Speaker Paul Ryan said before the Presidents Day break.

The House is considering setting up special funds for the uninsured, which would provide a boost to the non-expansion states. But any governor that feels slighted is sure to make noise during the legislative debate over the bill.

And even if Ryan, McCarthy, Scalise and Team Trump manage to get whatever concoction they eventually come up with, through the House, the Senate has its own considerations, including a lack of gerrymandered all red districts. Senators can actually lose their seats for throwing too many people off their health care. Lisa Murkowski (R-AK) already told her state's legislature that she won't vote for a House bill that rolls back Medicaid expansion (which they voted for) or that defunds Planned Parenthood, where lots of Alaskan women get their healthcare.

If Susan Collins (ME) and Dean Heller (NV) feel the House bill is too extreme, especially now that Obamacare is polling higher than ever before, they could join Murkowski and that's the end of that-- unless Trump can "make a deal" with a Manchin or Heitkamp. And every day that Ryan and Pence and Price and the rest of them run around like chickens without heads trying to piece something together, is a day closer to the 2018 midterms, which is significant in two ways. First, it will frighten Republicans in more mainstream districts that if they do something extreme they could lose their reelection bids and, second, there's every chance in the world that after the midterms, the Democrats will be back in control of the House, working on serious legislation to actually make the Affordable Care Act work better for ordinary Americans.

Late Wednesday Bloomberg Politics reported that Ryan has a new bill but it's under lock and key-- top secret. Apparently the GOP leadership doesn't want any public input from their own peanut gallery-- let alone the general public. "The document is being treated a bit like a top-secret surveillance intercept. It is expected to be available to members and staffers on the House Energy and Commerce panel starting Thursday, but only in a dedicated reading room, one Republican lawmaker and a committee aide said. Nobody will be given copies to take with them." And when they say "members," they mean only Republican members. Frequent leakers on the committee include staff members who work for Ryan Costello (R-PA), Adam Kinzinger (R-IL), David McKinley (R-WV), Leonard Lance (R-NJ) and Tim Walberg (R-MI). Crackpot Trumpist and committee member Chris Collins (R-NY) challenged any of his colleagues to dare leak it when they see it today. "Unfortunately for you," he hissed at reporters, "we’re making sure it won’t be leaked." Gus Bilirakis, the Florida nutcase who has been boo-ed and jeered at almost every town in his Florida district, added smugly, "We’re not having a hearing or anything." Paul Ryan went on Today to mislead people, claiming "We’re not hatching some bill in a backroom and plopping it on the American people’s front door," which is exactly what they are doing.

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At 8:50 PM, Anonymous Anonymous said...

This is indeed a sticky problem.

Both sides real concern is to make insurance and Rx companies richer. Obamanation via the lobbyist schtupping Sen. Baucus (leading the gang of 6 flogging ACA back in the day) chose a rube Goldberg plan to tax and punish people, force enrollment, compel many businesses to provide SOMETHING and do fuckall about rises in premia, copays, pricing and actual, you know, coverage.

The Rs' default position is to kill the 'spensive ones to save corporations from having to reimburse for care. But, while they wait to die (and become quite irate about it), they who are tagged to be dead might like ... not vote for the assholes who are killing them.
Frankly, I think ryan's death panel is misoverestimating americans. If Reagan could convince everyone that subtraction is really addition... surely these skidmarks can come up with a way to make those who are forced to die enjoy that ride.

This made me laugh... can you guess why?

"...there's every chance in the world that after the midterms, the Democra(p)s will be back in control of the House, working on serious legislation to actually make the Affordable Care Act work better for ordinary Americans."

I'm still chuckling at that. The Democraps haven't done any serious lege to make the lives of "ordinary americans" better for 40 years. They HAVE done a lot of serious lege to make the lives of corporations and billionaires better... and occasionally a few scraps fall to the "ordinaries", but not all that often. And when it happens, you just know it was an "oopsie" -- a few dollars that the corporations missed out on.

At 4:41 AM, Anonymous Hone said...

It is impossible for the Republicans to develop any plan that continues to cover people because their aim is the opposite, to get rid of the coverage. It is a joke. They have twisted the health care issue into a pretzel. It really is not so complicated! It is pure logic, something in short supply with Trump and the Republicans - you cannot replace something real with nothing and make it look like something.

And Yes to the above comment. The Dems still do not get it - they must change and they are digging in their heels for their own death spiral. They now have a fantastic opportunity to crush the Republican party and they keep up with the same old. Yet I am glad to see that Pelosi and Schumer are both calling for Sessions' resignation. That is something important in the right direction at least. Putin-gate here we come! But if they really want people's support and votes in 2018 they have to change their stance. We will see about Perez.

At 5:42 AM, Anonymous Anonymous said...

Hone, the uber-corrupt Pelosi and scummer are still pols who will rhetorically capitalize on whatever mistakes the other side makes.

It's instructive, however, to remember the long slate of uber-corrupt fascist neoliberal neocon skidmarks they insisted on running for winnable seats THAT LOST... because they were uber-corrupt fascist neoliberal neocon skidmarks. And how both keep a number of horrible Rs in their seats by never providing any sort of decent challenger (Issa, for one, has been recently covered here).

One can only assume that the money that owns these corrupt betrayers of FDR insists that certain Rs remain in their seats and that all candidates they support be of like mind with the rest of the democraps.

They will never change.

At 12:49 PM, Anonymous Anonymous said...

I am a part-owner of a medical staffing agency. Since the Great Recession erupted, half of our client hospitals have CLOSED. It didn't matter whether or not Obamacare was operating or not. The people can no longer afford healthcare without insurance no matter what.

The longer the Republicans pretend to be working on a replacement for Obamacare, the more people will die because neither plan meets their needs. Dentists are already struggling to stave off bankruptcy, and the other medical professions aren't going to be far behind. Elective surgeries are nearly a thing of the past, and the mandatory cases are finding it difficult to schedule the necessary facilities.

I know that the American People feel something is wrong with healthcare, but until they have to stare it in the face, eyeball to eyeball, they aren't going to act. Yell all you want at your town hall meetings. It will make you feel better for a while. But it will accomplish nothing. The corporations control your representation, and the media controls you. You will care more about the lies told about immigrants and voter fraud than you will corporate fraud being waged against you. Then know that all the corporations want you to do is drop dead and leave them alone to plunder the world.


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