Thursday, July 27, 2017

GOP "Skinny Repeal": A 'Trojan Horse' To Screw 16 Million Out Of Their HealthCare

"Yeah, we gonna sneak this skinny plan through when folks least suspect it!"

As Mitch McConnell's  ACA Repeal "Vote A- Rama" continues, assorted lone voices in the wilderness have tried to warn sane citizens not to mark victory too early. They point to McConnell and the GOOPs pushing a series of "mini-bill" votes through until a conference with the House can get the final job done - likely by 51 votes to 50 (Pence casting the tie breaker then relatively fast reconciliation with an earlier House bill). An end game that will emerge as a classic Trojan Horse move, as even the GOOPs now admit (see link at bottom).

Yes. it is true that yesterday a vote to "repeal and delay"  failed by 55-45 with 7 Republicans joining with Dems to reject the bill. This is the same ill-advised plan that had been favored by small-government conservatives, such as Rand Paul from Kentucky, who have been clamoring to repeal the law for years. The CBO estimated that 32 million people would lose health insurance over the next decade under this plan compared to current law.

So no wonder seven Republicans found their sanity long enough to reject it. But the $64 question is whether they can continue to do so as McConnell pushes the iterations toward "skinny repeal".

To set the legislative scene again: one  day after the Senate narrowly voted to open debate on repealing the Affordable Care Act (ACA) despite not knowing where it would lead, the so-called “skinny repeal” seemed the most probable of a number of options for the repeal or replacement of the ACA to succeed.

How or why is the skinny repeal a Trojan horse?

The “skinny repeal” would eliminate the individual mandate, the least popular provision of the ACA that requires all Americans to have health insurance or face a fine. It would also remove the employer mandate, requiring certain businesses to provide health insurance to employees, as well as a tax on medical device manufacturers. But, importantly, it would not touch the Medicaid program for the poor.  The danger here ought to be automatically evident to everyone as we note these aspects:

i) This cowardly mutant would barely meet the definition for "repealing Obamacare" and hence is most likely to get most small -c conservatives on board to vote for it.

ii) The Republican moderates - like Susan Collins and Lisa Murkoswki - would probably come on board because Medicaid would be left alone.

This means the "skinny repeal" has a damned good chance of being pushed through at the last minute.

Let's pursue this further.   If this measure passes the Senate with a simple majority, it would likely then enter a conference committee with the House, where Republicans could reconcile the differences and produce a larger repeal-and-replace measure later.  They could immediately claim 'victory' and that they succeeded in what they set out to do: repeal Obamacare (at least minimally).

Let's further observe that the Democrats are largely unable to stop this bill from moving forward. Saddled with only 48 votes (two of them - Angus King of Maine, Bernie Sanders of Vermont, independents) the party has remained united in opposition to any measure that would repeal the law, but has enjoined Republicans to work with them on solutions that would stabilize the insurance markets and lower premiums.

But as Republicans continued to work their way through a planned 20 hours of debate and prepared to vote for a series of amendments in the so-called “vote-a-rama”, it is still  unclear whether anything would be passed by the deadline of the end of this week set by the Senate majority leader, Mitch McConnell.  But what I am saying is don't put anything past McConnell to pull out all the stops to get it done.

This is exactly why Democrats have urged  ACA activists to continue putting pressure on lawmakers as the Senate enters the final, frenetic push toward repeal. For months, voters and activists have inundated the telephone lines of Republican lawmakers and protested at their offices and even some of their homes.  Up to now it has worked, but the key issue now is whether it will be sustained into the most critical '4th quarter'.

At a Planned Parenthood protest on the Capitol lawn Wednesday evening, Democratic lawmakers laid out the stakes.   Senator Kamala Harris, a Democrat from California, told the crowd:

"Keep doing your thing!. Keep being you. Keep doing what you’ve been doing because it’s working and it matters and it counts.”

"Thirty-six hours,” she added, referring to the amount of time left before the repeal vote.

So let’s keep calling. Let’s keep tweeting. Let’s keep writing. Let’s keep marching. Let’s keep shouting and we will win."

And what happens if "we" don't win and McConnell sneaks this revolting bill through? Well the consequences will be too horrific to contemplate.

The insurance markets would be roiled beyond belief, namely for people in the ACA exchanges.  Basically, minus the mandates, health care hell breaks loose. First, faced with a 20- 25 % spike in premiums even from next year, many will simply bail out.  These will likely be people who want insurance but feel they can't afford the increases. Their only option if seriously ill will be to visit ERs - jacking up even more expanses on the system.

Then, with no mandate or penalties hanging over their heads, the younger, healthier people will simply opt out of insurance altogether.  They will believe they don't need it, so why pay hundreds a month especially when they have college loans to pay off. This, logically, will leave the remaining insurance pool (again in the exchanges) older and sicker.

Such a trend - and it is expected to become a trend - will clearly  freak out insurers.  Facing the loss of the relatively healthy - who ordinarily would have helped pay for sicker citizens - the insurers will simply do what they did before the ACA and jack up premiums for everyone in the "sick" pool.  The federal government would then spend more providing subsidies to people who buy health insurance on their own - but save money by not providing subsidies to those who bailed. In other words the proponents of the bill - like Ted Cruz - are betting on the healthier folks bailing to save money to provide subsidies for those who buy their own.

Other adverse consequences are also projected. For example, with far more people uninsured, hospitals would be on the hook to provide  more care that they don't get paid for. Again, this would be mostly via ER visits by those with no insurance.   This will definitely threaten many hospitals' ability to stay open.

All in all, the "skinny" repeal, if pushed through and passed via a conference gambit, would be just about the worst calamity to happen to this nation's health care.

See also:

Republicans admit it: 'Skinny repeal' is a Trojan horse to turn Trumpcare over to the House


Thanks to Sen. John McCain (recall he was insulted during the '16 campaign by Trump as not being a 'real' war hero) the skinny bill has been sunk into oblivion. Along with Senators Lisa Murkowski (who Trump tried to blackmail into voting for the bill) and Susan Collins, McCain provided the needed 3rd opposition vote to deny the Reeps the 'skinny' majority (of 51) to pass it.  You can read more here:

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