Americans Want Obamacare Fixed - Not Abolished

The chart above is from a Kaiser Family Foundation survey done last August, but I think little has changed. The American public knows that Obamacare (Affordable Care Act) did not solve all the ills of our health care system. But they also think that it made some progress toward that -- especially in eliminating the pre-existing conditions that had insurance charging more or even denying coverage because of them. And they know that abolishing Obamacare without a sufficient replacement will destroy that (and cause millions of Americans to lose their health insurance).

Much remains to be done to fix our health care system, and abolishing Obamacare won't fix that. This is especially true because the Republicans, after 9 years of trying, have been unable to come up with a plan they can even get their own party to agree on. How bad is the current system? Consider these facts:

* Americans borrowed about $88 billion last year to pay for health care.

* Americans spent $126 billion of their savings last year to pay for health care.

* One-third of Americans worry that a medical emergency would force them into bankruptcy.

* About one-quarter of Americans deferred health care treatment last year because of cost (including 27% of Democrats, 21% of Republicans, and 30% of Independents).

* The current system still leaves millions of Americans without health insurance (especially in red states that have refused to expand Medicaid).

Obviously, something must be done. Democrats want to either go to a single-payer system (Medicare For All), or fix the current system and include a public option (that people could buy into). Both are good ideas, and better than what we have now.

Republicans want to abolish Obamacare, without having anything to replace it. Trump has said the Republicans would produce a better plan after Obamacare is abolished, but that's just another lie. In spite of their inability to agree on a plan, no plan they have proposed would improve on Obamacare. All of them would be a step backward, and hurt millions of Americans.

Trump does not have a plan either, but if you look at the budget proposal he recently submitted, you can see what kind of plan he wants. Here's what that is:

Last month, the Trump administration released its annual budget — a 148-page document that spells out the type of policies that it would like to become law. In that budget, the White House says it supports “enactment of legislation modeled after the Graham-Cassidy-Heller-Johnson bill proposed in September 2017.”

This is helpful because it gives us a clear picture of what the Trump administration actuallywants to see changed in our health care system. We can read the bill that the budget administration references right here and dive into policy briefs that explain how it would work.

Graham-Cassidy-Heller-Johnson (which I’ll shorten as Graham-Cassidy) was a plan put forward at the very end of the Republicans’ health care push in 2017. It would repeal the Affordable Care Act entirely, including consumer protections preexisting conditions and an expansion of Medicaid, that gave millions of low-income Americans coverage. The Obamacare subsidies that 8.8 million Americans use to purchase private coverage on the health law’s marketplaces would cease to exist.

The rules around private insurance would change a lot, in a way that is much less friendly to sicker Americans. The mandate that private Obamacare patients not be charged for preventive care visits would go away. Current limits on out-of-pocket spending for Obamacare enrollees would be abolished too, a change that could be especially challenging for those with costly medical conditions.

In Obamacare’s place, Graham-Cassidy would create something it calls a Health Care Grant Program, which would give states a lump-sum to fund its health care programs. States would also have the option to allow insurers to charge sicker people higher premiums. They could let insurers set higher prices for pregnant women, too (this was common practice before the Affordable Care Act). States could let insurers opt out of Obamacare’s essential health benefits requirements, which currently mandate that health plan cover a core set of services including prescription drugs and maternity care.

States that like Obamacare could try and keep the system running, using the money from their new health care grants. They could keep requiring insurers to charge sick people the same premiums as healthy people, keep the essential benefits package in place, and try to pay for their Medicaid expansion.

But they’ll probably find that quite difficult, because Graham-Cassidy would cut spending on these programs significantly. The Congressional Budget Office analyzed Graham-Cassidy shortly after its introduction. Their report estimates that the legislation would, over a decade, spend $230 billion less on health coverage programs than the Affordable Care Act.

Some states “would find it particularly challenging to reach current enrollment levels using the available subsidies,” CBO concludes.

That sharp cut in funding helps explain why CBO thinks that Graham-Cassidy won’t deliver on Mulvaney’s promise (speaking for Trump) that Americans won’t lose coverage if Obamacare is repealed.

Instead, the nonpartisan agency determined that “if this legislation was enacted, millions of additional people would be uninsured compared with CBO’s baseline projections.” The increase in uninsured would largely come from rolling back the Medicaid expansion. That program, which covers 61 million Americans and has grown significantly under the Affordable Care Act, would face a $1 trillion budget cut over the course of a decade.

The Public Says NO To Replacing Obamacare

Donald Trump has instructed his Justice Department to intervene on the side of the GOP-controlled states who are in court trying to abolish Obamacare (the Affordable Care Act). Those states have won a judgement from a Texas judge that ruled Obamacare unconstitutional, and the case is now pending before an appeals court -- and will likely wind up being heard by the U.S. Supreme Court.

Trump said he will be known after Obamacare is overturned as the "health care president". He says that's because it will be replaced by something better. There's only one problem with that -- he doesn't have a better plan (or any plan at all), and neither do the congressional Republicans. They have tried for nine years to come up with a plan, and they have failed. They can't even get the members of their own party to agree on a plan, and none of the plans they have proposed would cover all Americans or control medical costs.

The American people know that. They know that abolishing Obamacare would be a disaster, because the GOP has no plan. They also know that abolishing it would not be an improvement. It would just rob millions of Americans of the heal insurance they currently have.

As the chart above shows, only 35% of adults want to replace Obamacare with some nonexistent Republican plan, while 55% say they want to keep Obamacare and improve it.

The Democrats are floating a plan to replace Obamacare. They want to replace it with a single-payer system (like Medicare For All). That is more popular than what Trump wants to do, but not popular enough. As the chart below shows, the public is split on whether that is a good idea. About 43% say it's a good idea while 45% say it is not. That 2 point margin is within the poll's margin of error.

There is a change that would appeal to a majority of Americans though. It is illustrated in the bottom chart. About 51% say they want to keep Obamacare but also allow adults to buy into Medicare instead of purchasing private insurance. That may be the way to go for now. It will let the public get used to a public health insurance plan, and make it easier in the future to extend that plan to all Americans.

All of these charts reflect the results of a recent Quinnipiac University Poll -- done between March 21st and 25th of 1,358 voters nationwide, with a margin of error of 3.3 points.

Only 20% Of Public Support Latest Version Of Trumpcare

The Republicans have another version of Trumpcare they want to pass (to replace Obamacare). But the American public doesn't like it any better than the other plans they have proposed -- all of which would take health insurance away from millions of people. In fact, they seem to like this latest plan (to turn health insurance over to the individual states) even less than the other failed efforts.

The Republicans have promised for years now to repeal Obamacare, and to replace it with a plan that would be better for the American people. But we have seen several GOP plans now, and none of them would be better than Obamacare for the majority of Americans. The truth is that Republicans were just playing a political game in opposing Obamacare. They never had a better plan, and still don't.

Now that political game has put them between a rock and a hard place. If they don't pass this latest odious version of Trumpcare, they will face an angry base in the 2018 party primaries. And if they do get it passed, they will face an angry electorate in the 2018 general election. They have created a lose-lose situation for themselves.

Only a tiny 20% of Americans support this latest version of Trumpcare (the Graham-Cassidy bill), while a majority of 52% oppose it. About 42% say the plan will hurt them personally, and another 50% say it won't make any difference. That's 92% saying this plan won't make things better for them, while only 7% say it will. And a whopping 87% of the public doesn't like the part of the plan that would let states opt out of covering pre-existing condition (including 79% of Republicans).

The public doesn't want this bill to become law, and if the Republicans persist in this they will pay for it at the ballot box.

The charts above are from a new CBS News / SSRS Poll -- done between September 21st and 24th of a random national sample of 1,202 adults, with a 3 point margin of error.

NOTE -- It looks like America has dodged another repeal bullet. Yesterday evening, Senator Collins joined Senators McCain and Paul is saying they will vote NO on Graham- Cassidy. If the Democrats remain unified, then the bill cannot get the 50 votes it needs.

Graham-Cassidy Version Of Trumpcare Would Hurt Millions

The Republicans say they want to repeal Obamacare to help all Americans. That is nothing more than a sick joke. Every plan they have come up with would take health care insurance away from millions of Americans. The latest version is the Graham-Cassidy bill, and it may well be the worst plan yet.

The truth is that congressional Republicans don't believe decent and adequate health care is a right of every citizen. For them, health care is just a product to be sold to those who can afford it. That's why every plan they've come up with would hurt the poor, the working class, and many in the middle class.

This latest plan is no different, which is one reason they want to try and get it passed before the CBO can score it. They know it will hurt millions, and really don't care as long as they can undo the help given to citizens by Obamacare.

But while the CBO hasn't yet scored the latest version of Trumpcare, the Brookings Institute has done it -- and here is a tiny bit of their report:

On September 13, Senators Graham and Cassidy, together with two other Republican colleagues, introduced legislation that would repeal major portions of the Affordable Care Act (ACA). Press reports indicate that the legislation has gained considerable support among Senate Republicans, and Senate Majority Leader McConnell’s office announced on Wednesday that the Senate would hold a vote on this legislation sometime during the week of September 25.

This legislation has not yet been analyzed by the Congressional Budget Office (CBO), and CBO has indicated that it will not be able to provide a complete analysis of the legislation before the Senate vote. Notably, CBO stated that its analysis would not include “point estimates of [the Graham-Cassidy legislation’s] effects on the deficit, health insurance coverage, or premiums.” To help fill the gap left by the Senate’s decision to hold a vote in the absence of a complete CBO analysis, this analysis draws upon CBO’s estimates for prior legislation to evaluate how the Graham-Cassidy legislation might affect the number of people with health insurance coverage.

For years prior to 2020, this new legislation broadly tracks prior Republican bills, most importantly by immediately repealing the individual mandate. CBO’s analyses of these prior bills imply that the Graham-Cassidy legislation would reduce insurance coverage by around 15 million in 2018 and 2019. The reduction would be larger if uncertainty about the effects of the more radical changes implemented by the legislation in 2020 caused some insurers to pre-emptively withdraw from the individual market.

Starting in 2020, the Graham-Cassidy proposal would eliminate the ACA’s Medicaid expansion and Marketplace subsidies. Also in that year, the legislation would begin providing block grant funding to states, as well as allowing states to seek waivers from ACA regulations that bar insurers from varying premiums based on health status and require insurers to cover certain health care services.

To estimate the effects on insurance coverage during these years, we consider the various ways in which states might respond to the options provided by the legislation, using prior CBO analyses to evaluate the likely coverage outcomes for each of four broad categories of states. We then make assumptions about how many states will take each broad policy approach.

Based on this analysis, we estimate that the Graham-Cassidy legislation would reduce the number of people with insurance coverage by around 21 million each year during the 2020 through 2026 period. This estimate likely understates the reductions in insurance coverage that would actually occur under the Graham-Cassidy legislation, particularly toward the beginning and end of the seven-year period, because it does not account for the challenges states will face in setting up new programs on the bill’s proposed timeline, the possibility that uncertainty about the program’s future will cause market turmoil toward the end of the seven-year period, or the bill’s Medicaid per capita cap and other non-expansion-related Medicaid provisions. These estimates are, of course, subject to considerable uncertainty, most importantly because predicting how states would respond to the dramatic changes in the policy environment under the Graham-Cassidy proposal is very challenging. What is clear, however, is that the legislation would result in very large reductions in insurance coverage.

The Graham-Cassidy legislation’s adverse effects on insurance coverage are likely to increase after its block grant funding expires at the end of 2026. After that time, the legislation is similar to the “repeal and delay” proposal that the Senate considered in July, which CBO estimated would reduce the number of people with insurance coverage by 32 million people in the long run. Reductions in insurance coverage would likely be somewhat larger under the Graham-Cassidy proposal because of the legislation’s non-expansion related Medicaid provisions, which would further reduce insurance coverage.

Public Overwhelmingly Opposes Graham-Cassidy Bill

It's starting to look like the latest version of Trumpcare (the Graham-Cassidy bill) is in deep trouble. Yesterday, Senator McCain (R-Arizona) came out against the bill. He said:

"I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will (affect) insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won't be available by the end of the month, we won't have reliable answers to any of those questions."

That means only one more Republican "no" vote will kill the bill, and Senator Collins (R-Maine) has said she is leaning toward voting against the bill. Sen. Murkowski (R-Alaska) has not said how she would vote, but she voted against the last version of Trumpcare and many expect her to vote against this bill also.

This is probably a good thing for Republicans, even though they are unlikely to admit it. As the chart above shows, the public is against the bill -- with only 24% supporting it and 50% opposing it. And every demographic group (except Republicans) has significantly more opposing the bill than supporting it.

The chart reflects the results of a new Public Policy Polling survey -- done on September  20th and 21st of a random national sample of 638 registered voters.

The ABC News / Washington Post Poll (done between September 18th and 21st of a random national sample of 1,002 adults, with a 3.5 point margin of error) asked the question in a different way -- Which do you prefer, Obamacare or Trumpcare (Graham-Cassidy)? The respondents chose Obamacare 56% to 33%.

Medicaid Directors In The 50 States Oppose Trumpcare

Doctors, Hospitals, AARP, insurance companies, and a host of medical societies have all come out against the latest version of Trumpcare (the Graham-Cassidy bill) in the Senate. Now the NAMD, representing Medicaid directors in all 50 states, has joined in that opposition. Here is part of an article by Jessie Hellmann in The Hill:

The National Association of Medicaid Directors (NAMD) warned Republicans on Thursday that the Senate's latest ObamaCare repeal bill would place a massive burden on states.

The bill, sponsored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.), would eliminate ObamaCare's Medicaid expansion and subsidies beginning in 2020, converting the funding to state block grants.

It would also change the federal government's funding of the traditional Medicaid program from an open-ended commitment to the states to a per capita cap on each enrollee.

"Taken together, the per-capita caps and the envisioned block grant would constitute the largest intergovernmental transfer of financial risk from the federal government to the states in our country’s history," the NAMD's board of directors wrote in a statement Thursday.

The NAMD, which is a coalition of Medicaid directors from every state, noted that while the proposal is intended to create maximum flexibility, it does not provide the statutory reforms necessary "commensurate with proposed funding reductions."

The GOP bill would also require states create their own health-care programs by 2020, which the directors argue is a massive undertaking.

"The scope of this work, and the resources required to support state planning and implementation activities, cannot be overstated," the directors said. 

"States will need to develop overall strategies, invest in infrastructure development, systems changes, provider and managed care plan contracting, and perform a host of other activities. The vast majority of states will not be able to do so within the two-year timeframe envisioned here, especially considering the apparent lack of federal funding in the bill to support these critical activities."

The directors also hit Senate Republicans for not having a full Congressional Budget Office score before a possible vote on the bill, "which should be the bare minimum required for beginning consideration." 

"With only a few legislative days left for the entire process to conclude, there clearly is not sufficient time for policymakers, Governors, Medicaid Directors, or other critical stakeholders to engage in the thoughtful deliberation necessary to ensure successful long-term reforms," the directors said. 

Insurance Companies Join Those Opposing Trumpcare

The image above is no surprise. Everyone but the rich and Republicans oppose the Senate GOP's latest effort to repeal Obamacare (the Graham-Cassidy Trumpcare plan). Now even the private insurance companies are coming out against the plan. Here is a small part of an article by Robert Pear in the New York Times:

The health insurance industry, after cautiously watching Republican health care efforts for months, came out forcefully on Wednesday against the Senate’s latest bill to repeal the Affordable Care Act, suggesting that its state-by-state block grants could create health care chaos in the short term and a Balkanized, uncertain insurance market.

In the face of the industry opposition, Senate Republican leaders nevertheless said they would push for a showdown vote next week on the legislation, drafted by Senators Lindsey Graham of South Carolina and Bill Cassidy of Louisiana. . . .

The two major trade groups for insurers, the Blue Cross Blue Shield Association and America’s Health Insurance Plans, announced their opposition on Wednesday to the Graham-Cassidy bill. They joined other groups fighting the bill, such as the American Medical Association, the American Hospital Association, AARP and the lobbying arm of the American Cancer Society.

“The bill contains provisions that would allow states to waive key consumer protections, as well as undermine safeguards for those with pre-existing medical conditions,’’ said Scott P. Serota, the president and chief executive of the Blue Cross Blue Shield Association. “The legislation reduces funding for many states significantly and would increase uncertainty in the marketplace, making coverage more expensive and jeopardizing Americans’ choice of health plans.”

America’s Health Insurance Plans was even more pointed. The legislation could hurt patients by “further destabilizing the individual market” and could potentially allow “government-controlled single payer health care to grow,” said Marilyn B. Tavenner, the president and chief executive of the association. Without controls, some states could simply eliminate private insurance, she warned.

Insurers had been reluctant to speak out against the Republicans’ previous proposals in hopes that the White House and Congress would agree to stabilize insurance markets by providing critical funding for subsidies aimed at low-income Americans. But with hopes of securing that money before they finalize their rates virtually extinguished, insurers have less to lose by coming out against the proposal.

And many within the industry are worried that the next two years will be chaotic, with little support for the current market while states scramble to come up with a new way for individuals to buy policies.

The Real Heroes Of The Moment - Murkowski & Collins

 I watched the final Senate vote on repealing Obamacare Thursday night. And the moment that John McCain looked Mitch McConnell right in the eye and turned his thumb down (indicating that he voted NO on the final GOP plan to repeal) was dramatic and historic -- and I was proud that he chose to do the right thing for the American people instead of just toeing the party line. He deserves the credit he has received for defeating that odious bill.

But McCain did not do that alone. In fact, he could not have done it at all if not for two other Republicans who fought for sanity in the repeal effort from the very start of the process. Those two made it clear from the start that they would not vote for any plan that took insurance away from the people in their own states or in the country as a whole. And because of that politically courageous stand, they endured massive pressure from the White House and Republican leadership.

Those two Republicans are Lisa Murkowski of Alaska (pictured above left) and Susan Collins of Maine (pictured above right). Without their courageous and passionate stand for doing the right thing, McCain's historic moment would have been meaningless. For me, they are the true heroes of this moment.

I do not normally support these two Republican senators. While they are not in the teabagger-trumpista insane wing of the Republican Party, they are conservatives and normally vote for a conservative agenda. But I have to admire their political bravery regarding the health care issue.

Repeal Of Obamacare Dies In The Senate At 1:30am EST

(This photo image is from C-SPAN.)

At about 1:30 in the morning (EST), the effort to repeal Obamacare (at least part of it) died in the U.S. Senate. Majority Leader McConnell tried to float his "skinny repeal", but it was defeated on a 49 to 51 vote. Forty-nine Republicans voted for repeal, while three Republicans -- McCain (Arizona), Collins (Maine), Murkowski (Alaska) -- joined all forty-six Democrats and the two Independents to vote against repeal.

This is a victory for millions of Americans, who will get to keep their health insurance. But Obamacare is not perfect. It has problems. Will the Republicans now cooperate with Democrats to fix Obamacare? Or will they, along with Trump, try to make the situation even worse by refusing to properly fund the insurance subsidy program and Medicaid? It would not surprise me if they tried that -- continuing to disrupt insurance programs.

The "repeal and replace" effort might not be completely dead. This zombie monster will probably rise again in the future, and we can only guess what form it will take then. But for now we can breathe a sign of relief -- and hope that Republicans will join in an attempt to fix Obamacare, instead of continuing their effort to destroy it.

Trumpcare Makes It To The Senate Floor -- Barely

(Photo of the Senate vote to bring Trumpcare up for debate is from C-SPAN.)

Majority Leader McConnell asked for a vote to bring Trumpcare to the Senate floor for a debate yesterday afternoon, and the vote to do that was incredibly close. Fifty Republicans voted yes. Two Republicans (Murkowski of Alaska and Collins of Maine), two Independents (King of Maine and Sanders of Vermont), and all 46 Democrats voted no. That tied the vote at 50 for yes and 50 for no. Vice-president Pence broke the tie with a yes vote.

So, the House version of Trumpcare is now set for 20 hours of debate and a vote. The Senate is not going to pass that bill, and immediately McConnell introduced an amendment to replace it with the 2015 repeal version passed by the House and Senate (and vetoed by Obama).

McConnell asked that the amendment be considered as read (which is normal procedure) so the debate could begin. But Democrats objected and the amendment had to be read in its entirety. After that, the Republicans again tried to start the debate, but Democrats then objected that a quorum wasn't present -- and the debate was delayed again. After a couple of hours, McConnell tried another amendment -- this time to replace the House bill with the Senate version of Trumpcare. Democrats again objected to considering the amendment as read, and the whole thing (178 pages) had to be read aloud.

It seems obvious that Democrats are going to make this debate and vote a very long and tedious process -- and under the Senate rules, they have that right. And after this long and tedious process is completed, it is still unlikely that Trumpcare will be passed (and if it is, it's then unlikely the House will like the Senate version).

Trump celebrated the 51-50 vote, but the odds are still against a version of Trumpcare ever reaching his desk.

UPDATE -- About 9pm the Democrats relented and allowed a vote on whether to proceed with the amendment (which would be the latest version of Trumpcare with the Cruz plank that would allow worthless insurance policies to be sold to gullible people. Republicans lost the vote 43 to 57.

That's not the end of this Senate fight though. The GOP will probably come up with other versions in the coming days, and there will be many votes. One dangerous idea that's gaining strength is a "skinny repeal" -- just doing away with the individual and employer mandates (which would cause insurance premiums to skyrocket).

Public Thinks Trumpcare Doesn't Do What's Needed

Senate Majority Leader McConnell has promised that the Senate will vote next week on whether to bring a health plan to the Senate floor for debate. But he didn't specify what that bill would be -- the latest version of Trumpcare, or the repeal now and replace later plan.

It doesn't much matter though, because neither one would accomplish what the American public would like to see. About 62% of the public now thinks it is the responsibility of the federal government to assure that all Americans have coverage for medical care (about 10 points more that said that back in March). But both Republican plans go in the opposite direction.

The bipartisan Congressional Budget Office (CBO) has examined both the latest version of Trumpcare and the repeal and replace later idea. The CBO says the latest version of Trumpcare would take health insurance away from 15 million people in 2018, and at least 22 million by 2026. The repeal without replacing plan would take insurance away from 17 million in 2018, and at least 32 million by 2026.

It's easy to see why only 22% support the latest Trumpcare plan, and only 13% support repeal and replace later. The American people want more people covered with insurance -- not less. But the Republicans have no plan to cover more people.

So what should the Republicans do now? A huge majority say they should negotiate with the Democrats to fix Obamacare (see bottom chart).

Most of these numbers are from a recent AP-NORC Poll -- done between July 13th and 17th of a random national sample of 1,019 adults, with a margin of error of 4.1 points.

The bottom chart also uses numbers from a recent Fox News Poll -- done between July 16th and 18th of a random national sample of 1,020 registered voters, with a 3 point margin of error.

Trump Tries To Revive Health Plan That Public Doesn't Want

Yesterday, Donald Trump invited all the Republican senators to have lunch with him at the White House. The purpose of the lunch was to revive the Senate health plan to "repeal and replace" Obamacare -- a plan that had dies an ignominious death just a couple of days before because it couldn't get enough Republicans to back it.

While trying to revive the plan, Trump piled huge praise on it -- saying it would lower insurance premiums, provide better care for more people, and would "save" Medicaid. Those were all lies. As the CBO scoring has already shown, the GOP's Senate version of Trumpcare would actually raise insurance premiums significantly (because it would remove the individual and employer mandates), would throw millions of people off insurance rolls, and many of those would be the poor who need Medicaid (and couldn't afford to buy private insurance).

The senators would do well to ignore Trump, and pay attention to what the public wants. About 58% say they want to keep Obamacare and fix it, while only 35% say they want it repealed and replaced. And when you just look at the latest version of Trumpcare, only 20% support it while 57% oppose it.

But that last chart may be the one that bothers GOP senators the most. It shows that 53% of voters say they would be less likely to vote for anyone who voted for Trumpcare. A vote for Trumpcare would not be well received by voters in the next election.

The charts above are from the latest Public Policy Polling survey -- done between July 14th and 17th of a random national sample of 836 registered voters, with a margin of error of 3.4 points.

Trump Tries To Distance Himself From Health Plan Failure

(This caricature of a whining Donald Trump is by DonkeyHotey.)

We were let down by all of the Democrats and a few Republicans.

I think we're probably in that position where we'll let Obamacare fail. We're not going to own it. I'm not going to own it. I can tell you, the Republicans are not going to own it.

Those of the words of Donald Trump as he whines to the media after the failure of Senate Republicans to repeal and replace Obamacare.

He wants to blame Democrats for the GOP's failure (and his own, since he did very little to get the plan approved). But the truth is that the Democrats were never a part of this repeal plan. They were excluded by the Republicans in the writing of this bad bill, and in plans to get it passed without any hearings or public debate.

The Republicans have said they want to repeal and replace Obamacare for seven years now -- and the GOP's Congress has voted over 50 times to repeal. But that was while Obama was president, and they knew he would veto their futile efforts. It was easy to pass a plan that they knew would not go into effect.

And Trump campaigned on repealing Obamacare -- promising to replace it with a plan that covered everyone and had cheaper premiums. And he told Americans that would be done on "day one". That was also easy to do before being elected.

But things are different now. The Republicans now control both houses of Congress and the presidency. They can do whatever they want, and there's little the Democrats could do to stop them. They could have done one of two things: 1) come up with a better plan than Obamacare, or 2) fix the flaws in Obamacare. They chose to do neither. The best they could do was devise a plan that would raise premium costs and throw 22 million people off the insurance rolls. And they couldn't even agree on that.

Trump says he and the Republicans won't own whatever happens now. He's wrong about that. If Trump and the Republicans "let Obamacare fail" by refusing to adequately fund it, the public will know who to blame for that -- the Republicans and their president. And if they fund Obamacare but don't fix its flaws, the public will know who to blame for that -- the Republicans and their president.

Trump may not like it, but the party in power (especially one controlling Congress and the White House) always gets the blame for what is done (or not done). That's the way politics works in a representative democracy. Trump can deny responsibility all he wants, but as Truman told us, the buck always stops at the desk of the president.

Obamacare Is Twice As Popular As Trumpcare

Senate Majority Leader McConnell is keeping Trumpcare alive by the skin of his teeth. He has delayed any vote to bring Trumpcare up to the Senate for a vote, because McCain is recovering from an operation (and without McCain, 49 votes is the best he could do). Two Senators have already said they would vote NO -- Paul (Kentucky) and Collins (Maine). McConnell cannot afford to lose another vote.

But if the senators follow the wishes of the American public, they will kill this odious bill known as Trumpcare (that still will take insurance away from millions of Americans while giving the rich a nice tax break). Currently 50% would prefer to keep Obamacare (and fix it), while only 24% want Trumpcare to be passed.

The sticking point with the public is Trumpcares decimation of Medicaid. About 63% say it's more important to provide healthcare for the poor (which Trumpcare doesn't do) than to give tax cuts to the rich (which Trumpcare does do).

These charts represent the numbers in a new ABC News / Washington Post Poll -- done between July 10th and 13th of a random national sample of 1,001 adults, with a 3.5 point margin of error.

UPDATE -- Senators Lee (Utah) and Moran (Kansas) have now come out against the Senate bill. Trumpcare is dead -- and McConnell will not try to bring it up for a vote. He says he will instead try to repeal Obamacare without replacing it -- and delay the implementation of the repeal for two years to give Republicans time to come up with a replacement plan. Why does he think they can do that in two years, when they've been unable to do it after seven years?

Trumpcare Would Shift The Financial Burden To States

(This chart shows the amount the states would need to increase taxes to cover current Medicaid patients if the Senate bill is passed -- with the darker the color the more taxes would have to increase. You can go here for an interactive version of the map, where you can click on an individual state to see exactly how much taxes would have to rise in that state.)

The Senate Republicans are bragging that their version of Trumpcare will reduce the cost to the federal government of sustaining the Medicaid program. What they won't tell you is that they are just shifting the financial burden of Medicaid to the individual states. And to meet that burden, states would have to raise taxes or kick people off the Medicaid insurance program -- probably both.

The sad part of this is that there is no reason why we need to pay more taxes (on federal or state level) or make citizens go without health insurance coverage. Other developed nations cover all their citizens with health insurance, and they do it at less cost per capita than the United States. There is no reason why the United States could not cover all its citizens, and do it for less than is currently spent.

The easiest way would be to institute a single-payer insurance system (something like Medicare-For-All). How could costs be lowered in such a system? By cutting out insurance profits, lowering the costs of administering the insurance program (Medicare has much lower administrative costs than private insurance), and by negotiating medical costs with providers (doctors, hospitals, pharmaceutical companies, etc.).

And such a system would also be good for businesses. They would no longer have to provide insurance coverage for their workers (and their share of the program cost would be far less than they currently pay for employee insurance). They could use to money saved to compete more effectively, increase profits, or increase worker pay (thus increasing loyalty and longevity).

Unfortunately, the congressional Republicans (and some Democrats) are not ready to support a single-payer system. They (and the public) need to be educated.

Insurers: The Latest Version Of Trumpcare Is "Unworkable"

Doctors and hospitals have expressed their opposition to the Senate's latest version of Trumpcare. Now insurers are joining in that opposition. The CEO's of America's Health Insurance Plans and Blue Cross Blue Shield have sent a letter to Senate Majority Leader McConnell and Minority Leader Schumer. Note they say the Senate plan is unworkable, would undermine protections for those with pre-existing conditions, would raise the cost of insurance premiums, and would lead to widespread terminations of insurance coverage. That's a pretty broad condemnation of the Senate plan.

Here is the letter from the insurers:

U.S. Public Gives A Resounding NO To Trumpcare

Senate Republicans are still wrestling with their version of Trumpcare, and it's unknown whether McConnell can get 50 votes to pass it. But the American people have delivered their verdict, and it's not good. Only 28% now say they support Trumpcare as a replacement for Obamacare, while a substantial majority of 61% say they oppose it.

Meanwhile, about 50% now say they support Obamacare (although a lot of them would like for it to be improved) and 44% oppose it. That means Obamacare has nearly twice as much support as Trumpcare does among the general population.

Why doesn't the public like Trumpcare? The bottom chart gives one reason. About 65% of Americans don't want large cuts in federal funding for Medicaid. They know this would mean millions of Americans would no longer have any health insurance coverage -- and they don't like that.

These charts were made from information in a new Kaiser Family Foundation Poll -- done between July 5th and 10th of a random national sample of 1,183 adults, with a 3 point margin of error.

Senate GOP Made Trumpcare Even Worse Than Before

(Cartoon image is by Steve Sack in the Minneapolis Star-Tribune.

(This capsule of changes to Senate version of Trumpcare is from NBC News.)

The first version of Trumpcare (passed by the House of Representatives) was awful. It would toss 23 million people off the health insurance rolls, while giving huge tax cuts to the rich. The Republicans in the Senate panned it, and said they would do much better. Their leadership went behind closed doors and wrote their version of Trumpcare in secret. Oddly, it looked a whole lot like the House version -- throwing 22 million people off the health insurance rolls, and giving massive tax cuts to the rich.

The bill was universally panned by doctors, hospitals, the AARP, and nearly everyone else -- and couldn't get the 50 votes needed to even bring it to the Senate floor for a vote. Republican Senate leaders didn't give up though. They said they would make it "better", and went behind closed doors for another secret session. Yesterday, they revealed the latest version of Trumpcare -- and it's just as ugly as its predecessors.

The changes they made to make the bill more palatable to GOP's senators are shown above. But the main thing is that while they left a few of the taxes in, they still made sure the huge cuts to Medicaid would be made -- throwing millions of Americans who can't afford private insurance off Medicaid rolls. This third version of Trumpcare is just as hardhearted and mean-spirited at the two previous versions.

In fact, it may actually be worse. That's because they included a provision championed by Texas teabagger Ted Cruz. That provision would allow people to buy cheaper insurance policies that cover very little. Those policies would be OK -- until someone in the family got a serious illness (and that will happen to many silly enough to buy these fake policies). Those people will be hit with enormous medical bills -- bills their "insurance" will not pay. Many of them will go bankrupt trying to pay those bills.

Obamacare had significantly cut the number of individual bankruptcies each year by requiring insurance policies to have a minimum level of benefits. By allowing insurance companies to again sell these fake policies, bankruptcies will start to rise again (since most individual bankruptcies are due to an inability to pay medical bills).

This newest version of Trumpcare is a very bad bill. We must hope it doesn't get through the Senate. It would be disastrous to health care in this country if it does -- and sadly, most Republicans don't seem to care.

Public Opposes Trumpcare (And Plans With Fewer Benefits)

The Senate adjourned for the 4th of July holiday without passing a replacement plan for Obamacare. And many of those GOP senators have been ducking their constituents during that holiday. That's because the public really hates their plan to replace Obamacare with Trumpcare -- by a 20 point margin (27% if favor and 47% opposed).

The second chart shows many things that Obamacare required to be in insurance policies sold to the public. However, during the recess, Senators Ted Cruz (Texas) and Mike Lee (Utah) have come up with an amendment to Trumpcare, which they are trying to get their cohorts to approve.

That amendment would allow insurance companies to sell policies that don't include all (or maybe even any) of the benefits required by Obamacare. These policies would be cheaper, because they wouldn't cover a lot of things -- but consumers buying them could find themselves owing huge medical bills because their policies didn't cover their needs (especially if they, or a family member, got a serious illness). These people could find medical care denied, or be forced into bankruptcy.

Cruz and Lee are sadly mistaken if they think their silly amendment will make the public like Trumpcare better. As the second chart above shows, overwhelming majorities of Americans like the benefits required by Obamacare (even those who say they don't like Obamacare), and they don't want those benefits taken away just so insurance companies can sell a cheaper policy without them.

The chart below is interesting. It shows that while only 27% support Trumpcare, many more would support a single-payer system of health insurance that covered all Americans --about 42%, while only 31% say they would be opposed. But while that 11 point gap is encouraging, it is still not a majority (with about 27% still unsure about single-payer). Single-payer proponents need to work on that 27%, because our politicians won't consider single-payer until a substantial majority supports it.

All of these charts reflect informations in a new Economist / YouGov Poll -- done on July 3rd and 4th of a random national sample of 1,500 adults (including 1,323 registered voters), with a 3.1 point margin of error.

Does Trump Even Care About Healthcare For Americans ?

(Caricature of Donald Trump is by the inimitable DonkeyHotey.)

During his campaign for the presidency, Donald Trump promised his followers that he would immediately repeal Obamacare and replace it with something better. After being sworn in, he promised Americans that his plan to replace Obamacare would cover all Americans with health insurance.

Both of those promises have fallen by the wayside. The House Republicans passed a plan (AHCA) that would repeal Obamacare and throw 23 million Americans off the health insurance rolls. Trump embraced the plan as though it was a great victory -- and invited House Republicans to the White House for a victory celebration.

That plan immediately ran into trouble in the Senate, and a similar plan (BCRA) crafted by Senate GOP leaders has been unable to get enough Republican votes to pass. Now it's beginning to look like the Senate Republicans are not going to be able to come up with a plan they can agree on.

This has Trump once again changing his mind. He has now tweeted that the Senate should just repeal Obamacare, and worry about replacing it later. His thinking is that once Obamacare is repealed, people will be happy to accept any GOP plan -- even a bad one like those already proposed (which would take health insurance away from 22-23 million Americans, and raise premium prices for everyone).

Trump's proposal would repeal Obamacare, but delay that repeal from taking effect until next year -- which would give Republicans another year to come up with a plan. The problem with that is that after more than seven years of complaining about Obamacare, the Republicans have been unable to come up with a plan -- and there's no reason to believe that could do that in another year. This would just keep the argument alive over the bad Republican proposals, and have them trying to do something just a few months before the November 2018 election. That's something no Republican in Congress wants to happen.

Trump has now gone from promising to cover everyone to throwing most Americans under the bus. It brings this question to mind -- Does he really care about providing healthcare for Americans, or is he just desperate to get a legislative victory (and be able to show his cult followers that he can deliver on his promises).

So far, he has not delivered on any of the big promises of his campaign. There is no legislation (or funding) to build a wall between the U.S. and Mexico. There is no infrastructure legislation. There is no new immigration legislation. There has been no tax reform legislation. In short, there have been no major legislative achievements at all -- lending credence to the view that Trump and the Republican Congress are incapable of governing.

Trump and his family (and his friends) are rich. They have the money to buy any insurance they want (or pay any medical bills they might accrue). Most Americans are not so lucky. They need Obamacare to be fixed -- not repealed. But Trump seems ready to throw them under the bus to get a legislative victory. He has shown that he really doesn't care about healthcare for American citizens. He only cares about looking good to his cult followers -- and he needs a legislative victory (preferably repeal of Obamacare), even if that means thousands of Americans die for lack of insurance (and many more go bankrupt because they can't pay gigantic medical bills).

As usual, the narcissist-in-chief only cares about himself.