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.

Independents Want Congress To Focus On Fixing Obamacare

Republicans still want Obamacare repealed and replaced. Some Democrats are now willing to abandon Obamacare and pursue a single-payer system. What do Independents want?

The chart above shows what they want. By a 34 point margin, the Independents want the Republicans to stop trying to repeal Obamacare and concentrate on fixing its problems. And by a 17 point margin, they want Democrats to also concentrate on fixing the problems with Obamacare.

The two parties need to pay attention to what Independents want. Neither party has enough members (i.e., voters) to win in 2018 or 2020 by themselves. Independents will decide the election in those years, and the party that gives Independents what they want will be the party that wins.

I personally think a single-payer system would be best, but that's not going to happen right now. Democrats need to focus their efforts right now on fixing Obamacare.

The chart above is from a new Kaiser Family Foundation survey -- done between September 13th and 18th of a random national sample of 1,179 adults, with a 3 point margin of error (with the margin of error for Independents at 6 points).

Obamacare Repeal Rears Its Ugly Head Again

 If you thought the Republican effort to repeal Obamacare, and take health insurance away from millions of Americans, was dead, then you are wrong. Republican senators Cassidy (Louisiana) and Graham (S. Carolina) have come up with a new plan -- and this one might be the worst one yet.

Their new plan eliminates the federal insurance subsidies, and federal medicaid payments. Instead, it sends block grants to each state for that state to come up with their own health plan. It also lowers the amount of money that the states that expanded Medicaid will get, and raises the amount the states that didn't expand Medicaid will get.

This is an admission by Washington Republicans that they are incapable of coming up with a plan to provide Americans with health insurance, so they are punting the ball to the individual states. You can bet the Republican states will continue to deny heal insurance to many of their citizens, while Democratic states will have to drop many from their insurance programs (or increase their state budgets to cover them). The plan also gives states the right to petition to remove any of Obamacare's requirements -- like coverage for pre-existing conditions.

This is a very bad plan, and will undoubtably raise significantly the number of Americans without any health insurance. Can it pass? Maybe. About 48 of the 52 Republicans have said they'll vote for it according to Cassidy. He and Graham needs two more votes. Rand Paul (Kentucky) has already said he would vote against it (because he wants a repeal with no replacement). That means it's down to Murkowski (Alaska), Collins (Maine), and McCain (Arizona). If two of those three vote for the bill, it will have 50 votes, and Pence will break the tie to pass it.

The GOP has until the end of this month to pass the bill. After that, they'll have to start all over (and that means it couldn't come up again until at least well into next year.

Frankly, I don't understand why the Republicans are doing this. They could have moved on to other issues (tax cuts, immigration, infrastructure, etc.) and maybe gotten some people to swallow their lies. But passing this bill, which is certain to take insurance away from millions will just hurt them in the 2018 election -- and may hurt state GOP governments also.

They have two weeks to get the bill passed. Millions of Americans will be holding their breath.

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.

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.

House Republicans Pass Odious Obamacare Repeal Bill

“They have this vote tattooed on them. This is a scar they will carry.” -  House Minority Leader Nancy Pelosi (D-Calif.)

The House Republicans finally passed their version of Trumpcare, and it was truly a bad bill. It will throw millions off health insurance rolls (both private insurance and Medicaid), significantly raise insurance costs for those with pre-existing conditions and older Americans (50-64), allow insurance companies to sell worthless policies without required benefits, raise insurance premium costs for everyone by eliminating the individual mandate, and cause the deaths of thousands each year (by denying them access to preventative care) -- while giving a huge new tax break to the rich.

Pelosi is right. This odious bill will tattoo the Republicans, and follow them into the 2018 election -- whether the Senate passes it or not. This is the most mean-spirited and hard-hearted bill that either house of Congress has passed in my lifetime.

Here is what Patrick Caldwell had to say about this in Mother Jones:

Republicans in the House of Representatives narrowly voted to repeal Obamacare Thursday afternoon, approving a bill that would cut Medicaid funding by 25 percent, allow older Americans to be charged higher health insurance premiums, and scrap all federal funding for Planned Parenthood. It would also allow states to permit insurance companies to charge more for people with preexisting conditions and to choose not to provide a range of benefits, including maternity care and mental health coverage.

The House passed the GOP plan, dubbed the American Health Care Act, by a 217-213 margin, with all but 20 Republicans voting in favor of the law. No Democrats voted for the bill. The bill will now head to the Senate, where a number of Republicans have called for significant changes to the legislation.

When the Congressional Budget Office analyzed an earlier version of the AHCA in March, it found that under the bill, 24 million fewer people would have health insurance than under Obamacare—and that was before Republicans added a provision allowing insurance companies to raise rates on people with preexisting conditions in states that receive a waver. But we still don't know exactly what impact the bill that just passed the House will have; that's because Republicans rushed through the vote before the CBO could release estimates of how many people would be insured under the new legislation.

The Republican bill is a hodgepodge of policies overturning Obamacare. It includes the most controversial parts of the original Obamacare repeal bill that Republicans pushed for in March. For example, it would replace the current Obamacare assistance for premiums—which guarantee that lower-income families will only have to devote a certain percentage of their income to buying insurance—with a lower subsidy based strictly on age. It also ends Obamacare's Medicaid expansion and imposes a cap on all Medicaid funding; those provisions will result in the government spending $880 million less on Medicaid over the next decade, lowering annual Medicaid spending by 25 percent in 2026 and covering 14 million fewer people through that program. The bill also replaces Obamacare's age restrictions: Current law allows insurance companies to charge older Americans a maximum of three times as much as younger people. Trumpcare would bump that ratio up to 5-to-1, raising the rates for older people who don't yet qualify for Medicare.

As harsh as they were, those provisions still weren't enough to win over enough House conservatives in March. So last week, Republicans added an amendment that would allow states to opt out of preexisting condition protections and requirements for essential benefits coverage. Republicans have claimed that people with medical problems would be taken care of through so-called high-risk pools, but the Republicans' bill is light on details requiring states to implement those risk-pools and would only devote a small portion of the funding necessary to cover everyone with preexisting conditions.

So, Trumpcare ditches a lot of protections for the poor and the sick. But Republicans still get something they like out of the bill: tax cuts for the rich. The legislation eliminates all of the taxes in Obamacare—totaling more than $1 trillion—which mostly hit the top slice of the wealthy.

The bill now heads to the Senate, where it faces an uncertain future. The same fights between mainline Republicans and hardcore conservatives will play out again, with a number of senators already voicing skepticism of the House plan. And unlike their colleagues in the lower chamber, Republicans will have to deal with another eye-catching number from the CBO about the number of people who will lose insurance under the bill.

Public Opposition To GOP Health Care Plan Is Growing

Trump, and his Republican cohorts in Congress, are still claiming they will repeal Obamacare -- and replace it with a plan of their own. They have been negotiating among themselves since their initial plan failed, and while they claim they are "close" to agreeing on a plan, there is no date set for a vote in Congress (or real evidence they have a plan that will work).

Rumor has it that, in an effort to please their "freedom caucus", they have made their original plan even worse. It now will not only reduce or eliminate subsidies (throwing millions off the health insurance rolls), but now will allow states to decide whether insurance companies can charge some people more (like those with pre-existing conditions), or whether insurance companies have to sell a plan with guaranteed benefits.

It's no surprise to me that Republicans can't agree to vote on a plan. They are probably reading the same polls that we all are -- polls that say the opposition to their "repeal and replace" plan is growing more unpopular each day.

The chart above shows this. Back in February, about 34% said they had little or no confidence in the Republican plan. That has now grown to 50% (half of the population). Most people now want Obamacare kept, and fixed.

This chart is from a new NBC News / Wall Street Journal Poll -- done between April 17th and 20th of a random national sample of 900 adults, with a margin of error of 3.3 points.

The GOP Dilemma In Trying To Replace Obamacare

(Cartoon image is by Daryl Cagle at cagle.com.)

Evidently the first attempt to "repeal and replace" Obamacare was enough to convince Republicans that they have no workable plan. Trump, along with some GOP leaders are trying to resuscitate their terrible plan now.

They put themselves in a bad situation with years of attacking Obamacare -- and assuring the public they could pass a better plan (which would offer cheaper and better insurance to everyone). But they have been unable to come up with any plan that would even come close to doing that.

Here is Paul Krugman's take on the GOP's dilemma, in his New York Times column:

Imagine a man who for some reason is determined to stuff a balloon into a box — a box that, aside from being the wrong shape, just isn’t big enough. He starts working at one corner, pushing the balloon into position. But then he realizes that the air he’s squeezed out at one end has caused the balloon to expand elsewhere. So he tries at the opposite corner, but this undoes his original work.

If he’s stupid or obsessive enough, he can spend a long time at this exercise, trying it from various different angles, and maybe even briefly convince himself that he’s making progress. But he’s kidding himself: No matter what he does, the balloon isn’t going to fit in that box.

Now you understand what’s happening to G.O.P. efforts to repeal and replace the Affordable Care Act.

Republicans have spent many years denouncing Obamacare as a terrible, horrible, no good law and insisting that they can do much better. They successfully convinced many voters that they could preserve the good stuff — the dramatic expansion of coverage that has brought the percentage of Americans without health insurance to a record low — while reducing premiums, shrinking deductibles and, of course, doing away with the taxes on high incomes that pay for the program.

Imagine a man who for some reason is determined to stuff a balloon into a box — a box that, aside from being the wrong shape, just isn’t big enough. He starts working at one corner, pushing the balloon into position. But then he realizes that the air he’s squeezed out at one end has caused the balloon to expand elsewhere. So he tries at the opposite corner, but this undoes his original work.

If he’s stupid or obsessive enough, he can spend a long time at this exercise, trying it from various different angles, and maybe even briefly convince himself that he’s making progress. But he’s kidding himself: No matter what he does, the balloon isn’t going to fit in that box.

Now you understand what’s happening to G.O.P. efforts to repeal and replace the Affordable Care Act.

Republicans have spent many years denouncing Obamacare as a terrible, horrible, no good law and insisting that they can do much better. They successfully convinced many voters that they could preserve the good stuff — the dramatic expansion of coverage that has brought the percentage of Americans without health insurance to a record low — while reducing premiums, shrinking deductibles and, of course, doing away with the taxes on high incomes that pay for the program.

And each time the plan turns out to have a fatal flaw. Millions will lose coverage; or they’ll keep coverage, but it will become so threadbare it’s almost worthless; or premiums will skyrocket for the most needy unless vast sums — hundreds of billions of dollars — are devoted to those high-risk pools.

The important thing to remember is that these problems don’t keep popping up because the people devising the plans are careless, and keep forgetting crucial issues. They’re popping up because the G.O.P. is trying to stuff a big balloon into a small box, and every time you squeeze it somewhere it inflates someplace else.

And because the task Republicans have set for themselves is basically impossible, their ongoing debacle over health care isn’t about political tactics or leadership. Even if Donald Trump were the great deal maker he claims to be, or Paul Ryan the policy wonk he poses as, this thing just can’t work.

The only way Republicans might have been able to do what they promised would be if they had some way to make health care much cheaper. That would in effect let some air out of the balloon, and maybe make it possible to get it into the box after all. But they don’t.

The truth is that while Republicans have portrayed Obamacare as a crazy, inefficient scheme, it has in fact been much more successful at containing costs than even its proponents expected.

There are some things we could do that would probably make it even cheaper, but they would all involve moving left — say, introducing a public option, or going all the way to single-payer. The G.O.P., which is determined to move right instead, reducing the public sector’s role, has offered no reason for anyone to believe that it could do better.

All of this raises the obvious question: If Republicans never had a plausible alternative to Obamacare, if this debacle was so inevitable, what was the constant refrain of “repeal and replace” all about?

The answer, surely, is that it began as a cynical ploy; at first, the Republicans hoped to kill health reform before it really got started. And now they’ve trapped themselves: They can’t admit that they have no ideas without, in effect, admitting that they were lying all along.

And the result is that they just keep trying to stuff the balloon into that box.

Trump/Ryan Did NOT Have A Mandate To Repeal The ACA

There have been many takes on why the Republican plan to repeal and replace Obamacare failed. This is part of Nate Silver's explanation at fivethirtyeight.com:

While most reporting has focused on the House Freedom Caucus’s objections, the AHCA also faced significant dissent from moderate Republicans, perhaps enough to kill it.¹ And considering that the bill would almost certainly have faced resistance from moderates in the Senate even if it had passed the House — and that no Democrats in either chamber had pledged to support it — the narrative that the Freedom Caucus was principally responsible for the bill’s demise is at least a little dubious.

The more fundamental, Politics 101 problem is that Ryan drafted a bill that was too far removed from what voters actually wanted. If the bill wasn’t killed by moderate Republicans, it was probably going to exact a significant electoral penalty on the GOP, like the one Democrats endured after passing Obamacare in 2010.

And then there’s Trump. His philosophy toward the size and scope of government has never been clear, exactly. But from the hints he’s given — such as in advocating for a trillion-dollar infrastructure plan — he tends more toward the center than either the Ryan or the Freedom Caucus wings of the GOP.

Trump was elected without much of a mandate, given his narrow margin in the Electoral College and his loss in the popular vote. But congressional Republicans didn’t have much of a mandate, either. Although people seemed to forget about it as they focused on Trump’s upset win at the top of the ticket, Republicans lost seats in both the House and the Senate in last year’s elections.

How many congressional seats a party gains or loses when it takes over the White House is a good measure of whether there was an overall mandate for the party’s agenda or instead the presidential result reflected a more incremental (and perhaps quirky or circumstantial) victory. Among the 11 times in the past century when the presidency changed parties, Warren G. Harding in 1920, Franklin D. Roosevelt in 1932, Ronald Reagan in 1980 and Barack Obama in 2008 all came into office with major gains for their party in Congress and a lot of wherewithal to enact sweeping changes. Trump, George W. Bush, Bill Clinton, Jimmy Carter and John F. Kennedy did not, by contrast. Dwight Eisenhower and Richard Nixon were somewhere in between.

Unsurprisingly, there’s a correlation between a party’s gains or losses in Congress and the margin of its presidential victory. But it isn’t a perfect one. Clinton won the Electoral College fairly definitively in 1992, but his Democrats lost nine seats in the House and only broke even in the Senate. Eisenhower’s congressional gains were modest given his landslide presidential victory, meanwhile. You could interpret that as meaning Eisenhower and Clinton were elected more on their personal qualities — Eisenhower’s résumé, Clinton’s personality — than on the basis of their party’s agendas. And that was reflected in the policies they pursued. Eisenhower was one of the most centrist presidents of all time, while Clinton ran — and mostly governed — as a “New Democrat,” somewhat against his party’s tax-and-spend reputation.

Trump isn’t in the Eisenhower or Clinton category because his own electoral performance was underwhelming, just as his party’s was in Congress. Instead, the better comparison is to George W. Bush, who like Trump lost the popular vote and also saw his party lose seats in Congress. But Bush also governed in a fairly bipartisan fashion early in his term² before moving to the right after the Sept. 11 attacks.

Instead of offering a centrist or a populist solution, however, the AHCA gave voters a bill that nobody was asking for. Republicans have been running on repealing and replacing Obamacare for seven years, and they’ve won a lot of elections in that period. You can argue that they have a mandate on the issue, even if they don’t have one overall. But Ryan and Trump pretty much ignored where public opinion stands on health care. Medicaid, which the AHCA would have rolled back, is extremely popular, for instance. About two-thirds of voters support government funding for Planned Parenthood; the AHCA would have cut it. But the bill didn’t do much to address the problems voters were actually concerned about, such as rising premiums.

Furthermore, Ryan and Trump advanced this bill despite receiving a warning shot from the public: Obamacare had almost immediately become more popular after Trump won the election. I don’t recall a lot of other times when public opinion shifted so quickly on a bill in response to an election result.³ It was as though voters were throwing up a big yield sign to congressional Republicans — we didn’t expect Trump to win the election; instead, we elected you to serve as a check on Hillary Clinton, so proceed with caution. Ryan barreled right on through it.

Most Americans Want To Keep Obamacare (And Fix It)

Obamacare has not been an overwhelmingly popular program with the general public -- that is, until they saw what the Republicans wanted to replace it with. After seeing that terrible replacement bill, the number supporting Obamacare has now exceeded the number opposing it.

Currently, 51% say Obamacare should not be repealed, while 43% think it should. In addition, large pluralities think the replacement plan would increase the number without insurance (48%), would increase costs for those who buy insurance (48%), and would create higher deductibles (42%). They also think it will increase the cost of insurance for everyone but the rich -- younger people (41%), older people (45%), lower income people (46%), urban dwellers (41%), and rural dwellers (42%).

And that's not all. The public really doesn't like the ban for funding of Planned Parenthood. Three out of four Americans (75%) believe the government should continue funding Planned Parenthood, while only 22% was the funding cut off.

The Republicans are bucking a strong public opinion headwind with their effort to replace Obamacare with their own inadequate plan.

The charts above are from a new survey by the Kaiser Family Foundation -- done between March 6th and 12th of a random national sample of 1,206 adults, with a margin of error of 3 points.

Ryan Blames Poor/Working People For Losing Insurance

Speaker Paul Ryan (R-WI) was on Face the Nation:

QUESTION: How many will lose coverage under GOP health plan?

PAUL RYAN: “I can’t answer that question. It’s up to people.”

 The quote above shows just how slimy Speaker Ryan really is. His replacement plan for Obamacare will cost at least 15 million people (and probably many more than that) the health insurance they were able to get under Obamacare. But he wants you to believe that his inadequate plan would let everyone buy insurance, and if anyone doesn't buy it then it's because they didn't want insurance. 

That's more than disingenuous -- it's an outrageous LIE! Providing access is not the same as providing insurance (or even providing a real chance for people to buy insurance). Access means nothing to an individual or family that does not make enough to purchase insurance. 

No one should be asked to deny food or housing to their family to buy health insurance. Decent health insurance should be a right of all citizens, and those who cannot afford it should be helped by the government. The GOP plan doesn't do that. It treats health insurance as a product instead of a right -- a product that all Americans can choose to buy or reject.

Ryan, and his GOP cohorts, don't really care about the health and well-being of all Americans. They only care about the rich, and that's why their "plan" benefits the rich far more than it does anyone else -- and actually hurts poor and working class Americans.

Is "Repeal & Replace" A Huge Gift For Democratic Party ?

(Cartoon image is by Nick Anderson in the Houston Chronicle.)

The Republicans in Congress have been screaming for the repeal of the Affordable Care Act (Obamacare) for years now, and claiming that they could replace it with a better plan. The problem, of course, is that they could not agree on any plan to replace Obamacare even though they had years to come up with one. It was really just a bit of political theater designed to keep their base happy, because they never expected to be in a position to actually accomplish repeal.

But they (and everyone else) got a surprise last November when Trump won the White House. Now they control the White House and Congress, and their base is demanding they do what they had been promising for years -- repeal Obamacare. So, after a few months of party infighting, the Republican leadership came up with a plan. It's not a good plan, and would result in at least 15 to 20 million Americans losing the health insurance they had gained through Obamacare (while doing nothing to control medical or insurance costs).

While this "plan" would be good for rich people (giving them a big tax break), it would not be good for most Americans -- and that includes Trump voters. Those benefitting from the repeal composed only 10% of Trump voters, while half of Trump voters were white voters without a college degree (the group that would be hit the hardest by a repeal). Are these people going to remain loyal to Trump (and the Republicans) after they lose their health insurance? Probably not, since that would put their families at risk.

I'm beginning to think the Republican's "repeal and replace plan" may be the biggest gift the Democratic Party has received since the Great Depression. And it really doesn't matter whether the plan is passed or defeated.

Nothing can bring voters to the polls as fast as a danger to their families -- and that's exactly what this plan represents. If the plan is passed, millions of angry voters will show up at the polls -- and they'll want to take that anger out on those who took their insurance away from them.

If the plan is not passed (and there's a decent chance it won't be passed), then a different set of angry voters will be ready to take their anger out on the Republicans -- the teabaggers in their party. They'll be ready to kick the incumbent Republicans out of office, and replace them with even more extreme right-wingers (making the party unpalatable to most Americans. Or they could even split off and form their own political party (splitting the conservative vote, and electing Democrats even in red districts).

The Republicans have put themselves between a rock and a hard place, and they don't have a clue as to how to fix that. I don't want Obamacare to be repealed, but whether it is or not, I am starting to enjoy the dilemma the Republicans have created for themselves -- and I am thankful for their "gift".

As Written, GOP Plan Can Be Filibustered By Democrats

(Cartoon image is by Nate Beeler in The Columbus Dispatch.)

The Republicans knew that if they tried to pass a repeal of Obamacare outright, the Democrats in the Senate would filibuster it to death (i.e., force it to have an unreachable 60 votes). So they decided to do it in a sneaky way -- by attaching repeal to a budget reconciliation bill (which cannot be filibustered). But it looks like they may have screwed that up.

A budget reconciliation bill can only contain items that affect the government's budget -- and one of the parts of repeal the GOP included in the bill does not meet that requirement. The bill contains a provision that requires people who have a lapse in insurance to pay more to the insurance company in the first year after purchasing insurance. The problem (for Republicans) is that provision does not affect the budget in any way. It only affects the size of the premiums that an individual must pay the private insurance company.

The Republicans had included the provision to help insure people don't drop their insurance (and then buy it again after they are sick) -- which would cause premiums for everyone to rise. But if they keep the provision in the reconciliation bill, then Democrats will be able to filibuster the bill (and it would only take 41 of them to kill the bill).

Once again, the congressional Republicans have shown that their most common attribute is incompetence. They have had years to come up with a plan, and still screwed it up.

It's A Rocky Road Ahead For "Repeal And Replace"

The Republican's plan to replace Obamacare (the Affordable Care Act) has only been revealed for a couple of days now, and it looks like it is already in trouble. To pass it, the Republicans would have to stick together to overcome unanimous Democratic opposition -- but that looks unlikely.

The "Freedom Caucus" (the teabagger Republicans in the Congress) are upset over the bill because it still contains some subsidies to help offset the cost of insurance (although those subsidies are smaller for the working class families -- who need them the most). These nuts just want Obamacare repealed, and don't care that doing that would take health insurance away from 20 million or more people. For them ideology is more important that the lives of Americans.

The odds are they will vote against the plan, and if they do, the plan might not be able to be approved in either the House or the Senate. Some might think these teabagger congress-critters would eventually cave and vote for the GOP plan, but I'm not so sure. The right-wing press (Breitbart News, etc.) have almost unanimously come out against the plan, and with encouragement from them, the teabaggers could well stick to their opposition.

And that would be fine with a majority of Americans. Most Americans agree with the Democrats on this issue, in that they don't want to see Obamacare repealed. As the top chart shows, about 56% of the public wants Obamacare saved (with 51% saying it should be kept and improved). Only 39% want it repealed (with 31% wanting it repealed and replaced).

And it gets worse for the Republicans. The two aspects they hate the most about Obamacare are the individual mandate to have insurance and the subsidies to help low/moderate income families to buy insurance. As the second and third charts above show, the public now favors both of those aspects of Obamacare -- with 84% supporting providing the subsidies, and 53% supporting the individual mandate.

It's turning out to be tougher to repeal Obamacare than the Republicans thought it would be -- and I'm beginning to think they might not be able to do it.

These charts were made from info in a new Monmouth University Poll -- done between March 2nd and 5th of a random national sample of 801 adults, with a 3.5 point margin of error.

AMA And AHA Both Oppose The GOP's Health "Plan"

It's not just Democrats that oppose the horrendous "repeal and replace" plan the congressional Republican leadership has proposed. Medical professionals have also come out against the plan. Below are letters sent to Congress by the American Medical Association (AMA) and the American Hospital Association (AHA).

From the AMERICAN MEDICAL ASSOCIATION:

Dear Chairman Brady, Chairman Walden, Ranking Member Neal and Ranking Member Pallone:

On behalf of the American Medical Association, I am writing to share our views on the “American Health Care Act” (AHCA) as detailed in committee prints released by the Committee on Ways and Means and the Committee on Energy and Commerce.

More than 20 million Americans currently have health care coverage due to the Affordable Care Act (ACA) and among the AMA’s highest priorities for on-going health system reform efforts is to ensure that these individuals maintain that coverage. While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.

The AMA has long supported advanceable, refundable tax credits as a preferred method for assisting individuals in obtaining private health care coverage. It is important, however, that the amount of credits available to individuals be sufficient to enable one to afford quality coverage. We believe that credits should be inversely related to an individual’s income. This structure provides the greatest chance that those of the least means are able to purchase coverage. We believe credits inversely related to income, rather than age as proposed in the committee’s legislation, not only result in greater numbers of people insured but are a more efficient use of tax-payer resources. 

AMA policy also supports increased flexibility in the Medicaid program so that states may pursue innovations that improve coverage for patients with low incomes. We are concerned, however, with the proposed rollback of the Medicaid expansion under the ACA. Medicaid expansion has proven highly successful in providing coverage for lower income individuals. Beyond the expansion, the underlying structure of Medicaid financing ensures that states are able to react to economically driven changes in enrollment and increased health care needs driven by external factors. The Medicaid program, for example, has been critical in helping many states cope with the increased demand for mental health and substance abuse treatment as a result of the ongoing crisis of opioid abuse and addiction. Changes to the  program, therefore, that limit the ability of states to respond to changes in demand for services threaten to force states to limit coverage and increase the number of uninsured.

In addition to the concerns listed above, the AMA cannot support provisions that repeal the Prevention and Public Health Fund or that eliminate the ability of patients to receive their care from qualified providers of their choice. The Public Health and Prevention Fund has supported many critical projects, including investments in immunization, childhood lead poisoning, and health-care associated infections. Currently the fund comprises approximately 12 percent of the budget of the Centers for Disease Control and Prevention and should be preserved. In addition, choice of health care provider is an important element of a reformed health care system. The AMA cannot support provisions that prevent Americans from choosing to receive care from physicians and other qualified providers, in this specific case, those associated with Planned Parenthood affiliates, for otherwise covered services.

As you consider this legislation over the coming days and weeks, we hope that you will keep upmost in your mind the potentially life altering impact your decisions will have on millions of Americans who may see their public, individual or even employer-provided health care coverage changed or eliminated. We encourage you to ensure that low and moderate income Americans will be able to secure affordable and adequate coverage and that Medicaid, CHIP, and other safety net programs are maintained and adequately funded. And critically, we urge you to do all that is possible to ensure that those who are currently covered do not become uninsured.

Sincerely,
James L. Madara, MD 

You can read the letter from the AMERICAN HOSPITAL ASSOCIATION here.

GOP Offers A Terrible "Repeal & Replace" Insurance Plan

(The graphic above, from the New York Times, shows the high points of the plan being pushed by Republican congressional leaders.)

(This chart, from the Kaiser Family Foundation, shows the change in tax credits [called subsidies when paid in advance] between the ACA and the new Republican plan.)

Donald Trump is bragging about the new Republican plan to replace Obamacare. That just means he has broken another promise he made (lied to Americans). He had promised that the new plan would provide insurance for all Americans, but this plan doesn't even come close to that. In fact, fewer Americans will have health insurance if it passes.

Some observations about the plan:

* The plan will cause between 10 million and 20 million Americans to lose their current health insurance. We're not sure of which figure is closer because the Republicans have not submitted their plan to the nonpartisan Congressional Budget Office for scoring -- and they're trying to rush the plan through Congress before the CBO delivers the bad news. I suspect the total of those who lose their insurance will be closer to the 20 million figure.

* About half of the American population has an income that's within 150% of the poverty level. With lower (or no) subsidies, they will not be able to pay higher prices for insurance.

* Millions will lose their insurance because their subsidies will be cut or eliminated, but they won't be the only ones. Large businesses will no longer be required to provide insurance for their employees -- and it's a safe bet that many of them will decide to drop that insurance benefit.

* While those in the working class will see their tax credit (i.e., subsidy) cut, those making $75,000 or more will now get that credit (which they did not receive under the ACA). It's another example of the Republicans taking from the poor to give to the rich.

* With millions more Americans without insurance, hospital emergency rooms will once again be packed by those without insurance (and many of them without the ability to pay). The law says they have to treat those people, but someone must pay or the hospitals will cease to exist. That means they will have to charge more for their services to everyone else. In other words, medical costs will rise higher and faster.

* Insurance premiums will also rise higher and faster than they currently do. The insurance companies will have a significantly smaller base of people (and that base will be sicker since many young healthy people will opt out of buying insurance). Added to that will be the higher costs of medical care. If this plan is passed, many will soon pine for the "low" cost of insurance under Obamacare.

* Many of the poor will continue to go without any kind of insurance (to help them afford life-saving measures like preventative care). The plan not only caps Medicaid funds at current level (meaning no new states can expand Medicaid), but also makes the Medicaid program simply a block grant to the states. That means states can make their own rules, and you can be sure that many GOP-controlled states (like Texas) will be very stingy, excluding most of the poor from health insurance.

This is a terrible plan, and it casts a dark cloud over health care in the United States. The U.S. was already the only developed nation that did not provide health insurance for all its citizens, and now many millions more will have to try to survive without health insurance. It shows that the Republicans simply don't care about the welfare of most Americans. They care only about how they can funnel more money into the bank accounts of the rich and the corporations.

There may be a couple of glimmers of light shining through that dark GOP cloud:

First, the bill may not be able to get through Congress. The Democrats will oppose it, and they might be joined by enough Republicans to kill it. The House Freedom Caucus (teabagger Republicans) don't like the plan. They want a repeal without a replacement plan (or at least a plan with any kind of subsidies). If enough Republicans oppose the plan, it will die (and in the Senate, it wouldn't take many).

Second, if the plan does somehow make it through Congress, the effect will be so bad on health care in this country that many more Americans will see a single-payer, government-run insurance program (like Medicare for all) as a viable option to fix the mess -- and that is really what is needed.

Is Obamacare Going To Be Repealed (Maybe Not) ?

(Cartoon image is by Dave Granlund at davegranlund.com.)

The Republicans have been trying to repeal Obamacare ever since it was passed. They have passed over 50 bills in the House of Representatives to repeal it. Of course, they knew it was just an exercise in political theater since President Obama would have instantly vetoed it if it ever reached his desk.

But they have a Republican president now -- one who has promised his supporters that he would sign a bill repealing Obamacare. And they control both houses of Congress. So why hasn't Obamacare (the Affordable Care Act) been repealed? They promised during the campaign that it would be one of the first  things they did.

It turns out that repealing Obamacare isn't as easy as they had imagined it would be. First, with repeal looking imminent, a majority of the public (as poll after poll has shown) has realized that they actually like the program -- and they don't want it repealed. They just want it improved.

Second, the Republicans are getting a lot of public opposition to the repeal. This last week the Congress was in recess, but only about a quarter of the congressional Republicans scheduled a town hall meeting with their constituents. They knew that such a meeting would be filled with angry people demanding to know what was going to happen with their health insurance -- and they have no answers for those people.

Third, the public doesn't want to see 20 to 30 million people lose their health insurance due to a repeal of Obamacare. That's the view of about three-quarters of the voting public. They are not going to be happy with any plan that does not let those people keep their insurance.

The problem though for the Republicans, is that none of the so-called "plans" being floated by congressional Republicans to replace Obamacare would protect those people -- and none of those plans have been able to get majority support among congressional Republicans. That's because they know that an inadequate replacement plan (one that throws millions of Americans under the bus) would be a prescription for disaster in coming elections -- and could easily cost them control of Congress.

So what do Americans want in a replacement plan? According to a recent Economist / YouGov Poll (done between February 18th through 22nd of a random national sample of 1,500 adults, with a 3 point margin of error), the public wants the following:

Well, guess what? That is just Obamacare without an individual mandate to buy insurance. It turns out that the public likes everything about Obamacare except the individual mandate. That means the only change to Obamacare the public would accept would be to eliminate the individual mandate.

But that's a problem too. Without the individual mandate, insurance premiums would rise faster and higher than they already are rising -- and once the public saw that, they would be angry with Republicans for eliminating it.

It looks like the Republicans, with their promises and propaganda, have painted themselves into a corner. And they cannot repeal Obamacare without hurting their party (and their own electoral chances). Adding to their problems is the fact that repealing Obamacare would not only cost millions their insurance, but would cost the country more than a million jobs (see charts below from the Economic Policy Institute). As the charts show, all states would have people lose insurance and would lose jobs, but some states would be hurt more than others.