An emotional Donald Trump supporter on Tuesday told CNN’s Don Lemon he wouldn’t be able to afford health insurance if it weren’t for Obamacare, the signature legislation the president has promised to repeal.
Lemon also spoke with pastor and veteran Janice Hill, whose daughter would have died without the Affordable Care Act.
“You’re a life long republican, yet you and your wife are insured through Obamacare,” Lemon said to guest Don Riscoe. “What will happen to that insurance if Obamacare is repealed?”
“We probably won’t be insured,” a visibly upset Riscoe replied.
“You okay?” Lemon asked.
“Yes,” he said. “We won’t be insured if Obamacare goes away. We won’t be able to afford premiums.”
“I know we can’t afford $1,000 a month,” he continued. “I don’t know the exact number but … we wouldn’t be able to afford coverage without the infrastructure.”
Riscoe said Obamacare “does have problems” that need to get fixed. “I hope that there’s something that will be in place that we can still have coverage for myself and a lot of others,” Riscoe said.
Pastor Hill told Lemon the bill’s plan to slash funding for Medicaid is really what’s going to hurt.
“When they take away Medicaid, it’s not only going to hurt my daughter who is not on Medicaid now because she’s working full time, but it’s going to hurt the people in my state. It’s going to hurt veterans, which i’m a veteran. Ten percent of veterans are on medicaid.”
“It’s going to hurt the employment rate,” she continued. “It’s going to hurt people’s access to health coverage. They’re not going to go for any kind of preventive care. It’s going to be critical when they do go. It’s going to cost more money. This bill doesn’t make sense.”
“Let’s face it,” Sen. Orrin G. Hatch of Utah said. “The House bill isn’t going to pass over here.’’
So the Republican Party’s seven-year crusade to repeal the Affordable Care Act begins anew for the 58th time. That number, alas, is no exaggeration.
The first 55 times House Republicans voted to repeal Obamacare, they were thwarted by President Obama’s veto power. The 56th time came in March when the Republicans controlled all three branches of government for the first time. Having seven years to prepare replacement legislation, the GOP offered up the American Health Care Act (call it AHCA 1.0). The Republicans held no hearings, consulted with no interest groups, avoided all debate. The legislation was so unattractive it died before even coming to a vote.
The 57th time came last week when the House passed a revised version of the AHCA—call it AHCA 2.0—which was immediately dismissed by Republicans and Democrats alike in the Senate.
Now the 58th effort to repeal and replace Obamacare is getting underway. Led by Senate Majority Leader Mitch McConnell and his handpicked Gang of 13 (all of them white men), the Senate Republicans face the same political challenge as their House counterparts: how to deprive millions of Americans of health insurance without actually admitting that’s what they are doing.
The preferred solution of House Republicans in the wake of AHCA 2.0—to lie, dissemble and spin—was so implausible that even Senate Republicans wasted no time in repudiating the House bill, even if they could not say what they would replace it with.
“All they know is that the American Health Care Act is a toxic product, they didn’t think they’d have to deal with this anymore, and they’re determined to at least create the impression that they’re starting from scratch,” writes Jim Newell of Slate.
Here are six realities that the Senate Republicans now face in passing health care legislation.
1. Millions Harmed
The House voted on AHCA 2.0 before the non-partisan Congressional Budget Office could do an analysis of its cost and reveal how many people it would deprive of health insurance. The CBO’s initial estimate that 24 million more Americans would lose their health insurance within a decade spooked many lawmakers in the upper chamber.
“You can’t sugarcoat it,” Senator Bill Cassidy (R-Louisiana) told Fox News. “It’s an awful score.”
Given the stately decorum of the upper chamber of Congress, there will be plenty of time for CBO to score the Republican bill. No one knows how many people it will throw off the insurance rolls, but it is most likely an eight-digit number. Otherwise, Republicans won’t save enough money to fund their tax cuts.
2. Moderate Republican Worries
The Republicans how hold 52 seats in the Senate. They need 50 votes, plus the tie-breaking vote of Vice President Mike Pence, to pass a bill. But there are a half-dozen Senate Republicans who have already indicated AHCA 2.0 is a non-starter.
Two of them, Susan Collins of Maine, and Louisiana’s Cassidy, have introducted their own health care legislation, which would scale back spending on Obamacare, but not change the architecture of the health insurance system. It’s a reasonable compromise, which is why it has absolutely no chance. But Collins and Cassidy will have leverage in negotiating with McConnell and more conservative colleagues.
3. Popularity of the ‘Pre-Existing Conditions’ Ban
Obamacare eliminated insurance companies’ right to refuse coverage based on pre-existing conditions. The provision is so popular that the authors of ACHA 2.0 made sure they did not actually use the term in their bill, the better to buttress the lie that the bill will not deny coverage to people with pre-existing conditions.
Dean Heller (R-Nevada), the only GOP senator up for reelection in 2018 in a state Clinton won, was not fooled. He came out against the House bill hours after it passed, saying, “We need assurances that people with pre-existing conditions will be protected.”
Nor was Collins fooled.
“It’s true that under the House bill that a state that gets a waiver would still have to provide coverage to people with pre-existing conditions,” she told ABC News. “But that coverage might well be unaffordable. And if the coverage is unaffordable, that doesn’t do any good for a child who has juvenile diabetes and is going [to] have that her entire life.”
On the one hand, these swing-vote Republicans will be in a position to protect those with pre-existing conditions as the legislation is drafted.
Despite President Trump’s campaign pledge not to touch Medicaid, the House bill proposes cutting $880 billion in Medicaid funding over the next decade, which is one reason so many senators declared the bill DOA.
“We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services,” they wrote.
Republican governors in at least four states share those concerns. In a letter to House and Senate leaders, the governors of Ohio, Michigan, Arkansas and Nevada declared that AHCA 2.0 “provides almost no new flexibility for states, does not ensure the resources necessary to make sure no one is left out, and shifts significant new costs to states.”
On the one hand, McConnell and the Gang of 13 may have to scale back the Medicaid cuts to gain the votes of the moderate bloc. On the other hand, see Marshall’s Iron Law, above.
5. Premiums Sure to Rise
Even with the $85 billion added by House leaders to help older people pay for their insurance premiums, Kaiser Health News reports that “many moderates feel the age-based tax credits in the bill replacing those in the Affordable Care Act are too small, particularly for people in their 50s and early 60s. “
The CBO estimated that under AHCA 1.0, the premiums for a 64-year-old with an income of $26,000 a year could rise from $1,700 currently to more than $14,000. AHCA 2.0 is likely just as bad if not worse, for low- and middle-income households.
“Older people buying their own insurance, especially those with lower incomes, are probably the hardest-hit group under this bill,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, told the Wall Street Journal.
Any effort to prevent premiums from rising would require keeping, not repealing, the Obamacare subsidies. One possible solution: keep the Obamacare subsidies and rebrand them as Trumpcare. For those who believe in “alternative facts,” this might be plausible.
6. Sick People Pay for Tax Cuts
“The House’s plan offered a spectacular tax cut for the wealthy — those in the top one-tenth of one percent of incomes would get tax cuts averaging more than $200,000,” writes Paul Waldman in the Washington Post. How much the Senate health care legislation benefits America’s richest familes will be a key feature of the Senate debate.
Which points to the underlying reality. Obama’s Affordable Care Act was a reasonable compromise between the many stakeholders in the health care system: patients, doctors, hospitals, insurance companies, and taxpayers. Trump’s AHCA is an effort to tear down and rebuild the system without consulting any of the stakeholders, save high-income taxpayers, the only group of Americans sure to benefit if the Senate passes some version of health care “reform.”
Moments before the House’s Thursday vote to destroy Obamacare and its protections affecting all private health insurance policies, House Minority Leader Nancy Pelosi warned Republicans that voting for the draconian bill would imperil their careers.
“You have walked the plank from moderate to radical,” she said. “And you’re walking the plank for what—a bill that will not be accepted by the United States Senate? Why are you doing this? … You have every provision of this bill tattooed on your forehead. You will glow in the dark on this one.”
Twenty Republicans sided with every Democrat and voted no—nine were from districts where Hillary Clinton beat Donald Trump. They seem to know how a yes vote would be received. The rest, 217 of them, voted yes. But with the November 2018 elections 18 month away, how much will the House vote help Democrats retake 24 additional seats for a majority?
“The Cook political report is moving 20 races toward Democrats,” wrote the Daily Kos’ pollwatcher. “It doesn’t mean they are in the Democratic column, they just are a little closer now. This is a great opportunity for us if we can keep the enthusiasm up and spread that enthusiasm to the 37% of people who thought voting doesn’t matter.”
Kos is in the cheerleading business. Its conclusion “this is how a wave starts” is unsurprising. It copied Cook’s list and ended, “If we can keep up the enthusiasm, work hard, and stay focused on where the real threat is coming from, we might just survive this fascist attack on our democracy and end up changing the world.”
The author of the Cook Report’s new assessment, David Wasserman, has a more precise idea of the uphill climb Democrats face to retake the House. He’s one of the few analysts who understand how the GOP’s extreme partisan redistricting after 2010 resulted in states that might be evenly split when it comes to voting for president but end up sending twice as many Republicans to the House. That’s because they drew political boundaries that effectively segregated voters.
Wasserman’s analysis post-Thursday’s vote said three Republicans faced likely defeat in 2018. They were, as summarized in his report:
• CA-25: Rep. Steve Knight (R) – Northern LA County: Santa Clarita, Palmdale Toss Up. Knight prevailed with 53 percent in 2016 while Trump lost this rapidly suburbanizing seat 50 percent to 43 percent.
• CO-06: Rep. Mike Coffman (R) – Denver southeast suburbs: Aurora, Littleton Toss Up. Coffman ended up voting against the AHCA, but his hesitation to announce his position likely won’t assuage voters who want to send a message to President Trump next year.
• MN-02: Rep. Jason Lewis (R) – Twin Cities south suburbs: Eagan, Burnsville Toss Up. Lewis prevailed by one of the slimmest margins of any GOP freshman in 2016, 47 percent to 45 percent – and followed it up by casting a vote for Republicans’ AHCA bill.
That’s only three seats, not the 24 needed. He moved three Republican incumbents from “lean Republican” to “toss-ups.” He also moved 11 incumbents from “likely Republican” to “lean Republican.” And he moved six from “solid Republican” to “likely Republican.”
“In light of the vote, we are shifting our ratings in 20 districts, all reflecting enhanced opportunities for Democrats,” Wasserman said. “The major caveat is that 18 months is an eternity in politics and that as always, we will continue to adjust our outlook as events unfold and the landscape develops.”
Kos and Wasserman are both correct in their tentative characterizations. What the House GOP did on Thursday could be the start of a blue wave. But it would have to be a very big wave, as Wasserman notes, because the most vulnerable GOP incumbents still are on semi-solid red ground. Of the three new toss-up races, Colorado’s Coffman—elected as a Tea Partier—voted no on Obamacare repeal. He may have delayed his decision, as Wasserman noted, but he voted no. You can be sure he’ll tout that.
Where are the other 17 races with potentially vulnerable Republicans? Of the 11 “lean Republican” seats, three are in California, two in Texas, and the rest single seats in Arizona, Illinois, Iowa, Kansas, Minnesota and New Jersey. Of the six Wasserman moved to “likely Republican,” two are in Illinois, and the rest single seats in Kansas, Michigan, New Jersey and Ohio.
Statistical handicapper Nate Silver, at fivethirtyeight.com, also sounded an upbeat but cautionary note. He wrote, “27 Republicans voted for AHCA [the House bill] and won their races by <15 points last time around. They’re in the danger zone.”
On closer inspection of his data, one sees that it does not quickly add up to 24 seats needed to retake the House. Only four GOP incumbents who voted for the ACHA won their 2016 races by less than a 4 percent margin of victory. Most of the 27 that Silver cited were won by Republicans with at least 10 percent margins of victory.
Could the House’s Obamacare repeal be the start of a blue wave taking the House in 2018? Yes, but it’s going to have to be a very big wave where dozens of Republicans are defeated by double-digit margins. That’s no ordinary landslide.
WASHINGTON — The House on Thursday narrowly approved legislation to repeal and replace major parts of the Affordable Care Act, as Republicans recovered from their earlier failures and moved a step closer to delivering on their promise to reshape American health care without mandated insurance coverage.
The vote, 217 to 213, held on President Trump’s 105th day in office, is a significant step on what could be a long legislative road. Twenty Republicans bolted from their leadership to vote no. But the win keeps alive the party’s dream of unwinding President Barack Obama’s signature domestic achievement.
The House measure faces profound uncertainty in the Senate, where a handful of Republican senators immediately rejected it, signaling that they would start work on a new version of the bill virtually from scratch.
“To the extent that the House solves problems, we might borrow ideas,” said Senator Lamar Alexander of Tennessee, chairman of the Senate health committee. “We can go to conference with the House, or they can pass our bill.”
Even before the vote, some Republican senators had expressed deep reservations about one of the most important provisions of the House bill, which would roll back the expansion of Medicaid under the Affordable Care Act.
But a softening of the House bill, which could help it get through the Senate, would present new problems. For any repeal measure to become law, the House and the Senate would have to agree on the language, a formidable challenge.
Just before the House vote, the Senate gave final approval on Thursday to a $1.1 trillion spending bill that will finance the government through September, and unlike the health care legislation, the spending bill had broad bipartisan support.
After weeks of negotiations and false starts, Mr. Trump and House Republicans were not about to dwell on the tough road ahead. Passage of the health care bill completed a remarkable act of political resuscitation, six weeks after House leaders failed to muster the votes to pass an earlier version of the measure, a blow to Mr. Trump and Speaker Paul D. Ryan of Wisconsin.
“Yes, premiums will be coming down; yes, deductibles will be coming down, but very importantly, it’s a great plan,” Mr. Trump boasted on Thursday at the kind of White House Rose Garden victory ceremony typically reserved for legislation that is being signed into law, not for a controversial bill that passed just one chamber.
“We want to brag about the plan,” Mr. Trump said, after asking those assembled how he was doing in his debut as a politician. “Hey, I’m president!”
Mr. Trump quickly turned his attention to pressuring the Senate to act, calling the majority leader, Mitch McConnell, Republican of Kentucky, to talk about the way forward for the health plan.
Democrats, who voted unanimously against the bill, vowed to make Republicans pay a political price for pushing such unpopular legislation. As Republicans reached the threshold for passage, Democrats serenaded them with, “Na na na na, na na na na, hey hey hey, goodbye!”
“I have never seen political suicide in my life like I’m seeing today,” Representative Louise M. Slaughter, Democrat of New York, said on the House floor before the vote.
Representative Nancy Pelosi of California, the Democratic leader, warned moderate Republicans who supported the measure: “You have every provision of this bill tattooed on your forehead. You will glow in the dark on this one.”
The House bill would eliminate tax penalties for people who go without health insurance. It would roll back state-by-state expansions of Medicaid, which covered millions of low-income Americans. And in place of government-subsidized insurance policies offered exclusively on the Affordable Care Act’s marketplaces, the bill would offer tax credits of $2,000 to $4,000 a year, depending on age.
A family could receive up to $14,000 a year in credits. The credits would be reduced for individuals making over $75,000 a year and families making over $150,000.
The nonpartisan Congressional Budget Office said the first version of the bill would trim the federal budget deficit considerably but would also leave 24 million more Americans without health insurance after a decade. Average insurance premiums would be 15 percent to 20 percent higher in 2018 and 2019, but after that, they would be lower than projected under current law.
Mr. Alexander of Tennessee, chairman of the Senate health committee, said Thursday that Republicans had been quietly working for several months on their own bill and would take the House measure under consideration for ideas and components.
Senate Republicans will face some of the same dynamics that stymied the House for weeks. Moderate senators will demand significant concessions, which in turn could alienate three hard-liners: Senators Ted Cruz of Texas, Rand Paul of Kentucky and Mike Lee of Utah.
Republican senators are certain to face pressure from governors worried about constituents on Medicaid losing their coverage. Republican leaders changed the House bill to woo hard-line conservatives, allowing state governments to roll back required coverage for essential services like maternity and emergency care. States could also seek waivers that would let insurers charge higher premiums for some people with pre-existing medical conditions.
“We cannot pull the rug out from under states like Nevada that expanded Medicaid, and we need assurances that people with pre-existing conditions will be protected,” said Senator Dean Heller, Republican of Nevada, who is up for re-election next year.
Senator Bill Cassidy, Republican of Louisiana, said he wanted to ensure that the final repeal bill “fulfills President Trump’s promises to lower premiums, maintain coverage and protect those with pre-existing conditions.”
Democrats are confident that some provisions of the House bill will be found to violate special budget rules that Republicans must follow in order to skirt a Senate filibuster.
“This bill is going nowhere fast in the United States Senate,” the Democratic leader, Chuck Schumer of New York, said. He said his Republican colleagues “should refuse to follow their House colleagues over a cliff, reject repeal, and work with Democrats to improve our health care system in a bipartisan way.”
Republicans have promised for seven years to repeal the Affordable Care Act, under which around 20 million Americans gained health coverage. But they had no consensus on how much of the law should be repealed and had great difficulty devising a comprehensive replacement. Their doubts were reinforced by constituents who said the health law had saved their lives.
Doctors, hospitals and other health care providers joined patient advocacy groups like the American Cancer Society and AARP in opposing the repeal bill.
But House Republicans said that insurance markets in many states were already melting down, and they pointed to Iowa, where the last major insurer under the Affordable Care Act has threatened to pull out.
There may be “nobody to write insurance for people that are in the Obamacare exchanges” in 94 of Iowa’s 99 counties, said the House Republican whip, Steve Scalise of Louisiana.
The House vote on Thursday occurred before the Congressional Budget Office had released a new analysis of the revised bill with its cost and impact. Democrats angrily questioned how Republicans could vote on a bill that would affect millions of people and a large slice of the American economy without knowing the ramifications.
The Republican bill, the American Health Care Act, would make profound changes to Medicaid, the health program for low-income people, ending its status as an open-ended entitlement. States would receive an allotment of federal money for each beneficiary, or, as an alternative, they could take the money in a lump sum as a block grant, with fewer federal requirements. The bill would also repeal taxes imposed by the Affordable Care Act on high-income people, insurers and drug companies, among others. And it would cut off federal funds from Planned Parenthood for one year.
Many defenders of the bill focused less on its details than on what they saw as shortcomings of the Affordable Care Act.
“Obamacare has hijacked the free market and has taken some Americans’ liberties with it,” Representative Doug Collins, Republican of Georgia, said on the floor, adding that the health law “replaced our doctors with bureaucrats, because that’s what socialized medicine does.”
Democrats worked to link House Republicans’ actions to an unpopular president. “The Pied Piper of Trump Tower is playing a tune today, and they must dance,” said Representative Lloyd Doggett, Democrat of Texas.
Representative Jim McGovern, Democrat of Massachusetts, told Republicans: “You are taking away essential health care protections. You are allowing insurance companies to discriminate against people with pre-existing conditions.”
In truth, Republicans argued, with so many problems afflicting the Affordable Care Act, the status quo is unsustainable, regardless of what Congress does. Hours before the vote, Mr. Trump pointed to Aetna’s announcement this week that it would no longer offer policies on Virginia’s Affordable Care Act exchange.
The newest version of the Republican health care bill would exempt lawmakers and their families from some of its most unpopular — and life-threatening — provisions.
The bill would allow states to repeal some provisions of the Affordable Care Act, such as protections covering people with pre-existing medical conditions and requiring insurance companies to pay for prescription drugs and mental health treatment.
But a GOP amendment would maintain those protections for members of Congress and their own families, reported Health Affairs Blog.
The amendment proposed by Rep. Tom MacArthur (R-NJ) has helped gain the support of conservative lawmakers who believe that high-risk groups should pay more for coverage to drive down the cost of insurance premiums for others.
But moderate Republicans remain opposed to the current plan, and a Washington Post/ABC News found 70 percent of Americans want protections for pre-existing conditions to apply to all states.
“The best evidence yet that the new GOP repeal plan is a disaster for people’s health care is that the GOP exempted Members of Congress from living under it,” said Leslie Dach, director of the Protect Our Care Campaign.
WASHINGTON — House Republican leaders, facing a revolt among conservatives and moderates in their ranks, pulled legislation to repeal the Affordable Care Act from consideration on the House floor Friday in a major defeat for President Trump on the first legislative showdown of his presidency.
“We’re going to be living with Obamacare for the foreseeable future,” the House speaker, Paul D. Ryan, conceded.
The failure of the Republicans’ three-month blitz to repeal President Barack Obama’s signature domestic achievement exposed deep divisions in the Republican Party that the election of a Republican president could not mask. It cast a long shadow over the ambitious agenda that Mr. Trump and Republican leaders had promised to enact once their party assumed power at both ends of Pennsylvania Avenue.
And it was the biggest defeat of Mr. Trump’s young presidency, which has suffered many. His travel ban has been blocked by the courts. Allegations of questionable ties to the Russian government forced out his national security adviser, Michael T. Flynn. Tensions with key allies such as Germany, Britain and Australia are high, and Mr. Trump’s approval ratings are at historic lows.
Republican leaders were willing to tolerate Mr. Trump’s foibles with the promise that he would sign into law their conservative agenda. The collective defeat of the health care effort could strain that tolerance.
Mr. Trump, in a telephone interview moments after the bill was pulled, tried to put the most flattering light on it. “The best thing that could happen is exactly what happened — watch,” he said.
“Obamacare unfortunately will explode,” Mr. Trump said later. “It’s going to have a very bad year.” At some point, he said, after another round of big premium increases, “Democrats will come to us and say, ‘Look, let’s get together and get a great health care bill or plan that’s really great for the people of our country.’”
Mr. Trump expressed weariness with the effort, though its failure took a fraction of the time that Democrats devoted to enacting the Affordable Care Act in 2009 and 2010. “It’s enough already,” the president said.
A major reason for the bill’s demise was the opposition of members of the conservative House Freedom Caucus, which wanted more aggressive steps to lower insurance costs and to dismantle federal regulation of insurance products.
In a day of high drama, Mr. Ryan rushed to the White House shortly after noon on Friday to tell Mr. Trump he did not have the votes for a repeal bill that had been promised for seven years — since Mr. Obama signed the landmark health care law. During a 3 p.m. phone call, the two men decided to withdraw the bill rather than watch its defeat on the House floor.
Mr. Trump later told journalists in the Oval Office that Republicans were 10 to 15 votes short of what they needed to pass the repeal bill.
The effort to win passage had been relentless, and hardly hidden. Vice President Mike Pence and Tom Price, the health secretary, visited Capitol Hill on Friday for a late appeal to House conservatives, but their pleas fell on deaf ears.
“You can’t pretend and say this is a win for us,” said Representative Mark Walker of North Carolina, the chairman of the conservative Republican Study Committee, who conceded it was a “good moment” for Democrats.
“Probably that champagne that wasn’t popped back in November may be utilized this evening,” Mr. Walker said.
At 3:30 p.m. on Friday, Mr. Ryan called Republicans into a closed-door meeting to deliver the news that the bill would be withdrawn, with no plans to try again. The meeting lasted five minutes. One of the architects of the House bill, Representative Greg Walden, Republican of Oregon and the chairman of the Energy and Commerce Committee, put it bluntly: “This bill’s done.”
“We are going to focus on other issues at this point,” he said.
The Republican bill would have repealed tax penalties for people without health insurance, rolled back federal insurance standards, reduced subsidies for the purchase of private insurance and set new limits on spending for Medicaid, the federal-state program that covers more than 70 million low-income people. The bill would have repealed hundreds of billions of dollars in taxes imposed by the Affordable Care Act and would also have cut off federal funds to Planned Parenthood for one year.
Mr. Ryan had said the bill included “huge conservative wins.” But it never won over conservatives who wanted a more thorough eradication of the Affordable Care Act. Nor did it have the backing of more moderate Republicans who were anxiously aware of the Congressional Budget Office’s assessment that the bill would leave 24 million more Americans without insurance in 2024, compared with the number who would be uninsured under the current law.
The budget office also warned that in the short run, the Republicans’ legislation would drive insurance premiums higher. For older Americans approaching retirement, the cost of insurance could have risen sharply.
With the House’s most hard-line conservatives holding fast against the bill, support for the legislation collapsed Friday after more and more Republicans came out in opposition. They included Representatives Rodney Frelinghuysen of New Jersey, the soft-spoken chairman of the House Appropriations Committee, and Barbara Comstock of Virginia, whose suburban Washington district went for the Democratic presidential nominee, Hillary Clinton, in November.
“Seven years after enactment of Obamacare, I wanted to support legislation that made positive changes to rescue health care in America,” Mr. Frelinghuysen said. “Unfortunately, the legislation before the House today is currently unacceptable as it would place significant new costs and barriers to care on my constituents in New Jersey.”
The bill died after Republican leaders, in a bid for conservative support, agreed to eliminate federal standards for the minimum benefits that must be provided by certain health insurance policies.
“It’s so cartoonishly malicious that I can picture someone twirling their mustache as they drafted it in their secret Capitol lair last night,” said Representative Jim McGovern, Democrat of Massachusetts. “Republicans are killing the requirements that insurance plans cover essential health benefits” such as emergency services, maternity care, mental health care, substance abuse treatment and prescription drugs.
Mr. Trump blamed Democrats for the bill’s defeat, and they proudly accepted responsibility.
“Let’s just, for a moment, breathe a sigh of relief for the American people that the Affordable Care Act was not repealed,” said Representative Nancy Pelosi of California, the House Democratic leader.
Defeat of the bill could be a catalyst if it forces Republicans and Democrats to work together to improve the Affordable Care Act, which members of both parties say needs repair. Democrats have been saying for weeks that they want to work with Republicans on such changes, but first, they said, Republicans must abandon their drive to repeal the law.
“Obamacare is the law of the land,” Mr. Ryan said. “It’s going to remain the law of the land until it’s replaced.”
Whatever success Mr. Trump had in making business deals, he utterly failed in his first effort at cutting a deal at the pinnacle of power in Washington, Democrats said.
“This is not the art of the deal,” said Representative Lloyd Doggett, Democrat of Texas, alluding to Mr. Trump’s best-selling book. “It is the art of the steal, of taking away insurance coverage from families that really need it to provide tax breaks for those at the very top.”
Rejection of the repeal bill may prompt Republicans to reconsider the political strategy they were planning to use for the next few years.
“We have to do some soul-searching internally to determine whether or not we are even capable of functioning as a governing body,” said Representative Kevin Cramer, Republican of North Dakota. “If ‘no’ is your goal, it’s the easiest goal in the world to reach.”
Representative Robert Pittenger, Republican of North Carolina, offered this advice to hard-line conservatives who helped sink the bill: “Follow the example of Ronald Reagan. He was a master; he built consensus. He would say, ‘I’ll take 80 percent and come back for the other 20 percent later.’”
Failure of the House effort leaves the Affordable Care Act in place, with all the features Republicans detest.
“We tried our hardest,” said Representative Michael C. Burgess of Texas, chairman of the Energy and Commerce subcommittee on health. “There were people who were not interested in solving the problem. They win today.”
“The Freedom Caucus wins,” he added. “They get Obamacare forever.”
CNN’s Erin Burnett Out Front on Tuesday profiled a former Donald Trump supporter who attended 45 rallies during the campaign, but no longer supports the president or his agenda.
Kraig Moss shadowed Trump’s campaign rallies during the 2016 election to tell the story of his son, Rob Moss, who died on Jan. 16, 2014 from a heroin/fentanyl overdose at age 24. The grieving father was a staunch Trump supporter, and was encouraged to support then-candidate Trump by his promise to help addicts struggling with addiction. Trump even reached out to Moss personally at a rally, calling him “a great father,” and assuring him, “your son is proud of you.”
“I’m not on the Trump trail anymore, and I’ve lost my heart,” Moss told CNN’s Elizabeth Cohen in an interview, pointing to the president’s support of the American Health Care Act, which would drop an addiction treatment and mental health mandate that covers 1.3 million Americans. Moss told Cohen he believes Rob would still be alive if he had health insurance.
“I believed everything he said,” Moss said. “Now I don’t believe he was true in his word when he was speaking. I think he was looking for votes, to be honest with you.”
“It’s not at all what Mr. Trump promised everybody he was going to provide for us,” he added. “I feel that now—anger, I feel hurt inside.”
Moss has set up a GoFundMe page in honor of his son. He hopes to raise awareness about the dangers of heroin. You can visit that page here.
An astounding 24 million Americans will lose health insurance by 2026 under the House Republican leadership’s proposed Obamacare repeal, according to a Congressional Budget Office report detailing the estimated effects released Monday.
The 24-million figure comes in waves. The first is people who now have insurance under the Affordable Care Act purchased through state or federal insurance exchanges. The second wave is from lower-income people who would lose their coverage through state-administered Medicaid programs.
“In 2018, 14 million more people would be uninsured under the legislation than under current law,” the CBO’s summary said. “Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.”
“Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026,” the CBO report continued. “The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped.”
Taken together, the CBO estimates that the House Republican plan to repeal Obamacare would deprive 24 million people who now have health insurance of that coverage within a decade.
“In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law,” CBO said.
Before Obamacare, over 15 percent of U.S. residents were uninsured. Today, that number is less than 10 percent, the Washington-based Economic Policy Institute said. Obamacare has seen 19.2 million newly insured individuals between 2010 and 2015, including 2.8 million children.
Meanwhile, health insurance costs would rise 15-to-20 percent for many buying coverage on the open market as early as next year, CBO said, because those seeking insurance would be generally sicker as a cohort, meaning their medical costs would be more.
“The legislation would tend to increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter, relative to projections under current law,” CBO said. “In 2018 and 2019, according to CBO and JCT’s [Joint Committee on Taxation] estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.”
The CBO report also said the House GOP bill would lead to turmoil in insurance markets as a new mix of health plans, coverage options and deductibles emerge. Younger people would mostly be seeing lower costs, but middle-aged and older people would see sizable increases.
“Although average premiums would increase prior to 2020 and decrease starting in 2020, CBO and JCT estimate that changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules,” the report said. “Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.”
The political reaction to the CBO report is as swift as it is predictable. Republicans seeking the repeal of Obamacare at any societal cost have been saying for days that CBO’s numbers can’t be trusted—another version of the right’s fact-dismissing alternative universe. Meanwhile, opponents of Obamacare repeal are saying CBO’s analyses are even more harmful than they anticipated.
“The CBO score only confirms what was already clear, that this bill is not an honest attempt at health care reform, it is instead a tax cut for the wealthy at the expense of the health of millions of everyday Americans,” said Patriotic Millionaires, a coalition of progressive business owners whose experience includes providing employee benefits.
“It is obscene to be cutting the taxes of people like me and my husband for any reason right now,” said Molly Munger, coalition member and co-director of Advancement Project, a nationwide civil rights group. “To cut rich old people’s taxes so that you can take health care away from younger low-income families is especially crazy. We should be investing in these younger people—they are our country’s future. Don’t do me this ‘favor,’ GOP. It’s greedy and wrong at every level.”
“Because I have diabetes, am over 50, and self-employed, I was paying $5,000 a month for family policy that had a $20,000 deductible. Under the ACA, we now pay $1,400,” said Charlie Fink, director of the New Musical Development Foundation, and another coalition member. “We’re fortunate enough to absorb the hit when prices go back to what they were before, but what about the rest of America’s families, more and more of whom are in our position? A $4,000 tax credit will cover less than 10 percent of the increase in their insurance costs. This will crush them.”
House Republican leaders are in a standoff with conservatives over the Republican ObamaCare replacement bill rapidly moving to the House floor. Unless one side gives ground, the bill appears unable to pass.
Conservatives have a range of objections, and many of them are vowing to vote against the legislation unless substantial changes are made. Leadership is pushing back, saying that lawmakers will ultimately face a take-it-or-leave-it proposition with the bill.
The objecting conservatives are looking for help from President Trump, who they say is more willing to negotiate the bill than Speaker Paul Ryan(R-Wis.) and the rest of House leadership.
Trump has endorsed the House GOP bill, but conservative House Freedom Caucus Chairman Mark Meadows (R-N.C.) said his conversations with the administration indicate they are “still willing to negotiate in good faith; that has been reaffirmed time after time.”
“President Trump isn’t as committed to one policy approach as the leadership team is,” said conservative Rep. Justin Amash (R-Mich.). “The leadership team seems to be very committed to this particular approach. And I think the White House just wants to get something done that will fulfill the promise the president made to repeal and replace.”
House Republican leaders have started referring to their bill as a “binary choice.”
“At the end of the day, members are going to have to make a choice: Do they want to vote with Nancy Pelosi or do they want to support President Trump to get that bill to his desk?” House Majority Whip Steve Scalise (R-La.) said Thursday on Fox News.
The conservatives say they won’t back down.
Asked about a leadership assumption they will relent and vote for the bill, Rep. Mark Meadows (R-N.C.), chairman of the conservative House Freedom Caucus, told reporters: “That would be a faulty assumption.”
Conservatives say that leadership doesn’t have the votes to pass the bill without them.
“They’re way short of 216,” said Freedom Caucus member Rep. Raul Labrador (R-Idaho), referring to the needed number of votes for a majority. (Vacancies in the House bring down the number from the usual 218.)
The conservative Republican Study Committee is pushing an amendment to the bill that would move up the date for freezing ObamaCare’s Medicaid expansion to 2018, instead of 2020. Leadership worries that change would drive away Senate moderates already concerned about repealing the Medicaid expansion.
“That’d be very difficult to do,” House Majority Leader Kevin McCarthy (R-Calif.) said Friday of the Medicaid change.
Meanwhile, conservative Freedom Caucus members on Friday said their main concern now is that the measure does not do enough to drive down healthcare costs. They want the bill to repeal ObamaCare’s “essential health benefits,” which mandate healthcare services that plans must cover, as well as ObamaCare’s insurance regulations, like the ban on discriminating against people with pre-existing conditions.
Conservatives say that if those requirements were repealed, insurers could offer cheaper plans that cover less. Right now, they say, the GOP bill could actually raise premiums.
“Obviously we’re going to try to make this bill better, where it actually lowers premiums, so at this point, that’s why there’s not 218 votes, or 215 or 216 whatever the magic number is,” Meadows said. “That’s why there’s not enough votes, because at this point, the number one priority, the top priority, you can throw everything away, is driving premiums down. If we don’t do that, we will have failed.”
The problem, though, is that Senate rules do not appear to allow those items to be repealed through the reconciliation process being used that allows Republicans to bypass a Democratic filibuster in the Senate.
The House committees that wrote the GOP bill say they have been in touch with their Senate counterparts and their understanding is that essential health benefits cannot be repealed through reconciliation.
House conservatives, though, are frustrated with the Senate rules and say that if need be, the presiding officer of the Senate should simply overrule the Senate parliamentarian, who rules on what can be included.
That would be a drastic step, though, of which many Senate Republicans are likely to be wary. Firebrand Sen. Ted Cruz (R-Texas) is pushing the same approach as House conservatives.
McCarthy acknowledged that the Senate rule limiting reconciliation, known as the Byrd Rule, is “frustrating,” but called for pushing ahead with the legislation anyway.
“It’s unfortunate that in the House we are being contained with all of our ideas based upon a Senate rule and a Byrd rule,” McCarthy said. “I think that’s a frustrating part, but we know where we are, and we’re not going to sit back because ObamaCare is failing.”
House GOP leadership says that other ideas that won’t pass muster under Senate rules can be passed in a different “phase” or “bucket” of their plan, in separate bills. Some of those bills could even be voted on the same week as the main repeal and replace measure, McCarthy said. The administration will also take actions on its own, leadership emphasizes.
But conservatives say putting measures in separate bills is not good enough, because they would need 60 votes in the Senate to pass, and therefore are likely to never become law.
“I’m more concerned that whatever needs 60 votes won’t get done,” Meadows said. “Bucket 3, that’s an aspirational bucket.”
Meadows said he is putting his faith in Trump to negotiate changes, even if Ryan doesn’t want to.
“Since the president has to sign whatever ultimately becomes law, his willingness to negotiate would certainly carry a lot of weight,” Meadows said.
President Donald Trump said last week that “nobody knew that health care could be so complicated.”
But the aides and advisers who worked on health care for Bill Clinton and Barack Obama — they knew.
“Maybe I should just say karma is a serious thing,” said Neera Tanden, who was a top health official in the Obama administration. “Health care is hard. Governing is hard. And Republicans are now living with the fruits of never putting forward a plan and making promises they can’t keep.”
It’s a strange place to be for the Democratic operatives and elected officials who saw their party devastated in part by Obamacare. And some can’t help but feel a bit of cosmic justice as they watch Republicans, who passed their plan Friday in the House Ways and Means Committee, stuck in a policy quagmire they know all too well.
“It’s healthcare, it should be easy. Everyone goes to the doctor. But it’s super hard,” Gruber said. “As a result, it’s easy to demonize everything.”
He added, “They (Republicans) have spent years trying to demonize Obamacare and say there was something better, but there was nothing better … It’s overall a sad story. I don’t think anybody can feel good about this.”
Clinton strategist James Carville, a veteran of both recent Democratic reform efforts, has a maxim that “the mover on health care loses,” as he told Democratic donors at a January retreat in Florida. “To do something is to lose.”
After years of unpopularity, nearly six-in-10 Americans now say they want to keep Obamacare or make only minor fixes to it. Fewer than four-in-10 call for repealing it or replacing, according to a new Monmouth Poll.
Republicans “now own the American health care system, which is something that they very effectively said that we owned for seven years,” said Ben Wakana, a former spokesperson for Obama’s Department of Health and Human Services.
“As you see this circular firing squad, part of the problem is they don’t have any principles on health care,” he added. “The thing that kept us grounded when things got hard was we had principles. That kept us all on the same team and in the same room.”
“If you look at the big debates about health care starting with Truman, going to Nixon, going to Clinton, going to now, you find that on the surface, the issues look really straightforward because everybody agrees health care is a big mess. But then you peel it open and it’s unbelievably complex,” said Robert Blendon, a Harvard professor who studies the politics of health care. “It starts to break apart the minute you get into the details.”
That’s exactly what happened after House Republicans rolled out their draft bill to repeal and replace Obamacare Monday night. The response swift and largely negative, leaving a plan seven-years-in-the-making in critical condition less than 24 hours after its public debut.
“The Republicans have done what Democrats couldn’t: Brought the popularity of Obamacare to record levels. They made every election a referendum on Obamacare,” said former Rep. Steve Israel, a Democrat.
Israel led House Democrats’ election efforts during the brutal 2010 midterm, when Republicans rode an anti-Obama backlash to gain 63 seats. Now Israel anticipates Democrats will run on, instead of away from, health care.
“You can expect House Democrats to make the midterm election on ‘Ryancare,” he said.
And the party’s campaign arms are zeroing in on a handful of provisions in the proposed draft they think are politically toxic: Funding cuts to efforts to fight the opioid epidemic, penalties for Planned Parenthood, and a tax break for insurance company CEOs who make more than $500,000 a year.
The 2018 midterm elections are still a ways off, but Democrats say they intend to put repeal front and center.
“GOP Senate candidates will now have to defend an agenda that protects the wealthy and well-connected at the expense of Americans who actually work for a living,” said Maryland Sen. Chris Van Hollen, who chairs the Democratic Senatorial Campaign Committee. “Regardless of whether it gets a vote, we’ll make sure there is no rock Republican Senate candidates can hide under.”