House May Need to Vote Again on GOP Obamacare Repeal Bill

House Republicans barely managed to pass their Obamacare repeal bill earlier this month, and they now face the possibility of having to vote again on their controversial health measure.

House Speaker Paul Ryan hasn’t yet sent the bill to the Senate because there’s a chance that parts of it may need to be redone, depending on how the Congressional Budget Office estimates its effects. House leaders want to make sure the bill conforms with Senate rules for reconciliation, a mechanism that allows Senate Republicans to pass the bill with a simple majority.

Republicans had rushed to vote on the health bill so the Senate could get a quick start on it, even before the CBO had finished analyzing a series of last-minute changes. The CBO is expected to release an updated estimate next week.

“Unaware,” said Representative Jeff Denham of California, with noticeable surprise Thursday, when advised that his party leaders still hadn’t sent the bill over to the Senate. Denham was one of the House Republicans who ended up voting for the measure, after earlier in the week opposing it.

“I am on the whip team and we have a lot of conversations, but we have not had that one. So I am going to look into it,” said Denham, a member of the party’s vote-counting team.

In the Senate, the bill must hit separate $1 billion deficit reduction targets in the jurisdiction of the Finance Committee and the chamber’s health committee. Republican aides said failing to meet those numbers would force the House to fix the bill even if the legislation meets the overall cost-savings target.

If Republican leaders hold onto the bill until the CBO report is released, then Ryan and his team could still redo it if necessary. That would require at least one more House vote of some sort.

Ryan told conservative radio host Hugh Hewitt on Friday that he doesn’t think the House will need to vote again on the health law. “We just want to, out of an abundance of caution, wait to send the bill over to the Senate when we get the final score,” Ryan said.

It’s unclear what assumptions the CBO will make about what states will do with that newly created flexibility. If millions of people sign up for much cheaper, minimal insurance, that could trigger billions — and potentially even hundreds of billions — in costs over a decade because of the House bill’s health insurance tax credits.

Read the complete article on Bloomberg web site.

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Republicans Fake Healthcare

‘This more egalitarian vision of healthcare freedom may sound utopian, but it is entirely achievable.’ Photograph: Mark Makela/Getty Images

aul Ryan is promoting Trumpcare as if it were some sort of medical Magna Carta – a brave declaration of healthcare freedom. “We’re not going to make an American do what they don’t want to do. You get it [healthcare] if you want it. That’s freedom” he recently said on Face the Nation. Freedom to die uninsured, that is.

It’s not that House Republicans are proposing some libertarian healthcare promised land wherein open heart surgeries and rounds of chemo are bartered and traded like tubes of toothpaste – far from it. Instead, the bill largely relies on Obamacare’s blueprint, although it mangles its details for the benefit of the rich while stripping coverage from a staggering 24 million people by 2026 (according to Monday’s estimates from the Congressional Budget Office).

Ryan’s healthcare bill would, like the Obamacare, provide subsidies (or tax credits) for the purchase of private insurance policies. Yet these tax credits would be comparatively more regressive and less generous than those in the Affordable Care Act (ACA); many Americans would thus be freed from having affordable premiums.

The Republican bill also discards Obamacare’s cost sharing subsidies for low-income individuals, who would henceforth have the freedom to pay higher copayments and deductibles. Additionally, it prevents tax credits from being used for the purchase of plans that cover abortion, freeing more women from control over their own reproductive systems.

The bill would also punish those with low incomes by squeezing federal funding of Medicaid beginning in 2020, effectively emancipating millions of poor people from the ranks of the insured.

Trumpcare would at the same time cut the ACA’s taxes on the wealthy, which, as the New York Times recently reported, would redistribute upward some $144bn over a decade to millionaires. Now in fairness, this provision would increase freedom for some: freedom, for instance, to buy a second vacation home, or a first yacht.

And finally, what Ryan seems to see as Trumpcare’s greatest emancipatory element – the elimination of the ACA’s unpopular individual mandate – would simply be replaced by a 30% premium penalty, assessed by insurers, for those who spent time uninsured. As Patrick Henry might have put it: give me a continuous coverage premium surcharge as opposed to a tax penalty, or give me death.

Unbelievably, Ryan sees “freedom” in all of this devastation.

For Ryan and those in his ideological camp, freedom in healthcare is basically the freedom of the consumer, who should be free to buy – or not buy – the particular insurance plan that suits his or her needs and tastes. Hence the bewilderment of Representative John Shimkus who recently asked why, exactly, men should be compelled to buy plans that cover maternity care (Trump’s pick to lead the Center for Medicare and Medicaid Services, Seema Verma, has said something similar).

Ryan thus offers a peculiar vision of healthcare freedom. For the medical literature tells us – to no one’s surprise – that the uninsured are more likely to die. And as noted, the CBO has now estimated that Trumpcare will increase the ranks of the uninsured by 24 million in a decade from now.

The bill would thus increase our freedom to die of health conditions that are amenable to modern medical care, and thereby liberate tens of thousands of people a year off of the face of the planet.

Read the complete article on The Guardian newspaper web site.

Trump’s Cabinet Looks For Healthcare Solutions.

 

U.S. political debate stuck in the past.

Excerpts from an article by Chrystia Freeland in the Globe & Mail.

In choosing Paul Ryan as his running mate, Republican presidential contender Mitt Romney swapped his Massachusetts pragmatism for a proudly ideological commitment to limited government. The Democrats, by contrast, believe in the essential role government plays, and are willing to raise taxes, at least on the rich, to pay for it.

Thanks to smart machines and global trade, the well-paying, middle-class jobs that were the backbone of Western democracies are vanishing. The paradoxical driver of this middle-class squeeze is not some villainous force – it is, rather, the success of the world’s best companies, many of them American.

It took more than the spinning jenny or the steam engine to transform local, agrarian, family-based communities into national, urban, individualistic ones. New political and social institutions will be needed to midwife the latest shift into global and virtual communities. Inventing those institutions is difficult, and talking about them can be frightening, but that is the political conversation the Western world should be having.

Read the full article here.