Tag Archives: obamacare

Trump Is Now Threatening to Sabotage Millions of Insurance Plans

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President Donald Trump is now threatening to wipe out health insurance for millions of people in order to make a political statement. In an interview with the Wall Street Journal Wednesday, Trump suggested that unless Democrats agree to his plans to dismantle Obamacare, he might use his executive authority to intentionally trigger a death spiral for the individual insurance markets.

Specifically, Trump threatened to stop making payments to insurance companies to reimburse them for subsidies that help offset the costs of deductibles and copayments for low-income people. Those subsidies are mandated by Obamacare; if the feds stopped reimbursing insurers for this expense, they would likely abandon the individual markets and leave millions without coverage.

The president seemed to acknowledge in the interview that halting the reimbursements would likely result in the healthcare markets collapsing, but he said he might go through with it in order to extract concessions from Democrats. “Obamacare is dead next month if it doesn’t get that money,” Trump told the paper. “I haven’t made my viewpoint clear yet. I don’t want people to get hurt…What I think should happen and will happen is the Democrats will start calling me and negotiating.”

Obamacare includes a host of mechanisms to make buying insurance easier and more affordable for people who don’t receive coverage through their employer and have to buy it on the individual market. The law primarily does this by offering subsidies—varying by income—to offset the costs of premiums for people who earn up to 400 percent of the poverty level. But the law was also designed to provide $7 billion per year in “cost sharing reduction” payments to insurance companies so that people below 250 percent of the poverty line would have lower deductibles and copayments.

These payments were explicitly included in the health care law, but through the convoluted quirks of legislative procedure, Republicans have alleged that Congress technically didn’t “appropriate” money for the program. The Obama administration went ahead and started making the payments anyway, and in 2014 House Republicans sued the White House, saying that the administration shouldn’t be able to spend that money. A federal district judge sided with Republican last year, and the Obama administration appealed.

After Trump’s inauguration, both the White House and Congress sought to stall the lawsuit, asking the courts to give them more time to figure out whether or not Obamacare will be repealed. When the GOP repeal bill failed last month, Trump was faced with a dilemma: He could order the his administration to keep fighting the House’s lawsuit, or he could ditch the appeal and end the reimbursement payments. It sounds like Trump may now be leaning toward the latter. In addition to his Journal interview, Trump reportedly has become active behind-the-scenes, as well. According to Politico, the president called Health and Human Services Secretary Tom Price and dictated a statement that he wanted the agency to release on the issue.

As Trump himself said, ending the program would be a disaster for Obamacare. It would cause insurance companies to flee the individual markets (which, in some parts of the country, already suffer from a lack of insurance options). And the remaining insurance offerings would jump in price. An analysis by the Kaiser Family Foundation found that premiums for a baseline plan would jump 19 percent if cost sharing disappears.

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Trump Is Now Threatening to Sabotage Millions of Insurance Plans

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Today’s Idiocy Roundup

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There’s so much to learn in the world. A couple of days ago, for example, the Department of Health and Human Services issued this statement regarding CSR subsidies for Obamacare:

The New York Times report is inaccurate. The administration is currently deciding its position on this matter. We have not been contacted by Democrats to help save Obamacare, perhaps because they consider Obamacare to be a losing cause. Democrats need to help solve this failed Obamacare plan.

That sounded really aggressive for an agency statement, and I was a little surprised. How had they picked up the Trump style and rhythm so perfectly? Today I learned the answer via Politico:

Two administration officials said the HHS rebuttal was personally ordered by an incensed Trump, who feared that the Times story hurt his negotiating position. Trump took the unusual step of calling HHS Secretary Tom Price to dictate a blistering statement that challenged the story and swiped at Democrats, one senior administration official said.

Today Trump made his position even clearer. Insurers will most likely pull out of the exchanges or jack up premiums if CSR payments are halted, and Trump said explicitly that he was willing to do this if Democrats didn’t come to the table. I’m not a world-class negotiator or anything, but isn’t it sort of unusual to talk openly about your threat to personally blow up Obamacare unless Dems knuckle under? That makes it hard to subsequently blame Democrats, doesn’t it?

In other news, I’m not the only one who’s been learning new things. A few weeks ago Trump announced that health care was a lot more complicated than he had thought, and today he explained that Chinese President Xi Jinping schooled him on North Korea too:

Mr. Trump said he told his Chinese counterpart he believed Beijing could easily take care of the North Korea threat. Mr. Xi then explained the history of China and Korea, Mr. Trump said. “After listening for 10 minutes, I realized it’s not so easy,” Mr. Trump recounted. “I felt pretty strongly that they had a tremendous power” over North Korea,” he said. “But it’s not what you would think.”

This is probably something I would have kept to myself, but maybe that’s wrong. I suppose Trump is setting a good example by showing that you’re never too old to listen and learn.

What else? There was this:

That was quick! Hooray for NATO! However, it’s unclear what produced this change of heart. Was it the influence of H.R. McMaster? The alleged Russian collusion in Syria’s use of chemical weapons? Or did the NSA pick up some sigint of Vladimir Putin mocking Trump?

In an interview with the Wall Street Journal today, Trump also said he’s changed his mind and now supports the Export-Import bank. He’s also thinking about reappointing Janet Yellen as chair of the Fed. And this:

Asked how he has changed since taking office, the former businessman—who as a candidate touted his ability to cut deals—said: “The magnitude of everything is so big, and also the decisions are so big. You know, you’re talking about life and death. You’re not talking about ‘you’re going to make a good deal.’”

Huh. The presidency isn’t just about making good deals. Since that was basically Trump’s sole alleged qualification for the office, I wonder what role he now thinks he’s going to play?

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Today’s Idiocy Roundup

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Trump Floats Nonsense Idea of Privatizing Airports and Dams

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Philip Howard attended Tuesday’s infrastructure confab with President Trump. The Guardian reports on what he told them:

Donald Trump is considering privatising America’s airports and dams as part of an infrastructure building programme that could exceed past estimates of a trillion dollars….“America can do much more than it has, and can do what other countries in Europe and Australia have done, by harnessing private capital,” Howard said. “So it could privatise a number of assets such as airports and dams, and get a lot of capital from that, as well as increase the tax base.”

Hundreds of airports around the world have been privatised or partly privatised but, Howard noted, virtually none in America….Last year the Cato Institute, a conservative thinktank, published a paper that endorsed privatising the nation’s more than 500 commercial airports, which are currently owned by state and local governments and rely on the federal government for capital improvements.

Is Trump really thinking about this? Who knows. But I’m a little mystified. The federal government can’t privatize airports that are owned by states and cities. And even if it could, states and cities would get the money. So what’s the point?

I’d say Trump had four big domestic priorities when he took office:

Repeal Obamacare.
Cut taxes for the rich.
Spend $1 trillion fixing roads and bridges.
Build a wall.

The Obamacare effort has already crashed and burned. His tax plan apparently won’t work with Obamacare in place, so now he’s delaying that to take another run at health care. He doesn’t have anywhere near enough support for his infrastructure plan, which is why he’s desperately scanning the horizon for weird ideas to fund it. And the wall hasn’t gone anywhere yet. It may yet make progress, but even Trump admits it won’t cover anything close to the whole border.

On foreign policy, he’s crashed and burned on his immigration plan; reversed himself on Russia; launched a strike on Syria with no apparent follow-up plan; still has no proposal for defeating ISIS; caved in to China on Taiwan; and has gone soft on trade.

So what has he done? He’s signed a few bills reversing some Obama executive orders, but that’s about over since the easy stuff has an early May deadline. He produced a kinda-sorta budget, which was even deader on arrival than most presidential budgets. He managed to pick a name off a list and nominate him to the Supreme Court, something he apparently considers a helluva hard day’s work. Beyond that, he’s tweeted, convened some “listening sessions,” held a couple of rallies, watched uncounted hours of TV, played lots of golf, and generally developed a reputation as the laziest president in anyone’s memory. Is there anything important I’m missing here?

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Trump Floats Nonsense Idea of Privatizing Airports and Dams

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The House Freedom Caucus Finally Comes Clean

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Sarah Kliff reports on the latest from House conservatives:

The House Freedom Caucus laid out two demands on Thursday for a health care bill its members would support: ending Obamacare’s essential health benefits and its “community rating” provisions.

Good for them! I’m serious. The key starting point for any kind of comprehensive health care plan is a ban on turning down customers with pre-existing conditions. But once you do that, you have to control the price insurers can charge (aka “community rating”), or else they’ll simply jack up premiums for people with expensive conditions to a million dollars per year, which accomplishes the same thing as turning them down. But if insurers are required to cover anyone who applies, they also need plenty of healthy people to balance out their risk pool. So you end up with an individual mandate. But if you have a mandate, you have to have subsidies for poor people. You can hardly expect to legally require insurance for people who don’t have the money to buy it, after all.

At that point, you have the entire edifice of Obamacare. There’s no way around it. That’s why Paul Ryan’s plan looked an awful lot like Obamacare lite.

So if you’re a conservative who flatly doesn’t want an expensive, comprehensive, government-funded health care program, there’s only one way to get there: ditch the pre-existing conditions ban by calling for an end to community rating. This is hugely unpopular, so it takes some guts to tell the truth and propose getting rid of it.

It’s also cruel and meanspirited, but that goes with the ultraconservative territory. But at least they’re being honest. Compare this to Paul Ryan, who kept the pre-existing conditions ban (via his “continuous coverage” provision), which then forced him to accept all the bells and whistles of Obamacare. His solution was to wave his hands and then keep the funding so low that his program essentially did no good at all. He didn’t have the stones to simply admit that what he really wanted to do was repeal Obamacare and then do nothing at all to replace it.

Now, it so happens that Obamacare’s pre-existing conditions ban has no direct effect on the federal budget, and therefore can’t be repealed via reconciliation. It can only be repealed under regular order, which requires 60 votes in the Senate. So the Freedom Caucus folks are out of luck. But at least they’re displaying a bit of honesty.

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The House Freedom Caucus Finally Comes Clean

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BREAKING: Donald Trump Played Golf This Weekend

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The sad thing about this tweet is that it really would be news if Donald Trump was at the White House working this weekend:

But no: Trump played golf at his club in Virginia this weekend, so it’s not clear what Fox was up to here. Perhaps they meant to say that by 5:26 pm on Sunday, Trump was back in the White House.

Normally, I’d suggest that everyone cool it with the golf snark. We’ve now had four consecutive presidents who have taken endless grief every time they hit the links, and it’s pretty stupid. Let ’em golf if they want to. But there are two differences with Trump. First, the guy really does play a ton of golf. You’d think the first few months of a new presidency would be a busy time, but Trump has played 12 rounds of golf, mostly at Mar-a-Lago, in only ten weekends. That’s more than he played before he was president. Second, like an embarrassed drunk, he’s now trying to hide his golf addiction. This weekend marked the second in a row in which his press office tried to pretend that Trump was “meeting with people” at the club, only to have Trump’s golfing exposed, as they must have known it would be, by someone with a cell phone tweeting out pictures. Why do they bother with such flimsy and easily exposed lies?

And while we’re on the subject of Trump, I’d like to note that he’s hit the quadfecta I predicted on Thursday. He has now blamed all four of the following for the failure of Trumpcare:

Paul Ryan, for insisting on doing health care before tax reform and then being unable to shepherd the bill through the House.
The Freedom Caucus, for voting against his bill.
Democrats, for…being the opposition party, I guess.
Obama, for deliberately designing Obamacare to fail in 2017.

Apparently Reince Priebus is also taking some heat from within the White House, because he’s pals with Ryan and was supposed to know about all this congressional hoo ha. But it’s not clear if Trump himself blames Priebus for anything.

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BREAKING: Donald Trump Played Golf This Weekend

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What If I Told You That Republicans Spent Only 36 Days on Trumpcare?

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If you want to know why Trumpcare failed so disastrously, here’s a big part of the answer:

The process toward passing Obamacare began on March 5, 2009, when President Obama convened a “health summit” with various players in the health care industry. It finished 383 days later, on March 23, 2010, when he signed it into law.

Trumpcare began life on February 16, 2017, when Paul Ryan released an outline of what a Republican bill would look like. It was abandoned 36 days later, on March 24, 2017.

And this doesn’t even count the fact that Democrats had been seriously debating and designing health care policy for decades before Obamacare was born. Republicans had never gone much beyond the debating point point stage. But policy matters: detailed, messy, real-life policy that makes compromises in order to produce something that works and has the support of all the stakeholders. The problem is that Trump isn’t used to that kind of thing. Ezra Klein points out today that, in fact, Trump isn’t a very good dealmaker. That’s true, and it’s something I’ve written about frequently. But he also says this:

In Trump’s past jobs, he could simply move on from failed deals and find new partners, and new markets, and new sectors. But that’s not how the presidency works, and it’s not clear he realizes that.

“Take it or leave it” works only if you really are willing to leave it. Trump often is, because he can always turn around and do a different deal with someone else. But there’s only one Congress. If Trump gets bored after a whole month of negotiations and gives up, there’s no other Congress he can turn to. That’s why Trumpcare is dead.

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What If I Told You That Republicans Spent Only 36 Days on Trumpcare?

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Obamacare Repeal Is Dead

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Well, that’s it. Obamacare repeal has failed. The House will not vote on the Republican health care bill.

So what’s next? The first thing, of course, is for Trump to insist that he bears no blame for this. Possible candidates for being thrown under the bus include Paul Ryan, the Freedom Caucus, Democrats, Obama, and illegal immigration.

But what’s next after that? This is the depressing part. From a partisan perspective, I imagine the best bet is to sabotage Obamacare as much as possible and wait for it to fail. Then Trump can say that he was right all along (isn’t he always?) and now we really have to do something.

But there’s also the perspective of what’s best for the country. If Obamacare repeal can’t pass, the best bet is to work on making Obamacare better. This could be done fairly easily, since it’s mostly tweaks that are needed. There are even deals to be made here. Democrats would probably be willing to give Republicans some things they want (tort reform, expanded HSAs, etc.) in return for modest changes that would make Obamacare more stable (higher penalties, tweaks to the subsidies, funding the risk corridors, etc.).

But that’s a fantasy. There’s little chance of anyone in Congress these days working across the aisle to do what’s best for the country.

UPDATE: And the winner is…Democrats!

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Obamacare Repeal Is Dead

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Kansas Republicans Just Defied Donald Trump and Voted to Expand Medicaid

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On the same day the House was supposed to pass a bill dismantling Medicaid, Kansas Republicans took a big step toward expanding the program in their state.

In a voice vote Thursday morning, a committee in the Kansas Senate approved legislation that would enable the state to take advantage of an Obamacare provision offering Medicaid health insurance coverage to a wider group of poor people. The federal government would provide the vast majority of the funding.

Many deep-red states like Kansas have rejected Medicaid expansion based largely on their ideological objections to Obamacare. But as I reported earlier this week, a new bloc of moderate Republicans in the state—back by the health care industry and business community—have teamed up with Democrats to push Medicaid expansion. They point out that the state has given up, to date, nearly $2 billion in federal funds that could have helped both improve the health of the state’s low-income communities while also boosting its economy.

The Kansas House overwhelming passed Medicaid expansion earlier this year. The full state Senate is expected to vote on the issue Monday, according to KCUR. But they would likely need to cobble together a veto-proof majority, since Gov. Sam Brownback (R) has vocally opposed to adopting the program. In fact, Brownback released a letter Thursday, signed with seven other Republican governors, asking Congress to pass the repeal of Obamacare, which would eventually end funding for new sign-ups in the Medicaid expansion and would prevent states such as Kansas signing up in the meantime.

It’s unclear if Congress will heed Brownback’s request. The GOP’s bill to repeal and replace Obamacare was supposed to get a vote in the full House sometime Thursday, but with both conservatives and moderate Republicans balking, the vote was delayed. The Trump administration set a deadline for a Friday vote, saying the White House would otherwise abandon the effort. Congress is currently debating the measure, but vote counts from various news outlets suggest Republicans currently lack enough votes to pass the bill.

Read more about the fight for Medicaid expansion in Kansas here.

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Kansas Republicans Just Defied Donald Trump and Voted to Expand Medicaid

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The Republican Health Care Bill Is In Deep Trouble

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Jonathan Chait has a question:

No, no, no, no, no! Remember when we thought it might be better if Donald Trump won the Republican primary because Hillary Clinton would be sure to beat him? Then James Comey came along.

Shit happens, people, and there’s no predicting it. I doubt that the Republican bill can pass the Senate, but it might. The only thing we should care about is taking every possible opportunity to stop it, whenever and wherever we have a chance. Period.

(Besides, I doubt that voting for this bill will do much harm to Republicans when the midterms roll around. That’s still 20 months away, and besides, at least the yes voters can say they did everything they could to repeal Obamacare but leadership screwed it up.)

And speaking of the Republican bill, apparently the whip count really is falling short. So now the vote has been postponed to Friday. Maybe. It all depends on whether Paul Ryan and Donald Trump can figure out something else to capitulate on in order to win the votes of the crackpots in the Freedom Caucus.

Oh, and one more thing: CBO has rescored the bill. The original version reduced the deficit by $337 billion. The new one reduces it by only $150 billion. But that’s already out of date. They’ll have to score it again after Ryan and Trump finish negotiating with the conservatives. But it’s worth noting that Ryan doesn’t have a lot of headroom left if he also needs to negotiate with moderates who want a slightly less brutal program. Another $150 billion and the bill won’t reduce the deficit anymore. And if it doesn’t reduce the deficit, it can’t be passed under reconciliation.

But wait! One final thing: earlier I noted that the Republican bill is allowed to repeal only the elements of Obamacare that directly affect the budget. So if Republicans try to add provisions that repeal, say, essential benefits or pre-existing conditions, the Senate parliamentarian is likely to rule that they have to be jettisoned. However, as the presiding officer of the Senate, VP Mike Pence has the final word on this. He could just declare the parliamentarian wrong and allow the vote to go forward.

But what justification would he offer? As it happens, Republicans already have one handy. Last year, a number of them made the argument that the “direct effect” rule should be applied to the whole bill, not to its individual parts. In other words, Obamacare can be repealed completely because Obamacare as a whole directly affects the budget. If Republicans go down this road, that’s what you’re likely to hear.

However, my guess is that if Pence does this, he’ll lose a whole bunch of votes from moderate senators who won’t be a party to something that effectively kills the filibuster. So it probably can’t pass the Senate either way.

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The Republican Health Care Bill Is In Deep Trouble

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Conservatives Demand End to Pre-Existing Conditions Ban

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I guess I was wrong last night. The New York Times says President Trump has caved in to demands to repeal the minimum set of required benefits for health care insurance:

President Trump agreed to the demands of conservative House Republicans to remove federal requirements that health insurance plans provide a basic set of benefits like maternity care, emergency services, mental health and wellness visits as he struggles to round up enough votes to pass a broad health care overhaul.

But the Washington Post reports that this still wasn’t enough:

Conservative House Republicans rebuffed an offer by President Trump on Thursday to strip a key set of mandates from the nation’s current health-care law, raising doubts about whether House Speaker Paul D. Ryan (R-Wis.) has the votes to pass the bill.

….Rep. Justin Amash (R-Mich.), asked whether the White House had made its final negotiating offer, said that if that’s the case, “They’re not going to pass the bill.”…As of mid-afternoon Thursday, 37 House Republicans — mainly Freedom Caucus members — had announced their opposition to the bill, known as the American Health Care Act.

So what do conservatives want? Here’s the Post again:

Conservative lawmakers have asked to eliminate much of Obamacare’s Title I, which….bars companies from setting insurance rates based on a person’s sex, medical condition, genetic condition or other factors.

In other words, insurers could charge you more if you have a pre-existing condition. That would effectively kill off the Obamacare provision that requires insurers to cover everyone who applies. They’d simply price policies out of reach for people with expensive pre-existing conditions and that would be that.

Would this pass muster with the Senate parliamentarian, who has to agree that repealing Title 1 “directly affects” the budget? I doubt it. Would Mike Pence go ahead and overrule her? Maybe. Is this whole thing a debacle beyond imagining? Oh yes.

POSTSCRIPT: It’s worth pointing out that if Republicans go down this road, they’ve essentially killed the filibuster completely. Basically, they would have set a precedent that anything can be added to a reconciliation bill—which can’t be filibustered—and the vice president will overrule the parliamentarian and declare that it’s OK. At that point, the Senate can include reconciliation instructions for just about anything in its annual budget resolution. As long as the president and vice president are from the same party, they can then pass anything they want with 51 votes.

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Conservatives Demand End to Pre-Existing Conditions Ban

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